Grenadian doctors’ perceptions on abortion

OBJECTIVE: To assess perceptions of Grenadian physician on abortion. DESIGN AND METHODS: An online survey was created and emailed to all doctors registered to practice in Grenada. Once the data was collected, it was analyzed using SPSS. RESULTS: A response rate of 58% (45 out of 78 physicians) took part in this study. Almost all physicians (93%) indicated that they were personally aware of unsafe abortions being performed in Grenada. The three main complications physicians reported as arising out of unregulated abortion procedures were bleeding (18%), infection (17%), and uterine perforation (17%). Health education was identified by 93% of physicians as the best solution to preventing unsafe abortions. CONCLUSIONS: Almost all local physicians reported that unsafe abortions are taking place in Grenada and that the best solutions to this problem would be to provide health education along with use of modern contraception and the use of legalized and regulated abortion services. Specifically, the implementation of school-based health education program could prove effective in minimizing the conditions that lead to women being placed in a position where they feel that they have to resort to unsafe abortion procedures.

An assessment of work environment factors correlating with burnout status of physicians employed with the Public Hospital Authority in the Bahamas

OBJECTIVES: To identify factors associated with the Burnout Syndrome in light of the prevalence of that syndrome in physicians working in the Public Hospital Authority (PHA), Nassau, Bahamas. DESIGN AND METHODS: A cross-sectional study was done utilizing a self-administered survey comprising of demographics, general health, work environment, and Maslach Burnout Inventory items to assess burnout among salaried Physicians working in 9 departments of PHA. The Statistical Package for Social Sciences was used for data analysis. RESULTS: 153 physicians participated. Their mean age was 35.84 (ñ 7.09) years; median 34.00 (IQR: 31.00, 40.00) years . 64.7% (99) were females. No association was found between these, other socio-demographic variables measured and burnout status. Physicians in the department of Internal Medicine represented 22.2% (34), Family Medicine 20.3% (31), Emergency Medicine 19.6% (30), Pediatrics 13.7 (21), and physicians in other departments 22.3% (34) of the sample, 55.7% of physicians employed under the PHA collectively exhibited a moderate level of burnout, 9.9% of these physicians having severe burnout Separately, poor balance of family, 15 work environment potential stressors and 4 potential stress relievers were found to be each weakly or very weakly related to burnout status. Postgraduate programme year, irregular sleep pattern and lack of appreciation were moderately strong positively related. Logistic regression analysis showed the key predictors of burnout status to be lack of appreciation (OR=1.69, p=.002) and number of years worked post-internship (OR=.94, p=.039). CONCLUSION: Physicians sensing of appreciation and sleep hygiene were clear predictors of burnout.

Attitudes and practices of primary health care practitioners towards screening women over 55 years old for cervical cancer

Cervical cancer is an important preventable problem among Caribbean women. Age-specific cervical cancer mortality rates indicate that among older women in the Americas, Caribbean women are more likely than other women in the sub-region to die of cervical cancer. This implies that screening programmes which are widely available in the Caribbean are not producing the desired decrease in mortality. As physician recommendation regarding screening is an important variable in the use of these services, the attitudes and practices of primary care practitioners (PCPs) towards screening women over 55 years old for cervical cancer were examined. This study was carried out in the southeastern region of Jamaica. All public sector PCPs and a sample of private general practitioners proportionate to number in each parish, were invited to participate. The response rate was 84 percent, with a final sample of 122 persons (of a possible 146); 20 family nurse practitioners, 36 public medical officers and 66 private general practitioners. Women attending curative clinics in three community health centres were conveniently selected to determine actual screening experience. A total of 110 women 55 years and older agreed to participate. Over 80 percent of PCPS reported ordering annual Pap smears for female patients over 55 years old, with no difference in attitudes and practices towards screening women over 55 years old for cervical cancer, related to age, gender, profession, location or sector of employment. While patients reported a 73 percent lifetime history of being screened, only 28 percent had actually done a Pap smear in the previous year. Explanations given by PCPs in the focus group discussion for these discrepancies between providers' reported practice and patient compliance include their failure to remember to actually order the test and the patient not doing the test when ordered. Patients identified provider recommendation as the main motivation for being screened, and ignorance about Pap smear and its importance at their age as the major reason they were not tested (AU)

Doctors in the Jamaican Yellow Pages [abstract]

OBJECTIVE: To determine the characteristics of listings under the "Physicians and Surgeons" section of the Jamaican telephone directory Yellow Pages. METHODS: A review of the Greater Kingston Telephone Directories published by Cable and Wireless Jamaica Ltd for the period 1994/95 to 1999/00 was made. The section captioned "Physicians and Surgeons" in the National Yellow Pages of each of the five directories was used to obtain the following: a count of all listings and the font type (case, colour and emphasis) of each listing. Where listings were advertisements, than a structured content analysis was done to guage informativeness. RESULTS: For the five-year period of review, the mean number of listings was 244 (Standard Deviation (SD) = 24). There was a steady increase in the number of listings between 1994/95 (n = 219) and 1999/00 (n = 278). The proportion of listings that were in bold uppercase black font was fairly consistent throughout the period (mean of 32 percent). However, listings in bold uppercase red font showed an increase from 0.5 percent in 1994/95 to 2.5 percent in 1996/97, thereafter remaining close to this level. Listings qualifying as advertisements increased from 1.36 percent at the start of the period to 2.5 percent at the end. Consistent with this increase was an increase in total space occupied by advertisements and the diversity of colours and informational content. The majority of advertisements were by medical centres, of which dermatology services were the most frequent and consistent. The most informative advertisement over the period was by and individual physician. CONCLUSIONS: There has been an increase in listings in the "Physicians and Surgeons" section of the Jamaican National Yellow Pages over the five-year period of the study with an apparent trend towards more visible and sophisticated promotion services. (AU)

Every physician is a scientist

The physician-scientist is the physician who thinks scientifically about his work. The single most important route to improving medical practice and the health of the population is through clinical research and physician-scientists are vital here. (AU)

An assessment of some aspects of management by teritary prevention of diabetes by doctors at the primary care level

Diabetes Mellitus is among the top five leading causes of morbidity and mortality in Jamaica. This islandwide cross-sectional study examined the knowledge, attitudes and practice of primary care physicians concerning assessment of glycemic control and monitoring for long-term complications in diabetes. A total of 152 physicians completed a structured questionnaire. Exit interviews with 15 patients were also conducted to gain further insights in the physicians' management of diabetes. Data was analysed using Epi-Info version 6.04. The results showed that only 41 percent of respondents were familiar with PAHO guidelines for management of diabetes. Only 44 percent had correct knowledge about the concept of tertiary prevention of diabetes. The majority of physicians correctly identified the long-term complications of diabetes mellitus. A greater percentage of those who graduated in the 1980's and 1990's had correct knowledge of 4 or more of 6 tertiary prevention screening strategies identified, when compared with graduates of previous decades. Most physicians had positive attitudes towards use and usefulness of practice guidelines, educating their patients and the clinical management as recommended by regional and international organizations. Female physicians had higher attitude scores than their male counterparts. In general, only a small majority of physicians were influenced by cost of laboratory investigation when deciding to order them. The self-reported practice of physicians regarding monitoring for long-term complications by using certain screening strategies, revealed that they did NOT demonstrate a high degree of compliance with recommended practice guidelines. For example, dilated eye examinations, foot examinations for neurological deficits; glycosylated haemoglobin and microalbuminuria/24-hr. urinary albumin excretion rates were being monitored less frequently than recommended. The main exceptions were blood pressure and blood glucose monitoring for short-term glycemic control, where over 90 percent of physicians reported monitioring these frequently and on most patients. In conclusion, the result underscore the importance of continuing medical education and suggest that more proactive efforts should be instituted to ensure acceptable and optimal levels of control of diabetic patients (AU)

Evidence-based medicine-the decline of authoritarian medicine

Evidence-based medicine according to a British Medical Journal, 'Remains a hot topic for clinicians, public health practitioners, purchasers, planners and the public...and has become a common topic in the lay media'. An understanding of evidence-based medicine requires first of all an appreciation of classical medical practice, because evidence-based medicine represents a clear shift, in focus and orientation for student, teacher and practitioner of medicine alike. The classical medical practice paradigm according to an editorial in the Postgraduate Medical Journal requires doctors to identify the problem, use their experience, ask a trusted colleague, consult a reference text, or read a review. The same journal, says that the evidence-based approach - the new paradigm - requires doctors to formulate an appropriate clinical question, conduct a literature search, select the key articles, critically appraise the articles, and then apply the results of the search to the patient. This new emphasis on the use of medical literature in the provision of care is considered to be so fundamental as to constitute a paradigm shift. The evidence-based approach de-emphasizes intuition, and puts a much lower value on authority but does not reject it, since it recognizes that there are exceptional clinicians who have a gift for intuitive diagnosis and precise observation. It asserts, however, that systematic recording of observations in a reproducible and unbiased fashion will increase the confidence levels about knowledge of diagnosis, prognosis and efficacy of treatment, and further that an understanding of disease and physiological processes, while important, is insufficient as a guide for clinical practice (AU)

Wie was Professor Flu / Who was Professor Flu

The curriculum vitae of Professor Paul Christiaan Flu is described. This Surinam physician did important scientific work in Suriname and the Netherlands East-Indie of that time. Finally, he was appointed to Professor at the State University of Leyden in the Netherlands. Striking was his great interest fortropical medicine and he can be considered as the pioneer of parasitology in Suriname. No wonder tha the Medical Scientific Institute(MWI) in Paramaribois named after him.....a.o

A survey of the smoking habits of physicians in Curacao in 1995 - abstract

We sent a self-administered WHO smoking survey to all 245 physicians working on the island of Curacao. A response rate of 61 percent was reached without sending reminder letters. 33 percent were current smokers, smoking was more prevalent in males (68 percent) than females (34 percent), and the mean daily consumption was 11.8 cigarettes. Smoking prevalence and smoking behaviour amongst Curacaoan physicians proved to be highly similar to the data that have been revealed by Dutch studies, even though the smoking prevalence within Curacaoan population is lower than in the Netherlands. These findings may support the hypothesis of professional socialisation in medical school. Curacaoan and Dutch physicians also expressed similar opinions towards smoking. Among doctors the knowledge of smoking and diseases were found to be suboptimal. Curacaoan doctors report they want more information about smoking cessation programmes. (AU).

Back from the brink: a personal account of the illness Guillain-Barre Syndrome

Dr. Wahid Ali has spent a long and useful life, almost two decades of which were dedicated to public service. This book is a further contribution to that life of public service in that it gives a detailed account of the symptoms and effects of Guillain-Barre Syndrome, a disease which so few of us know about. This account is also, sadly, a reflection of the inadequacy of health care in our society. That Dr. Ali was able to emerge alive and well after the attack seems surely the result of his position in the society, and his ability to afford health care at the best institutions. He makes constant reference to this inequality. This autobiography demonstrates quite clearly the close link between the spirit and the physical being. It shows how positive thinking can affect the physical well-being of our human persons. The book recommends itself as a serious reflection of the condition of our lives in this place as we seek to create a new culture out of the diverse elements of this New World (Dr. Brinsley Samaroo-back cover)

Knowledge, perceptions and practices of medical doctors in Jamaica on primary health care and the concept "health for all by the year 2000"

As leaders of health teams, physicians are expected to have firm knowledge, perception and practice of the requirements of the concept of Primary Health Care (PHC) and Health for All by the Year 2000 (HFA-2000), which was declared in 1978. This study, done between December 1995 and February 1996 examinedthe effect of the source of training, geographicallocation, specialty and years in practice on the knowledge, perception and practice of medical doctors regarding primary health care (PHC) and Health for All by Year 2000(HFA2000). Using a cross-sectionalsurvey methods, a sample frame of 1246 registered doctors was taken and the doctors were interviewed with questionaires after exclusion of doctors at the UWI who had undergone a similar study (not practice) in 1994 by Wynter. Twenty years after Alma Ata Declaration, a fair number of doctors are still lacking in the practice of PHC/HFA but their knowledge and perception of PHC/HFA is good. The University of the West Indies-trained doctors had a higher knowledge and perception of PHC/HFA but lower practice level as compared to overseas trained doctors. Specialists had a high knowledge and perception PHA/HFA but a lower practice level as compared to general practitioners. Being located in the urban area was associated with a lower knowledge but a higher perception of PHC/HFA as compared to rural doctors. Geographical location did not influence the practice of PHC/HFA, however, the number of years in practice increased the practice of PHC/HFA. The emphasis on curative-prevention during their training, time, type and nature of patient contact, socio-economic factors and tears of exposure to disease and cure are some of the factors influencing positively or negatively on the knowledge, perception and practice of doctors in Jamaica. A socio-economic framework inclined towards improving a community-oriented medical education (for both undergraduates and practising physicians) would enhance PHC towards the achievement of HFA-2000 and beyond. (AU)

Gender perception of stress: a comparative study between male and female physicians - abstract

Practising physicians of varied disciplines in Trinidad and Tobago, were studied to determine whether there was any gender difference in the perception of stress. A total of 50 physicians (25 male and 25 female), were selected on the basis of: urban locality of practice, and a workday minimum of five hours. They were asked to complete a questionnaire involving four major sections: (i) general biodata (ii) social activities (iii) lifestyle and (iv) work attitudes. Results indicated that the female physicians perceived significantly more stress than their male counterparts in most of the areas studied (AU)

Is under-reporting of AIDS a problem in Jamaica?

A survey of physicians in Jamaica was conducted between March and September, 1993 in order to estimate the level of reporting of HIV and AIDS. A questionnaire was delivered to nearly all of approximately 1,200 physicians practising in Jamaica. Completed questionnaires were received from 518, a response rate of 35 per cent. Of the physicians responding, 46 per cent were in private practice only, 22 per cent in the public sector only and 32 per cent in both. Two-thirds (66 per cent) of the physicians in private practice had not diagnosed a case of AIDS and 65 had not had a patient with a positive HIV test result. Half (54 per cent) of the private physicians had reported all their AIDS cases, 8 per cent had reported some and 38 per cent (45 doctors) had reported none. The main reasons for not reporting were: "thought someone else had reported" (15 doctors), concern for confidentiality (11) and not knowing where to report (8). Only 9 per cent of private practitioners were currently seeing an AIDS patient and 12 per cent were seeing an HIV-infected person. Of physicians with current AIDS patients 16 per cent preferred not to report, 21 per cent intended to report and 63 per cent had reported. Nearly one-third (29 per cent) of private practitioners expressed reservations about treating persons with HIV/AIDS. Most (75 per cent) public sector physicians had seen one or more AIDS patients. Sixty-four per cent of these physicians said that all of their AIDS cases were reported, 4 per cent said some, 4 per cent said none and 28 per cent didn't know. Reporting of AIDS cases is better in the public sector than among private physicians. It is likely that some, if not many, of the AIDS cases not reported by private physicians are reported when admitted to hospital. It is not possible to estimate the precise level of under reporting of AIDS in Jamaica from this survey. However, more needs to be done to address the reservations of some private physicians and convince them of the need for timely reporting of HIV/AIDS cases (AU)

Is under-reporting of AIDS a problem in Jamaica? - abstract

A survey of physicians in Jamaica was conducted between March and September 1993 in order to estimate the level of reporting of HIV and AIDS. A questionnaire was delivered to nearly all of approximately 1,200 physicians practising in Jamaica. Completed questionnaires were received from 418, a response rate of 35 percent. Of the physicians responding, 46 percent were in private practice only, 22 percent in the public sector only and 32 percent in both. Two-thirds (66 percent) of the physicians in private practice had not diagnosed a case of AIDS and 65 percent had not had a patient with a positive HIV test result. Half (54 percent) the private physicians had reported all their AIDS cases, 8 percent reported some and 38 percent (45 doctors) had reported none. The main reasons for not reporting were: " thought someone else had reported" (15 doctors), concern for confidentiality (11) and not knowing where to report (8). Only 9 percent of private practitioners were currently seeing an AIDS patient and 12 percent were seeing an HIV-infected person. Of physicians with current AIDS patients 16 percent preferred not to report, 21 percent intended to report and 63 percent had reported. Nearly a third (29 percent) of private practitioners expressed reservations about treating persons with HIV/AIDS. Most (75 percent) public sector physicians had seen one or more AIDS patients; 64 percent of these physicians said that all of their AIDS cases were reported, 4 percent said some, 4 percent said none and 28 percent didn't know. Reporting of AIDS cases is better in the public sector than among private physicians. It is likely that some, if not many, of the AIDS cases not reported by private physicians, are reported when admitted to hospital. It is not possible to estimate the precise level of under-reporting of AIDS in Jamaica from this survey. However, more needs to be done to address the reservations of some private physicians and to convince them of the need for timely reporting of HIV/AIDS cases (AU)