Medicalising diagnoses and treatment preferences: a retrospective cohort study of throat-related consultations in electronic primary care records.

BACKGROUND: Rather than first diagnosing and then deciding on treatment, GPs may intuitively decide on treatment and justify this through choice of diagnosis. AIM: To investigate the relationship between choice of a medicalising diagnosis and antibiotic treatment for throat-related consultations. DESIGN & SETTING: A retrospective cohort study in a large database of UK electronic primary care records between 1 January 2010 and 1 January 2020. METHOD: All first throat-related consultations were included, categorised as either pharyngitis/tonsillitis or sore throat. The outcome was any antibiotic prescription on the consultation date. GP-level random effects on prescribing and on diagnosis were estimated in a series of mixed-effects regression models, including age, sex, weekday, month, and clinician characteristics as fixed effects. GPs were grouped into quintiles by antibiotic prescribing propensity, and described the proportion of patients they diagnosed with pharyngitis/tonsillitis or sore throat in each quintile. RESULTS: The analysis dataset included 393 590 throat-related consultations with 6881 staff. Diagnosis of pharyngitis/tonsillitis was strongly associated with antibiotic prescribing (adjusted odds ratio = 13.41, 95% confidence interval = 12.8 to 14.04). GP random effect accounted for 18% of variation in prescribing and for 26% of variation in diagnosis. GPs in the lowest quintile of antibiotic prescribing propensity diagnosed pharyngitis/tonsillitis on 31% of occasions, compared with 55% in the highest quintile. CONCLUSION: There is substantial variation among GPs in diagnosis and treatment of throat-related problems. Preference for a medicalising diagnosis is associated with a preference for antibiotics, suggesting a common propensity to both diagnose and treat.

Predisposing, enabling, and need factors associated with utilization of institutional delivery services: A community-based cross-sectional study in far-western Nepal.

Use of institutional delivery services can be effective in reducing maternal and infant mortality. In Nepal, however, the majority of women deliver at home. Using Andersen's behavioral model of use of health care services, this cross-sectional study aimed to identify factors associated with use of institutional delivery services in four villages and one municipality in Kailali district, Nepal. Mothers (N = 500) who had given birth in the 5 years preceding the survey (conducted between January and February 2015) were randomly selected by cluster sampling and interviewed using a semi-structured questionnaire. Bivariate analyses and multivariate hierarchical logistic regression analyses were performed. Among the women surveyed, 65.6% had used institutional delivery services for their last delivery, a higher proportion than the national average. Primiparity, having a secondary or higher education level, living in the Durgauli village, having husbands with occupations other than agriculture or professional/technical jobs, and having attended four or more antenatal care (ANC) visits had significantly increased use of institutional deliveries. Also, belonging to the richest 20% of the community and having experienced pregnancy complications were marginally significantly associated. These findings demonstrate the need for improving mother's education, encouraging them to attend ANC visits and addressing disparities between different regions.

From Visiting a Physician to Expecting Antibiotics: Korean Perspectives and Practices toward Respiratory Tract Infections.

Antibiotic resistance is steadily rising worldwide. Respiratory tract infections (RTIs) are common indications, mostly imprudent, for antibiotic prescriptions in outpatient setting. In Korea, antibiotic prescription rate for RTIs is still high. As physician visit and antibiotic prescribing are influenced by patient's perceptions and beliefs, we aimed to explore the general public's perspectives and practices toward RTIs and to develop the 'RTI clinical iceberg.' A cross-sectional survey was conducted in Wonju Severance Christian Hospital (WSCH) among 550 adults attending outpatient departments during January 2016. Differences in distributions between groups were examined using two-tailed Pearson χ² test. Using the Andersen's behavioral model as a conceptual framework, we constructed logistic regression models to assess factors associated with physician visit. Of 547 participants with complete questionnaires, 62.9% reported having experienced an RTI in the previous six months; 59.3% visited a physician for the illness, most commonly because the symptoms were severe or prolonged, and approximately 16% of them expected an antibiotic prescription from the visit. Perceptions of symptoms severity, the need factor, most strongly influenced physician visit. Predisposing and enabling factors such as inappropriate expectations for antibiotic for a sore throat or having national health insurance also influenced physician visit. Almost all participants who reported asking for an antibiotic were prescribed one, with a 37.1% non-adherence rate. Conclusively, public education on self-care for RTI symptoms that addresses their main concerns may reduce physician visits. Improving physician-patient relationship and informing patients about the lack of antibiotic benefit for most RTIs may also reduce antibiotic prescriptions.

Determinants of Body Mass Index and Intelligence Quotient of Elementary School Children in Mountain Area of Nepal: An Explorative Study.

The physical growth and cognitive development of elementary school children are very crucial and this group is large in number but has little research dedicated to it. The physical growth and cognitive development of children occur simultaneously and can be measured by body mass index (BMI) and intelligence quotient (IQ). Previous studies could not sufficiently focus on both aspects. The aim of this study was to identify determinants of BMI and IQ of students in two elementary schools in the Humla district of Nepal. Two randomly selected elementary schools and all children available there (n = 173) participated in the study. BMI was calculated with the objective of proper measurement of height and weight of the children. Likewise, the updated universal nonverbal intelligence test (UNIT) was applied for IQ. Descriptive statistics, t-test, analysis of variance and multiple linear regressions were used when appropriate. Study findings showed that one-tenth of the children had grade 2 thinness (-2SD) and about one-third had poor IQ (<85). The age of the children (p < 0.05) and household economic status (p < 0.001) were significant for the BMI. Likewise, frequencies of illness in the previous year, mother's education (p < 0.05) and father's education (p < 0.001) were significant factors for the IQ score. More commonly, BMI and IQ scores were significantly lower in the ultra-poor group. Economic status and parent education are still major determinants of IQ and BMI in these students. Special programs and strategies should be launched to improve the poor ranking of IQ and BMI.

Single-channel stereoscopic video imaging modality based on transparent rotating deflector.

In this study, we developed a single-channel stereoscopic video imaging modality based on a transparent rotating deflector (TRD). Sequential two-dimensional (2D) left and right images were obtained through the TRD synchronized with a camera, and the components of the imaging modality were controlled by a microcontroller unit. The imaging modality was characterized by evaluating the stereoscopic video image generation, rotation of the TRD, heat generation by the stepping motor, and image quality and its stability in terms of the structural similarity index. The degree of depth perception was estimated and subjective analysis was performed to evaluate the depth perception improvement. The results show that the single-channel stereoscopic video imaging modality may: 1) overcome some limitations of conventional stereoscopic video imaging modalities; 2) be a potential economical compact stereoscopic imaging modality if the system components can be miniaturized; 3) be easily integrated into current 2D optical imaging modalities to produce a stereoscopic image; and 4) be applied to various medical and industrial fields.

The components of self-perceived health in the Kailali district of Nepal: a cross-sectional survey.

Self-perceived health is a health measure with well-established links with mortality, healthcare services utilization, and future health. Various components of self-perceived health have been identified in different populations. In this study, we aimed to investigate the components of self-perceived health in a Nepali population. This was a cross-sectional survey conducted in the Kailali district of Nepal in 2014. The sample was initially consisted of 309 households, representative of the population of one municipality and one village; however, 304 participants were included in the analyses. Information on socio-demographic characteristics, health condition, satisfaction with healthcare services, psychological factors, and health behaviors was extracted. Logistic regression analyses were carried out to identify putative components of self-perceived health. Among the 304 respondents, 244 (80.3%) and 60 (19.7%) perceived their health as good and poor, respectively. Middle age and lower satisfaction with healthcare services were associated with worse self-perceived health, accounting for 10.3% of variance. No regular exercise, drinking, smoking, and being unhappy were also related with worse self-perceived health, after adjustment for age and satisfaction level. In the final model, however, drinking status did not significantly contribute. Our findings support previous findings that individuals with positive health behaviors and psychological wellbeing are more likely to perceive their health better. This study may direct public health policies toward more targeted interventions.

Practical approaches to the nutritional management of nonalcoholic fatty liver disease.

Nonalcoholic fatty liver disease (NAFLD) is the hepatic manifestation of metabolic syndrome and a serious health burden worldwide which increases risk of cirrhosis, type 2 diabetes mellitus (T2DM), and cardiovascular complications. Current epidemics of obesity, unhealthy dietary patterns, and sedentary lifestyles, all contribute to the high prevalence of NAFLD. Dietary patterns and nutrients are important contributors to the development, progression, and treatment of NAFLD. A healthy diet is beneficial for all NAFLD patients beyond weight reduction. Generally, hypercaloric diets, especially rich in trans/saturated fat and cholesterol, high consumption of red and processed meat, and fructose-sweetened beverages seem to increase the risk of progression toward nonalcoholic steatohepatitis (NASH), whereas reducing caloric intake and high-glycemic index (GI) foods, increasing consumption of monounsaturated fatty acids, omega-3 fatty acids, fibers, and specific protein sources such as fish and poultry have preventive and therapeutic effects. Therefore, nutrition serves as a major route of prevention and treatment of NAFLD, and patients with NAFLD should have an individualized diet recommendation. In this review, the evidence linking macronutrients to NAFLD are discussed.