Perceptions and utilization of generic medicines in Guatemala: a mixed-methods study with physicians and pharmacy staff.

BACKGROUND: Access to low-cost essential generic medicines is a critical health policy goal in low-and-middle income countries (LMICs). Guatemala is an LMIC where there is both limited availability and affordability of these medications. However, attitudes of physicians and pharmacy staff regarding low-cost generics, especially generics for non-communicable diseases (NCDs), have not been fully explored in Guatemala. METHODS: Semi-structured interviews with 30 pharmacy staff and 12 physicians in several highland towns in Guatemala were conducted. Interview questions related to perceptions of low-cost generic medicines, prescription and dispensing practices of generics in the treatment of two NCDs, diabetes and hypertension, and opinions about the roles of pharmacy staff and physicians in selecting medicines for patients. Pharmacy staff were recruited from a random sample of pharmacies and physicians were recruited from a convenience sample. Interview data were analyzed using a thematic approach for qualitative data as well as basic quantitative statistics. RESULTS: Pharmacy staff and physicians expressed doubt as to the safety and efficacy of low-cost generic medicines in Guatemala. The low cost of generic medicines was often perceived as proof of their inferior quality. In the case of diabetes and hypertension, the decision to utilize a generic medicine was based on multiple factors including the patient's financial situation, consumer preference, and, to a large extent, physician recommendations. CONCLUSIONS: Interventions to improve generic medication utilization in Guatemala must address the negative perceptions of physicians and pharmacy staff toward low-cost generics. Strengthening state capacity and transparency in the regulation and monitoring of the drug supply is a key goal of access-to-medicines advocacy in Guatemala.

Disparities in postpartum follow-up in women with gestational diabetes mellitus.

In Brief Postpartum follow-up for patients with gestational diabetes mellitus (GDM) is essential to manage future disease risk. In a diverse, urban population of GDM patients at a major medical center, high fasting glucose, high BMI at diagnosis, and low education level were associated with not following up in the endocrinology clinic after delivery; patients least likely to follow up are, therefore, also at greatest risk of GDM complications. Although race/ethnicity was not a significant predictor of follow-up, Hispanic/Latina and African-American patients were more likely to have risk factors for postpartum clinical attrition.

The art of equity: critical health humanities in practice.

BACKGROUND: The American Association of Medical Colleges has called for incorporation of the health humanities into medical education, and many medical schools now offer formal programs or content in this field. However, there is growing recognition among educators that we must expand beyond empathy and wellness and apply the health humanities to questions of social justice - that is, critical health humanities. In this paper we demonstrate how this burgeoning field offers us tools for integrating social justice into medical education, utilizing the frameworks of critical consciousness and structural competency. PRACTICE OF HEALTH HUMANITIES: Critical health humanities can be applied at multiple levels of learners, and in a variety of contexts. We are two physician-writers who have developed several educational programs that demonstrate this. We taught a seminar that introduced first-year and second-year undergraduates to concepts such as social determinants of health, intergenerational trauma, intersectionality, resilience, and cross-cultural care through works of fiction, poetry, film, podcasts, stand-up comedy, and more. Through creative projects and empathic reflection, students engaged with the complexities of structural forces that create and maintain health disparities. Medical students in their clinical years can engage in critical health humanities learning experiences as well. We teach several multidisciplinary electives that address social (in)justice in medicine, as well as mentor fourth-year students engaged in independent electives that foster critical awareness around health equity and ethics. Beyond the classroom, we have actively engaged in critical health humanities practices through story slams, literary journal clubs, conference presentations, and Grand Rounds. Through these activities we have included learners at GME and CME levels. These examples also demonstrate how community engagement and multidisciplinary partnerships can contribute to the practice of critical health humanities. CONCLUSION: In this paper, we explore the growing field of critical health humanities and its potential for teaching health equity through narrative practices. We provide concrete examples of educational activities that incorporate critical consciousness and structural competency - frameworks we have found useful for conceptualizing critical health humanities as a pedagogical practice. We also discuss the strengths and challenges of this work and suggest future directions.

Caregiver Strengths, Attitudes, and Concerns About Reading and Child Development in the Dominican Republic.

Background. Parents' beliefs about and engagement in reading aloud to young children and other positive parenting practices have been associated with early childhood development (ECD) and later achievement. Aim. This exploratory study sought to assess parental attitudes and self-reported practices regarding ECD in a rural, low-income community in the Dominican Republic with many risk factors for ECD delays, including high rates of poverty, iron-deficiency anemia, and malnutrition. Methods. We used the Parent Reading Belief Inventory and open-ended questions to evaluate parental beliefs regarding reading, self-efficacy in promoting child development, current positive parenting practices, and parents' concerns about the development of their 0- to 5-year-old children in Consuelo, Dominican Republic. We explored associations between demographic factors and strength of positive parenting beliefs and practices. Results. Overall participants had positive attitudes toward reading and their own importance in promoting their children's development. Participants with at least some high school education had significantly higher Parent Reading Belief Inventory scores (P = .03) than those with less formal education. Participants reported frequently singing, talking, and playing with their children, but less frequently reading with them. Few participants had access to reading materials for young children. Parental interest in programs to support ECD was high. Parents raised concerns about their children's behavior, personal and educational attainment, and early literacy. Conclusion. Children whose parents have less formal education may benefit most from interventions to promote beliefs and practices likely to improve ECD. In this community, there is high interest in learning more about ECD.