Preferences of people in choosing a family physician in rural areas: a qualitative inquiry from Iran.

BACKGROUND: Creating a stable and long-term relationship called 'longitudinality' between the population and general practitioners is crucial for the family physician program. The constant change of family physicians (FPs) can deteriorate longitudinality. This study aims to reveal what factors people usually consider when choosing a new FP or changing their current FP. METHOD: A qualitative study with a thematic analysis approach was carried out in Ilam province, Iran, in 2019. Purposeful sampling with a maximum variation strategy was followed to select the key informants. We did 34 interviews with following groups: patients (rural residents); FPs; and experts from Iran Health Insurance Organization, Ilam University of Medical Sciences, and Health Network Development Center. Data were analyzed using a thematic analysis to identify and contextualize the preferences of people in choosing a FP in rural areas. All the processes related to data coding and emerging themes were carried out using MAXQDA 2012 software. RESULTS: The content of the interviews was categorized into 2 main themes, 6 sub-themes, and 39 codes. The first theme was 'family physician characteristics' including four sub-themes: general behaviors, social and physical characteristics, professional expertise, and pharmaceutical prescriptions. The second theme was 'health center' consisting of two sub-themes including location and physical features and properties of the health center. CONCLUSION: Some of the factors extracted from the interviews may have a different effect on the choice of people with different demographics. For instance, patients may have different ideas about the age, gender, years of medical practice, and finally, language and origin of the birthplace of FPs. Quantitative studies are needed to rank the factors identified in this study according to their significance for choosing FP and reveal patients' preferences for each factor.

Possible health risk assessment for heavy metal concentrations in water, sediment, and fish species and Turkmen pregnant women's biomonitoring in Miankaleh Peninsula, Iran.

This study investigated the human biomonitoring of heavy metals in the water, sediments, and tissues of mostly consumed fish species using Turkmen pregnant women's biomarkers in winter 2019, at the Miankaleh Peninsula, north of Iran. Metal concentrations were measured in various fish organs as well as pregnant women's blood, hair, and nail as biological indicators. For this purpose, a total of 20 water and sediment, 14 fish, and 16 human samples were collected. Inductively coupled plasma mass spectrometry (ICP-MS) was used to evaluate the concentration of Cr, Co, Cu, As, Hg, and Pb. Results showed metals with the highest concentrations as Cu and Cr in water (93.35 and 80.91 µg/l, respectively), Hg and Pb in sediment (7.40 µg/g for both), Cu and Pb in the liver (27.00 and 18.9 µg/g for C. carpio; 1414 and 31.7 µg/g for L. auratus), muscle (10.00 and 18.80 for C. carpio; 37.20 and 8.27 µg/g for L. auratus), and skin (26.40 and 9.90 for C. carpio; 10.80 and 11.74 µg/g for L. auratus). In addition, Cu, in pregnant women samples, had the highest values at 2.53 mg/l, 8.87, 36.46, and 29.04 µg/g for blood, hair, fingernail, and toenail, respectively. However, Co showed the lowest concentration in all studied samples. Fish liver and fingernail of pregnant women did reveal the highest heavy metal accumulation, whereas fish muscle and blood of pregnant women had the lowest accumulated heavy metals. The concentration of Hg in water, sediment, fish muscle, and women's blood and hair exceeded the limits suggested by various organizations. Therefore, this study highlighted that heavy metal concentration, in particular Hg, in water, sediments, and fish is a serious risk to the health of local inhabitants who rely on fisheries products and recommended that necessary information should be provided to warn Turkmen pregnant women in consumption of Hg-contaminated fish in this area.