General Practitioners Can Evaluate the Material,Social and Health Dimensions of Patient Social Status

Objective

To identify which physician and patient characteristics are associated with physicians'' estimation of their patient social status.

Design

Cross-sectional multicentric survey.

Setting

Fourty-seven primary care private offices in Western Switzerland.

Participants

Random sample of 2030 patients ≥16, who encountered a general practitioner (GP) between September 2010 and February 2011.

Main measures

Primary outcome: patient social status perceived by GPs, using the MacArthur Scale of Subjective Social Status, ranging from the bottom (0) to the top (10) of the social scale.Secondary outcome: Difference between GP''s evaluation and patient''s own evaluation of their social status. Potential patient correlates: material and social deprivation using the DiPCare-Q, health status using the EQ-5D, sources of income, and level of education. GP characteristics: opinion regarding patients'' deprivation and its influence on health and care.

Results

To evaluate patient social status, GPs considered the material, social, and health aspects of deprivation, along with education level, and amount and type of income. GPs declaring a frequent reflexive consideration of their own prejudice towards deprived patients, gave a higher estimation of patients'' social status (+1.0, p = 0.002). Choosing a less costly treatment for deprived patients was associated with a lower estimation (−0.7, p = 0.002). GP''s evaluation of patient social status was 0.5 point higher than the patient''s own estimate (p<0.0001).

Conclusions

GPs can perceive the various dimensions of patient social status, although heterogeneously, according partly to their own characteristics. Compared to patients'' own evaluation, GPs overestimate patient social status.     

Preventing Torture in Nepal: A Public Health and Human Rights Intervention

In this article we address torture in military and police organizations as a public health and human rights challenge that needs to be addressed through multiple levels of intervention. While most mental health approaches focus on treating the harmful effects of such violence on individuals and communities, the goal of the project described here was to develop a primary prevention strategy at the institutional level to prevent torture from occurring in the first place. Such an approach requires understanding and altering the conditions that cause and sustain “atrocity producing situations” (Lifton 2000, 2004). Given the persistence of torture across the world and its profound health consequences, this is an increasingly important issue in global health and human rights.     

Doctors for Democracy. Health Professionals in the Nepal Revolution

Doctors for Democracy. Health Professionals in the Nepal Revolution. Vincanne Adams. New York: Cambridge University Press. 1998.252 pp.     

上海市患儿家长健康教育需求及现状调查

??????? 目的 了解上海市患儿家长对健康教育知识和方式的需求情况,提出做好患儿家长健康教育的方法和途径。方法 在文献检索和专家咨询的基础上,采用自行设计的调查问卷对200名门诊患儿家长和300名住院患儿家长进行调查,并对调查结果进行统计分析。结果 患儿家长对健康教育知识的需求广泛,教育方式的需求多样,对目前开展的健康教育,住院患儿家长的满意度要好于门诊患儿家长,但仍存在一定的不足。 结论 通过满足患儿家长对健康知识的需求、丰富健康教育的形式、加强医护人员人文教育等途径来做好患儿家长的健康教育。     

Factors associated with the introduction of prelacteal feeds in Nepal: findings from the Nepal Demographic and Health Survey 2011

Background

A prelacteal feed is any food except mother’s milk provided to a newborn before initiating breastfeeding. Prelacteal feeding is a major barrier to exclusive breastfeeding. It is a prevalent practice in Nepal. Little is known about the factors associated with providing prelacteal feeds to the Nepalese newborn. This study explored the factors associated with providing prelacteal feeds to children under three years in Nepal using the Nepal Demographic and Health Survey (NDHS) 2011.

Methods

This study utilised the NDHS 2011 child dataset which is a nationally representative study. The rates of providing prelacteal feeds were reported as a proportion. Complex Sample Analysis method was used to account for the cluster design and sample weight of the study. Chi-square tests and multiple logistic regression were used to analyse the factors associated with providing prelacteal feeds.

Results

A sample of 3948 mothers were included in the study. A total of 841 [26.5% (95% CI: 23.1%–30.3%)] weighted proportion) of mothers reported of providing prelacteal feeds to their newborn infants. Plain water (n?=?75), sugar/glucose (n?=?35), gripe water (n?=?3), sugar/salt solution (n?=?3), fruit juice (n?=?3), infant formula (n?=?96), tea (n?=?3) and other milk other than breast milk (n?=?556) were some of the types of prelacteal feeds reported. The multiple regression analysis showed that the mothers who had no education, were not working, were from the middle wealth quintile, who had not attended four antenatal care visits, were first time mothers and who were from the Terai/Plain region were more likely to provide prelacteal feeds.

Conclusions

Given that one in four infants were provided with prelacteal feeds, there is a need to implement breastfeeding promotion programs to increase the practice of exclusive breastfeeding and reduce prelacteal feeding practices. Breastfeeding counseling at antenatal clinics and peer support for exclusive breastfeeding should be included as part of breastfeeding promotion programs. Mobilisation of female community health volunteers for peer counseling is also a feasible option for Nepal.