Journal articles on the topic 'Physicians (General practice) Health and hygiene Victoria'

Background & Objective: Although menstruation is a natural physiological process and usually goes away without any complex problems provided proper care is taken during the period. However, menstruation is linked with religious and cultural meanings that can affect the perceptions of young girls and the ways in which the adult communities around them respond to their felt-needs. So, menstruation-associated complaints are not uncommon. The present study was, therefore, intended to determine the perception and practice of adolescent girls about menstruation in Barisal District. Methods: This cross-sectional descriptive study was conducted as part of Field-site Survey of the Department of Social Science & Public Health (SSPH). Having obtained consent from the parents/guardians, a total of 205 adolescent girls from the Barisal district (both from Barisal Metropolitan City and rural area of the District) who had experienced menarche at least 6 months prior to the day of interview were included in the study. Data were collected over a period of three months from July 2020 to September 2020. Before interview, the issue of menstruation was discussed with the respondents. The interview was done by the female Health Assistants (field staff of Upalzila Health Complex in the Government setting) so that the interviewees answer freely to such private matters as menstruation thereby reducing the chance of bias during interview. Result: Nearly 70% of the respondents were 14-16 years old with mean age of the girls being 15.2 ± 1.6 years. Majority of the respondents was unmarried (95.1%), urban resident (86.8%) and students of Public-School (66.8%). In terms of socioeconomic status, almost half (49.3%) was middle class, 29.8% lower middle class and 10.7% upper middle class. Most (87.8%) of the respondents had their menarche at 11-14 years with mean age at menarche being 12.9 ± 1.3 years. Over two-thirds (68.8%) of the respondents reported their length of menstrual cycle to vary from 26 – 30 days and period to vary from 3-5 days. A substantial proportion (83.4%) of respondents had regular menstruation. The predominant complaint during menstruation was fatigue or tiredness (73.2%) followed by pelvic pain (62%), malaise (60%) and low back pain (38.5%). Over half (50.4%) consulted with physicians, 11.8% with drug-sellers, 3.9% with herbal healer and 1.6% with homeopath for pain relief. Approximately 57% took analgesics to get relief from the pain. Other symptoms or complaints relating to menstruation were altered appetite (55.6%), abdominal bloating (39%), heavy bleeding (45.4%) and frequency of micturition (31.7%). About 46% of the respondents’ routine activities were adversely affected, social relationships disrupted (32.7%), family relationship hampered (25.4%), sports/exercise activities stopped or reduced (58%). Nearly half (47.8%) of them had to absent from the school during the period with average school absenteeism of 3-4 days each month being reported by more than half of the cases. Majority (94.6%) of the respondents perceived that ‘period of adolescent girls’ should occur every month and that their period should not make them anxious (81.5%). About 83% told that a period of 3-5 days duration be considered normal. Almost 94% took some sanitary measures while they were on period. Majority (87.3%) talked the issue to a family member and about 64% to friends. Over one-third (37.6%) sought suggestion about menstrual affairs from their mothers, 27.8% from their sisters, 26.8% from friends and relations and only 7.8% from doctors. Conclusion: Majority of the adolescent girls start menstruation at 11-14 years with mean age at menarche being 13 years. Adolescent girls usually adopt hygienic measures during the period by using sanitary napkin or clean home-made pad. The predominant symptoms experienced during the period are pelvic pain, malaise and low back pain. Other symptoms are loss of appetite, flatulence, heavy bleeding and frequency of micturition with personal, familial and social life being adversely affected and they remain absent from the school during the period in each cycle. Half of the girls consult with physicians for pain relief and take analgesics. Ibrahim Card Med J 2021; 11 (1): 79-85

Objective We sought to explore physician perspectives on the prescribing of cannabinoids to patients to gain a deeper understanding of the issues faced by prescriber and public health advisors in the rollout of medicinal cannabis. Design A thematic qualitative analysis of 21 in-depth interviews was undertaken to explore the narrative on the policy and practice of medicinal cannabis prescribing. The analysis used the Diffusion of Innovations (DoI) theoretical framework to model the conceptualisation of the rollout of medicinal cannabis in the Australian context. Setting Informants from the states and territories of Victoria, New South Wales, Tasmania, Australian Capital Territory, and Queensland in Australia were invited to participate in interviews to explore the policy and practice of medicinal cannabis prescribing. Participants Participants included 21 prescribing and non-prescribing key informants working in the area of neurology, rheumatology, oncology, pain medicine, psychiatry, public health, and general practice. Results There was an agreement among many informants that medicinal cannabis is, indeed, a pharmaceutical innovation. From the analysis of the informant interviews, the factors that facilitate the diffusion of medicinal cannabis into clincal practice include the adoption of appropriate regulation, the use of data to evaluate safety and efficacy, improved prescriber education, and the continuous monitoring of product quality and cost. Most informants asserted the widespread assimilation of medicinal cannabis into practice is impeded by a lack of health system antecedents that are required to facilitate safe, effective, and equitable access to medicinal cannabis as a therapeutic. Conclusions This research highlights the tensions that arise and the factors that influence the rollout of cannabis as an unregistered medicine. Addressing these factors is essential for the safe and effective prescribing in contemporary medical practice. The findings from this research provides important evidence on medicinal cannabis as a therapeutic, and also informs the rollout of potential novel therapeutics in the future.

Biomedical waste (BMW) management is an essential practice of healthcare professionals (HCPs) for preventing health and also environmental hazards. Coronavirus disease (COVID-19) has become a global pandemic, posing significant challenges for healthcare sectors. A cross-sectional study was performed to assess the knowledge, practice, and attitude on BMW management among HCPs when taking care of patients with COVID-19 and associated with demographic variables. From Al-Ahsa healthcare sectors, 256 HCPs were selected randomly, of which 105 (41%) had excellent knowledge, 87 (34%) had good knowledge, and 64 (25%) had poor knowledge with a mean score of 13.1 ± 3.6. A higher mean score was (14.4 ± 3.2) obtained by physicians, and (13.6 ± 3.8) nurses than the other HCPs. Regarding practice, 72 (28.1%) HCPs used and discarded PPE while handling biomedical wastes. Additionally, 88 (34.4%) followed proper hand hygiene before and after each procedure and whenever needed. Physicians, nurses, and respiratory therapists had a more favorable attitude than other HCPs. There was a statistically significant association found among knowledge level and educational qualification (p < 0.0001), gender (p < 0.001), and work experience (p < 0.05). Emphasis is needed to train all HCPs regarding proper BMW management during this pandemic to prevent infection transmission.

Poor hand-hygiene adherence endangers the safety of both healthcare workers and patients. A cross-sectional Knowledge Attitudes Practicing (KAP) survey (n= 268) and an observation of hand-hygiene compliance (n= 36) were conducted among staff in a general hospital in Syria. The aim of this study was to investigate the degree of compliance with hand hygiene protocols by general health care workers including their knowledge, attitude and practice. The mean overall observed hand-hygiene compliance rate was 45.7% (95% CI 37.1 – 54.3). Nurses were observed to have better compliance than physicians. Staff were observed to be more concerned in performing hand-hygiene after than before patient contact (before mean= 32.0%, after mean= 51.2%, p< 0.05). The questionnaire showed that there was a significant correlation between knowledge, attitude, and facilities on the one hand and poor self-reported adherence on the other. Multivariate analysis showed that poor adherence was statistically significantly associated with males (63.5%), untrained staff (58.5%) and unavailability of washing basins (60.4%). Poor adherence was high in ICU, among younger and unaware participants. Keywords: compliance, hand hygiene, hospital acquired infection, healthcare workers, Knowledge-Attituded-Practice (KAP), patient safetyAbstrak Kepatuhan pada kebersihan tangan yang buruk membahayakan keselamatan tenaga kesehatan dan pasien. Survei potong lintang Pengetahuan Sikap Praktek (n= 268) dan observasi kepatuhan kebersihan tangan (n= 36) dilakukan di antara staf di rumah sakit umum di Suriah. Tujuan dari penelitian ini adalah untuk mengidentifikasi tingkat kepatuhan dengan protokol kebersihan tangan oleh tenaga kesehatan termasuk pengetahuan, sikap dan praktik mereka. Rerata tingkat kepatuhan kebersihan tangan yang diamati secara keseluruhan adalah 45,7% (95% CI 37,1-54,3). Perawat diamati memiliki kepatuhan yang lebih baik daripada dokter. Staf yang diamati tampak lebih peduli melakukan kebersihan tangan setelah kontak dengan pasien dibanding sebelum kontak (rerata sebelum= 32,0%, rerata setelah= 51,2%, p< 0,05). Hasil kuesioner menunjukkan bahwa ada korelasi yang signifikan antara pengetahuan, sikap, dan fasilitas, namun disisi lain kepatuhan dilaporkan buruk. Analisis multivariat menunjukkan bahwa kepatuhan yang buruk secara statistik terkait secara signifikan dengan jenis kelamin laki-laki (63,5%), staf tidak terlatih (58,5%) dan tidak tersedianya tempat cuci tangan (60,4%). Tingkat kepatuhan yang rendah angkanya ditemukan cukup tinggi di ICU, di antara responden yang lebih muda dan tidak sadar. Kata Kunci: kebersihan tangan, kepatuhan, hospital acquired infection, tenaga kesehatan, keselamatan pasien, Pengetahuan-Sikap-Praktik

The individual medical practice is the form of practicing the profession of physician within which the attending physician is acting alone or together with other physicians and other categories of authorized medical personnel; it has a certificate of registration in the Sole register of medical practices, issued by the Public Health Authority, according to the legal provisions in force; it has a legal status from which it appears that its object of activity is the provision of medical services. The medical practice is established at the request of the attending physician or of the associate physicians of the medical civil society. The act of incorporation of the medical practice or of the medical civil society is the certificate of registration with the Sole register of medical practices. Due to the importance of observing the hygienic and sanitary conditions in the provision of quality dental care the hygienic-sanitary status was assessed in the provision of hygienic sanitary assistance. Given the importance of observing the hygienic and sanitary conditions in providing quality medical care, the hygiene and sanitary condition of 29 medical practices was assessed using an investigation checklist adapted according to the control checklist for medical practices created by the Directorate of Control within the County Public Health Department. Disposal of waste resulting from the medical activity is done in accordance with the regulations in force regarding this category of waste. In the final disinfection (BK eliminators), disinfectants based on formaldehyde may be used; it is preferable to use other disinfectants which the manufacturer recommends as such.

The urgency of the topic declared in the article is due to the attention of modern Ukrainian pedagogy to the problems of health of children and youth, which, in turn, involves the study of creativity in particular Polish physicians and educators of the interwar twentieth century. The purpose of the article is to represent the organizational, practical and literary heritage of the physician, hygienist, public and statesman Stanislav Kopchynskyi (Polish: Stanisław Kopczyński; 1873–1933). The study used a set of general and special methods, namely: historical and pedagogical analysis, synthesis, generalization, comparison of scientific sources, which became the basis for determining the degree of scientific development of the problem; concrete-historical method, which allowed to analyze and highlight the verified facts from the history of health education of students of secondary schools in Poland in a broad socio-cultural aspect; source analysis, source synthesis and biographical method, which contributed to the study of ideas, views and contributions of St. Kopchynskyi in the development of Polish theory and practice of school hygiene; for the reconstruction of fragments of the subject's activity the method of induction was used (the research began with the collection of facts, which were later systematized, analyzed and generalized). The study announces the «pre-war» professional and organizational experience of St. Kopchynskyi in the field of school hygiene, with which the scientist entered the «state» stage of his life, and characterizes the organizational activities of the hygienist during the interwar period of the twentieth century. Thus, the article contains the names of visitors to school hygiene and school doctors, who in the 20s ‒ 30s of the twentieth century. carried out systematic and purposeful work in the field of school hygiene and physical education, emphasized the scientific and educational activities of St. Kopchynskyi (the meaning of the so-called «Thursdays after the fifteenth» is detailed; the essence of systematic and appropriate hygienic education of secondary school students is outlined; the collection «Hygienic conversations. Methodical projects and instructions» is announced). It is concluded that St.Kopchynskyi represented a new paradigm of school hygiene, which provided a strong emphasis on the promotion of health among children and youth through education and upbringing and the involvement of students in active cooperation in nurturing their health.

Introduction:Many countries have a national antimicrobial resistance strategy. In Australia, primary care is especially important because this setting encompasses a high proportion of antibiotic use. While antibiotic use decreased during the 1990s, it began to increase again in the mid-2000s. In response to this, in 2009 NPS MedicineWise implemented a series of nationwide educational interventions for consumers, family physicians (general practitioners), and community pharmacies that aimed to reduce excessive antibiotic use.Methods:For consumers a social marketing approach was used, including strategies that leveraged collectivism, nudge theory, celebrity endorsement, and co-creation. Channels included social, print, radio, and other media as well as practice waiting rooms and pharmacies. For health professionals, interventions included face-to-face education, audits, comparative prescribing feedback, case studies, and point-of-care materials. Surveys of consumers and family physicians were conducted periodically to evaluate changes in knowledge and behavior. National Pharmaceutical Benefits Scheme claims data were analyzed using a Bayesian structural time-series model to estimate the cumulative effect of interventions by comparing the observed and expected monthly dispensing volumes if the interventions had not occurred.Results:The consumer survey results indicated that more people were aware of antibiotic resistance (seventy-four percent in 2017 versus seventy percent in 2014), with the minority requesting or expecting antibiotics for upper respiratory tract infections (URTIs) (twenty-two percent in 2017). People underestimated the usual duration of symptoms for URTIs and were more inclined to expect antibiotics beyond that timeframe. Compared with non-participants, family physicians who participated in the program reported more frequent discussions about hand hygiene (ninety percent versus eighty-two percent) and proper use of antibiotics with patients (ninety-five percent versus eighty-eight percent). Between 2009 and 2015 there was an estimated fourteen percent reduction in prescriptions dispensed to concessional patients for antibiotics commonly prescribed for URTIs.Conclusions:Family physicians and consumers have responded positively to national programs. Sustaining and building on these improvements will require continued education and further innovation.

Summary History of dentistry in the Central Serbian District of Jagodina has been influenced by traditional medicine for centuries. Development of dentistry in the region of Jagodina was slow, the level of oral and general hygiene was low and the sanitary prevention was absent. Trained physicians started to practice medicine and dentistry in the first half of the nineteenth century and they were educated in abroad universities. However, common people used to address to these physicians only when the traditional medicine were unable to help. Until the end of the World War II, common, mostly rural people, with the urgent dental treatment need were usually referred to the barbers, healers or empirics in the nearby villages rather than the dentists. Medications used for the urgent dental treatment were balsams and solutions made of herbs. After the World War II, the dental technicians who finished special courses started to practice dentistry. In 1947 the Regional Dental Office in Jagodina was opened and in 1955 the first Doctor of Dental Medicine who graduated from the School of Dental Medicine of University of Belgrade was employed. Nowadays, the Department of Dentistry represents is an important and independent part of the Health Care Centre in Jagodina.

Background: The recent coronavirus disease (COVID-19) pandemic is a serious health concern with far-reaching implications in every facet of human life. New challenges have emerged for ultrasound physicians engaged in diagnostic ultrasound examinations. Methods: Based on a comprehensive literature review the author has suggested a few precautionary measures that should be incorporated by the ultrasound physicians in their practice against the spread of coronavirus disease. Suggestions: Multi-level safeguard checks before, during, and after the ultrasound examination are suggested to protect ultrasound physicians, staff, and patients from COVID-19. The importance of triage for patient screening is stressed. Also, limiting patients by deferring non-urgent cases and cancelling aerosol-generating procedures is recommended. The need of counselling of patients and staff is stressed regarding the importance of facemasks, hand hygiene, and safe distancing. Incorporating different types of barriers against the virus such as facemasks, face-shields, personnel protective suits for ultrasound physicians and staff, and shielding the equipment and transducer with disposable or wipeable plastic sheets is suggested. Besides, the significance of cleaning and disinfection of the examination room and equipment by suitable disinfectants after each patient and at the end of the day is highlighted. Conclusion: Learning to live with the COVID-19 pandemic is the need of the day both for the general public and medical community. Being members of the medical community ultrasound physicians should gear up to the emerging challenges of COVID-19 to protect themselves, their patients, and allied healthcare staff from coronavirus infection.

Backgrounds Health care workers’ (HCWs) knowledge of and compliance with personal protective procedures is a key for patients’ and personnel safety. The aim of this study was to assess which factors are associated with higher self-evaluations of training on infection prevention and control (IPC) and higher self-assessment of IPC practices used by HCWs regarding COVID-19 in University Hospital in Krakow, Poland, in January 2021. Material and methods This was an online survey on the preparedness for COVID-19 epidemic of medical/non-medical staff and medical students. Questions included in the survey concerned participants’ socio-demographic characteristics, hospital staff involvement in the training, knowledge about the hand hygiene, and adherence to IPC measures. Knowledge and Performance Index (K&PI) based on selected questions was constructed for to reflect both subjective (self-evaluation) of preparedness and objective IPC knowledge and skills of HCWs participated in the IPC training. Results A total of 1412 health care workers, including 129 medical students, participated in the study. The largest group, 53.6%, was made up of nurses and paramedics. Age of respondents significantly correlated with knowledge of IPC and with K&PI. The mean age of workers with high K&PI was 42.39 ± 12.53, and among those with low, 39.71 ± 13.10, p < 0.001. 51% UHK workers participated in IPC training, but 11.3% of physicians, 28.8% of other HCWs, and 55.8% of students did not know the IPC standard precaution. Most participants, 72.3%, felt that they had received sufficient training; however, 45.8% of students declined this. There was no correlation between self-reported preparedness and the K&PI, indicating that self-reported preparedness was inadequate for knowledge and skills. Nurses and paramedics assessed their knowledge most accurately. Participants with low K&PI and high subjective evaluation constituted a substantial group in all categories. Students least often overestimated (23.8%) and most often (9.6%) underestimated their knowledge and skills. Conclusions Our study revealed inadequate IPC practice, especially as it refers to the training programme. We confirmed the urgent need of including theory and practice of IPC in curricula of health professions’ training in order to provide students with knowledge and skills necessary not only for future pandemic situations but also for everyday work.

Background: Mobile phones are increasingly associated with the transmission of pathogenic microbial agents. In the clinical setting where there is usually high exposure to pathogens, these devices may serve as vehicles for the transmission/spread of pathogens. This study determined the prevalence of bacterial contamination of mobile phones of health workers and the predisposing factors, in order to ascertain the risk of transmission of pathogenic bacteria through mobile phones.Methodology: This study was carried out in a private medical center at Mbouda, Cameroon, involving 78 health workers including health professionals (nurses, physicians, laboratory scientists) and hospital support workers (cleaners, cashiers and security guards), recruited by convenient sampling. Sterile swab sticks moistened with physiological saline were used to swab about three quarter of the surface of each phone. The swabs were cultured on MacConkey and Mannitol Salt agar plates which were incubated aerobically at 37oC for 24 hours, while Chocolate agar plate was incubated in a candle extinction jar for microaerophilic condition. The isolates were identified using standard biochemical tests including catalase, coagulase, and the analytical profile index (API) system. Data were analyzed using the Statistical Package for Social Sciences (SPSS) version 20.0.Results: Mobile phones of 75 of the 78 (96.2%) health workers were contaminated, with highest contamination rates for the phones of laboratory scientists (100%, 12/12), followed by support staff (98.9%, 13/14), nurses (97.7%, 43/44) and physicians (87.3%, 7/8), but the difference in contamination rates was not statistically significant (p=0.349). A total of 112 bacteria belonging to 12 genera were isolated, with predominance of Staphylococcus aureus (31.3%, n=35), Micrococcus spp (30.4%, n=34), coagulase negative staphylococci (10.7%, n=12) and Pseudomonas spp (5.4%, n=6). The laboratory (18.8%, 21/112) and medical wards (16.1%, 18/112) had the highest bacterial contamination of mobile phones (p=0.041), and more bacterial species were isolated from smartphones (68.8%, n=77/112) than keypad phones (31.2%, n=35/112) (p=0.032). There was no significant difference between phone contamination rates and the practice of hand hygiene or decontamination of work surfaces (p>0.05).Conclusion: The presence of potentially pathogenic bacteria on cell phones of health-care workers emphasizes the role of fomites in the transmission of infectious diseases. Consequently, good hand hygiene and decontamination practices are encouraged among health workers in order to limit the spread of hospital-acquired infections. Contexte: Les téléphones portables sont de plus en plus associés à la transmission d'agents microbiens pathogènes. Dans le cadre clinique où il y a généralement une forte exposition aux agents pathogènes, ces dispositifs peuvent servir de véhicules pour la propagation de la transmission des agents pathogènes. Cette étude a déterminé la prévalence de la contamination bactérienne des téléphones portables des agents de santé et les facteurs prédisposants, afin de déterminer le risque de transmission de bactéries pathogènes par les téléphones portables.Méthodologie: Cette étude a été réalisée dans un centre médical privé à Mbouda, au Cameroun, impliquant 78 agents de santé, y compris des professionnels de la santé (infirmiers, médecins, scientifiques de laboratoire) et des agents de soutien hospitalier (agents de nettoyage, caissiers et agents de sécurité), recrutés par échantillonnage pratique. Des écouvillons stériles humidifiés avec du sérum physiologique ont été utilisés pourécouvillonner environ les trois quarts de la surface de chaque téléphone. Les écouvillons ont été cultivés sur des plaques de gélose MacConkey et Mannitol Salt qui ont été incubées en aérobiose à 37°C pendant 24 heures, tandis que la plaque de gélose au chocolat a été incubée dans un pot d'extinction de bougie pour une condition microaérophile. Les isolats ont été identifiés à l'aide de tests biochimiques standard, notamment la catalase, la coagulase et le système d'indice de profil analytique (API). Les données ont été analysées à l'aide du package statistique pour les sciences sociales (SPSS) version 20.0.Résultats: Les téléphones portables de 75 des 78 agents de santé (96,2 %) étaient contaminés, avec les taux de contamination les plus élevés pour les téléphones des scientifiques de laboratoire (100%, 12/12), suivis par le personnel de soutien (98,9%, 13/14), infirmières (97,7%, 43/44) et médecins (87,3%, 7/8), mais la différence de taux de contamination n'était pas statistiquement significative (p=0,349). Au total, 112 bactéries appartenant à 12 genres ont été isolées, avec une prédominance de Staphylococcus aureus (31,3%, n=35), Micrococcus spp (30,4%, n=34), staphylocoques à coagulase négative (10,7%, n=12) et Pseudomonas spp (5,4%, n=6). Le laboratoire (18,8%, 21/112) et les services médicaux (16,1%, 18/112) avaient la contamination bactérienne la plus élevée des téléphones portables (p=0,041), et plus d'espèces bactériennes ont été isolées des smartphones (68,8%, n=77/112) que les téléphones à clavier (31,2%, n=35/112) (p=0,032). Il n'y avait pas de différence significative entre les taux de contamination du téléphone et la pratique de l'hygiène des mains ou de la décontamination des surfaces de travail (p>0,05).Conclusion: La présence de bactéries potentiellement pathogènes sur les téléphones portables des travailleurs de la santé souligne le rôle des fomites dans la transmission des maladies infectieuses. Par conséquent, de bonnes pratiques d'hygiène des mains et de décontamination sont encouragées chez les agents de santé afin de limiter la propagation des infections nosocomiales.

BackgroundSjögren’s Syndrome (SS) is a chronic autoimmune disease that affects the body’s glandular functions, especially the lacrimal and salivary glands, causing the mucous membranes to dry out (1). There are no diagnostic criteria, and classification criteria are often used to support the diagnosis (2).We identified a need to unify and consolidate the diagnostic process of patients with SS in the Capital Region of Denmark. A medical working group supervised the nurse-driven diagnostic process at Rigshospitalet, Glostrup. Here an interdisciplinary working group with physicians, nurses, and secretaries developed a diagnostic process and logistic based on the American-European Consensus Group Classification Criteria 2002 (3). The nurse’s took medical history and performed sicca tests and made sure that the patient received adequate guidance.With input from three patients, the nurses at the outpatient clinic developed - written material on eye and mouth dryness. We developed a “smart phrase” for our documentation platform in the interdisciplinary working group. The purpose of the ‘smart phrase”, was to unify the documentation and ensure continuity in the conversation with the patient. The Rheumatologists task was to disprove or confirm the diagnosis and perform a risk stratification especially in relation to the development of lymphoma, but also interstitial lung disease.ObjectivesThe aim of this project was to examine and evaluate the patients’ experience of nurse-driven diagnostic process.MethodsTo evaluate the new patient course, we performed a survey. The questions selected for the survey were primarily based on the patients experience of meaning and coherence in the diagnostic process. The questions were developed by the nurses in the Outpatient Clinic; “Do you feel safe going home after the consultation today?” “Did you get answers to the questions you asked while you were in the consultation?” “Did the staff take the time to listen to you?”. Also, the patients could add comments.ResultsA total of 34 consecutives responded to the questionnaire. 88% felt safe when returning home from the Outpatient Clinic, 85% received answers to their questions during the consultation. Altogether, 94% answered that the health care professionals were present and listened to them.The patients had the following comments: “The diagnostic process contained a lot of unresolved waiting time “ and “There has been some confusion about the division of tasks in the different hospital wards”.ConclusionWe found that the patients were satisfied with the nurse-driven diagnostic process. The diagnostic process created a feeling of safety in the patients and the patients found that they were listened to and allowed to ask questions. In addition, by evaluating the process investigation, we could change practice and further unify the diagnostic process. The result of the questionnaire supports the justification of the nurse competencies, by preforming a high level of information and guidance as well as the need for recognition of the patient’s symptoms.Therefore, the working group chose to meet again and evaluate. We decided that the nurse and rheumatologist consultation should be performed on the same day. Such consultation made it possible for the nurse to ensure continuity in the process, as the same nurse could follow the patient throughout the day. This optimized the opportunity for the nurse to guide the patient in the symptomatic treatment of eye and mouth dryness. Also, the nurse had the opportunity to guide in oral hygiene, fatigue, and lifestyle factors.The next step in our development project is to evaluate our revised nurse-led diagnostic process. In addition, the working group is currently working on material for a course in SS, where 4-6 patients and relatives can have the opportunity to participate.References[1]A.Voss et al. Reumatologi. FADL’s Forlag 2018. 238-251[2]Troldborg, A et al. National behandlingsvejledning, Sjögrens syndrom. 2020.[3]Troldborg, A et al. Sjögrens Syndrom, Dansk Reumatologisk Selskab 2010.AcknowledgementsI would like to thank the patients for the contribution to this project.Disclosure of InterestsNone declared

Abstract Background One barrier to hand hygiene compliance is overestimation of one’s own performance. Overconfidence research shows that overestimation tends to be higher for difficult tasks, which suggests that the magnitude of overestimation also depends on how it is assessed. Thus, we tested the hypothesis that overestimation was stronger for hand hygiene indications with low compliance (i.e., high difficulty), and the hypothesis that self-reported overall compliance based on a single item is higher than based on “5 Moments of Hand Hygiene” (WHO-5) items, since the single item implies an aggregation across indications. Methods In the WACH trial (German Clinical Trials Register [DRKS] ID: DRKS00015502), a questionnaire survey was conducted among physicians and nurses in nine surgical clinics (general/visceral surgery or orthopedics/trauma surgery) of six German hospitals. Self-reported compliance was assessed both by a single item and the WHO-5-items using percentage scales. These were compared with each other and with direct observations. Relative frequencies of the WHO-5 indications used to calculate the WHO-5-based self-reported overall compliance rate were estimated by a systematized review of the literature (see appendix). In analysis, t-tests, Chi2-tests and multiple linear regressions were used. Results Ninety-three physicians (response rate: 28.4%) and 225 nurses (30.4%) participated. Significant compliance differences between physicians and nurses were found for direct observations and were in favor of nurses, while no such differences were found for self-reports. Across the WHO-5, overestimation showed inverse correlations with observed compliance (physicians: r = −0.88, p = 0.049; nurses: r = −0.81, p = 0.093). Support for the hypothesis that the self-reported overall compliance based on one item is higher than that based on WHO-5 items was found for physicians (M = 87.2 vs. 84.1%, p = 0.041; nurses: 84.4 vs. 85.5%, p = 0.296). Exploratory analyses showed that this effect was confined to orthopedic/trauma surgeons (89.9 vs. 81.7%, p = 0.006). Conclusion Among physicians, results indicate stronger hand hygiene overestimation for low-compliance indications, and when measurements are based on a single item versus the five WHO-5 items. For practice, results contribute to infection prevention and control’s understanding of overestimation as a psychological mechanism that is relevant to professional hand hygiene.

INTRODUCTION. The guidelines issued by the World Health Organization (WHO) in 2009 regarding hand hygiene (HH) in health care provided health care professionals with scientific evidence that argued that HH principles should be respected when dealing with patients. Despite the passage of years and strenuous attempts to introduce these recommendations to the Polish health care facilities for the prevention of healthcare-associated infections (HAI), these principles are still not being implemented in an optimal way for the patient’s safety. OBJECTIVE OF WORK. The aim was to examine the views and attitudes of physicians (L) and nurses (P) towards the WHO rules of hand hygiene. MATERIAL AND METHODS. The study was performed by means of a diagnostic survey using a questionnaire of our own design; random sampling was used. The study involved 231 LP: 173 (74.9%) women, 58 (25.1%) men, including 93 (40.3%) doctors and 138 (59.7%) nurses. The study was conducted in a multiprofile hospital in Małopolska in 2017. The difference between what the respondents think (their views) and what they do in reality (what attitudes they display) was examined in relation to WHO principles, such as wearing natural short nails and jewelry on their hands. RESULTS. Negative practice of observing these HH principles in relation to views was detected (R = -0.014, p<0.05, R2 = 0.016). Respondents supported the view that the ring could affect HAI and rarely used it in practice, the practice was positive (R = 0.298, p <0.001, R2 = 0.085). Women strongly emphasized the view that wearing long nails has an impact on HAI spread, but in practice they often declared keeping long nails, practice was negative (R = -0.241, p <0.01, R2 = 0.054). In response to the question about the impact of nail painting on the spread of HAI, this view was poorly represented, in practice some of them wore painted nails, the practice was negative (R = -0.226, p <0.01, R2 = 0.045). CONCLUSION. Despite high support for the principles of hand hygiene, in practice, these principles were not always respected, the impact on the practice was negative in areas such as: general adherence to the HH principles, wearing long and painted nails. The compatibility of views with practice was detected in relation to wearing a wedding ring.

Abstract Background Healthcare workers (HCW) adherence to hand hygiene (HH) is the most effective infection prevention and control (IPC) measure to fight healthcare-associated infections (HAI) and is a crucial component for standard precautions, especially in a pandemic context. As suggested by the WHO and Joint Commission Network Project, evaluating adherence to HH is essential to identify deficiencies and promote improvement interventions. Methods San Raffaele Hospital in Milan, Italy, adopted internal audits to measure HCWs' adherence to HH according to WHO Guidelines. Public health (PH) residents were enrolled as auditors. They were trained with WHO technical manual for observers and handovers among residents. WHO observation form was used for collection. Process index was HH adherence, stratified by profession, unit, opportunity and indication. Results 8 PH medical residents carried out observations from January 2018 to December 2019. 434 HCWs were observed in 26 hospital units (191 nurses, 148 physicians, 83 healthcare assistants and 11 other professionals). Global adherence was 53%, calculated on 1,969 opportunities, and 2,221 indications observed, followed by 932 hands rubbing and 110 handwashing. Most observations involved nurses (adherence of 53%) and physicians (54%). Global adherence was generally higher in medicine, specialist surgery and intensive-care units while lower in general surgery and rehabilitation units. Indications with the highest adherence were “after body fluid exposure risk” (69%) and “after touching a patient” (64%). The lowest adherence (44%) was observed for “before clean/aseptic procedure” indication. The belief that gloves use may replace HH might partially explain the data. Conclusions Global HH adherence was in line with significant published data and was far better than 2016 data but slightly lower than observations in 2018 when the program started. We believe 2020 HH compliance could have changed due to HCW involvement in IPC against COVID-19. Key messages Hand hygiene (HH) audits represent a crucial tool of clinical governance and risk management: auditors’ training, monthly and annual reports, and feedbacks allowed to structure a virtuous process. If HH audits aim to improve practice we should understand when HH is most beneficial, assessing quality, improving performances through achievable targets using reproducible methods and technologies.

Abstract Background Qualitative methods offer a unique contribution to health research. Academic dissertations in the medical field provide an opportunity to explore research practice. Our aim was to assess the use of qualitative methods in dissertations in the medical field. Methods By means of a methodological observational study, an analysis of all academic medical dissertations’ abstracts between 1998 and 2018 in a repository databank of a large medical university faculty in Germany was performed. This included MD dissertations (Dr. med. (dent.)) and medical science dissertations (Dr. sc. hum.). All abstracts including “qualitativ*” were screened for studies using qualitative research methods. Data were extracted from abstracts using a category grid considering a) general characteristics (year, language, degree type), b) discipline, c) study design (mixed methods/qualitative only, data conduction, data analysis), d) sample (size and participants) and e) technologies used (data analysis software and recording technology). Thereby reporting quality was assessed. Results In total, 103 abstracts of medical dissertations between 1998 and 2018 (1.4% of N = 7619) were included, 60 of MD dissertations and 43 of medical sciences dissertations. Half of the abstracts (n = 51) referred to dissertations submitted since 2014. Most abstracts related to public health/hygiene (n = 27) and general practice (n = 26), followed by medical psychology (n = 19). About half of the studies (n = 47) used qualitative research methods exclusively, the other half (n = 56) used mixed methods. For data collection, primarily individual interviews were used (n = 80), followed by group interviews (n = 33) and direct observation (n = 11). Patients (n = 36), physicians (n = 36) and healthcare professionals (n = 17) were the most frequent research participants. Incomplete reporting of participants and data analysis was common (n = 67). Nearly half of the abstracts (n = 46) lacked information on how data was analysed, most of the remaining (n = 43) used some form of content analysis. In summary, 36 abstracts provided all crucial data (participants, sample size,; data collection and analysis method). Conclusion A small number of academic dissertations used qualitative research methods. About a third of these reported all key aspects of the methods used in the abstracts. Further research on the quality of choice and reporting of methods for qualitative research in dissertations is recommended.

Introduction: Antibacterial prescribing practices between 2004 and 2008 were investigated in the P. Giaccone University Hospital in Palermo, Italy to provide a foundation for critical analysis of the appropriateness of health-care resource usage. Materials and methods: Antibiotic prescribing practices between 2004 and 2008 were analyzed in the hospital as a whole and in different specialty areas. Results were expressed as defined daily doses (DDD) as a function of bed-days, number of admissions, and Diagnosis Related Group (DRG) points. Results: During the study period, increases were observed in the overall DDD per 100 bed-days (68.7 vs. 91.3) and the DDD per admission (4.53 vs. 5.54), but less variation was observed in the DDD/DRG score (3.55 vs. 3.63). Use of metronidazole, carbapenems, and glycopeptides increased, while use of third-generation cephalosporins, quinolones, and oral penicillins remained fairly stable. The drugs most commonly used in 2008 were (% of total DDD): levofloxacin (18.08%), amoxicillin + clavulanic acid (13.32%), ceftriaxone (9.01%), ciprofloxacin (8.21%), clarithromycin (5.74%), metronidazole (5.36%), ceftazidime (5.16%), amoxicillin (4.92%), gentamicin (1.88%), and meropenem (1.80%). An overall trend toward the prescription of newer wide-spectrum antibacterial agents was noted. National guidelines on chemoprophylaxis in surgery were observed in only 3/17 (17.7%) units. The prevalence of nosocomial infections was lower than those reported in the literature. Discussion: Although the cases treated in the hospital have become more complex over the years, the DDD documented in our study are far too high with respect to the actual clinical needs. These findings point to a trend toward the practice of excessively defensive medicine. Greater responsibility among physicians and the promotion of primary and secondary measures of preventive hygiene are fundamental to reduce the prescriptive pressure, a goal that should also have beneficial effects on health-care costs.

This special issue on Child Abuse and Neglect celebrates the 25th anniversary of the PGH-Child Protection Unit (CPU) and Child Protection Network and reinforces the latter’s nationwide intersectoral approach to child health. It stands as a testament to the pivotal role of research as one of the five pillars in the Care Continuum for Child Maltreatment; the other pillars being 1) integrated clinical care for the abused child, 2) prevention of child abuse at three levels, 3) training in all sectors, and 4) governance. These articles summarize evidence critical for evaluating, reviewing, and advancing policies.1 Operational analyses of existing infrastructure suggest practice guidelines that can help others establish the same. Qualitative analysis of operational deliverables ofthe PGH-Child Protection Unit and Child Protection Network in advancing the Care Continuum for Child Maltreatment – a roadmap for operational evaluation and set-up sheds light on key elements, intricacies, and variables of infrastructure and operations as a basis for plans on what, how, and where best to improve. The National Baseline Study dives into the prevalence of child physical and sexual abuse in the Philippines. DNA detection in cases of sexual abuse has revolutionized the investigation and prosecution of these cases, as explored by A Retrospective Look on the Use of DNA Evidence in a Sexual Assault Investigation in the Philippines. The Development of a Local Sexual Assault Investigation Kit:The Philippine Experience identifies key elements important for training modules on caring for child victims and handling evidence. The following studies focus on the human element: victims’ and perpetrators’ characteristics are summarized and analyzed. Child victims are studied in Comparison ofthe ClinicalProfile ofPrepubertal versusPubertal Female Child Sexual Abuse in a Tertiary Hospital. Obstetric and Perinatal Outcomes and the Factors Associatedwith It Among PregnantTeen/Adolescent Filipino 13-19 years old in a Tertiary Institution focuses on this special subgroup. Prevalence and Risk Factors of Suicidal Ideation Among Victims of Child Sexual Abuse highlights a key consequence. Juvenile perpetrators are studied in The Demographics of Minor Perpetrators of Sexually Assaulted Pediatric Patients from PGH from January 2013 to December 2018. Female perpetrators of child abuse are studied in The Demographic Profile of the Female Assailant: A Ten-Year Background Review of Female Perpetrators Committing Abuse Seen at the UP-Philippine General Hospital Child Protection Unit from January 2008 to December 2018. These articles review potential risk factors that come in the form of cultural practices. Research on normal behavior and acceptable cultural practice is characterized in EmicPerceptions ofAge-Appropriate Parent-Child Intimate Behaviors Related to Hygiene, Affection, and Privacy. Research on analysis of cultural perspectives on discipline and when disciplinary measures are inappropriate and qualify as abusive in Socio-cultural Perspectives on Child Discipline, and Child Abuse in the Philippines give insight into prevention initiatives in the community. Research on child protection advocacy through safe schools is reported in An Outcomes-based Evaluation of the Mindfulness for Safe Schools giving insight into policy and program design. These papers lay the groundwork for Clinical Practice Guidelines as mandated by the Philippines Department of Health (DOH),3 catalyzing research here and abroad,4-6 and advancing Child protection in the Philippines. Child protection in the Philippines grew from a few hospital-based CPUs to an organized Child Protection Network of 114 CPUs in 58 provinces and 10 independent cities, reaching 90% of the children in the Philippines. This speaks to intersectoral collaborations, generosity, professionalism, motivation for excellence, and commitment to children. This also speaks to the value of integrated medical care, governance and policy-making, training of current and future specialists, and research. After 25 years, we stand at the crossroads of analysis, strategy, and policy for child protection against abuse and neglect. Victoria L.M. Herrera, MDDepartment of Medicine Boston University School of Medicine United States of America Heather S. Spader, MD Pediatric Neurosurgery University of New Mexico United States of America Marilyn J. Kaufhold, MD Child Abuse Pediatrics Chadwick Center for Children and Families, Rady Children’s Hospital San Diego, California, United States of America REFERENCES Dubowitz H. Child abuse pediatrics: research, policy and practice. Acad Pediatr. 2011 Nov-Dec; 11(6):439-41. doi: 10.1016/j.acap. 2011.09.005. PMID: 22078838. National Unified Health Research Agenda 2017-2022. Manila: Philippine Council for Health Research and Development [Internet] 2022. [cited 2022 July] Available from https://doh.gov.ph/publication/National-Unified-Health-Research-Agenda-2017-2022. Republic of the Philippines. 2019. Republic Act 11223. An Act Instituting Universal Health Care for All Filipinos, Prescribing Reforms in the Health Care System, and Appropriating Funds Thereof. Lindberg DM, Wood JN, Campbell KA, Scribano PV, Laskey A, Leventhal JM, et al. Research priorities for a multi-center child abuse pediatrics network - CAPNET. Child Abuse Negl. 2017 Mar; 65:152-157. doi: 10.1016/j.chiabu.2017.01.015. Epub 2017 Feb 3. PMID: 28161656; PMCID: PMC5774239. Wekerle C, Black T. Gendered violence: Advancing evidence-informed research, practice and policy in addressing sex, gender, and child sexual abuse. Child Abuse Negl. 2017 Apr; 66:166-170. doi: 10.1016/j.chiabu.2017.03.010. Epub 2017 Mar 30. PMID: 28364956. Maholmes V. Federal research priorities in child abuse and neglect research: A commentary on multi-site research networks. Child Abuse Negl. 2017 Aug; 70:408-410. doi: 10.1016/j.chiabu.2017.03.026. Epub 2017 Apr 19. PMID: 28433205.

ObjectiveDescribe short-term health effects of the Hurricane using the syndromic surveillance system based on emergency departments, general practitioners and dispensaries in Saint-Martin and Saint-Barthélemy islands from September 11, 2017 to October 29, 2017.IntroductionIn Saint-Martin (31 949 inhabitants) and Saint-Barthélemy (9 625 inhabitants) islands in the French West Indies, the surveillance system is based on several data sources: (1) a syndromic surveillance system based on two emergency departments (ED) of Saint-Barthélemy (HL de Bruyn) and Saint-Martin (CH Fleming) and on mortality (SurSaUD® network [1])); (2) a network of sentinel general practitioners (GP’s) based on the voluntary participation of 10 GPs in Saint-Martin and 5 in Saint-Barthélemy; (3) the notifiable diseases surveillance system (31 notifiable diseases to individual case-specific form); (4) the regional surveillance systems of leptospirosis and arboviruses based on the biological cases reported by physicians and laboratories of two islands.On September 6, 2017, Hurricane Irma struck Saint-Martin and Saint-Barthélemy islands. Both islands were massively destroyed. This storm led to major material damages, such as power outages, disturbance of drinking water systems, road closures, destruction of medical structures and evacuation or relocation of residents.In this context, the usual monitoring system did not work and life conditions were difficult. The regional unit of French National Public Health Agency set up an epidemiological surveillance by sending epidemiologists in the field in order to collect data directly from ED physicians, GP’s and in dispensaries. Those data allowed to describe short-term health effects and to detect potential disease outbreaks in the aftermath of Hurricane Irma. This paper presents results of the specific syndromic surveillance.MethodsBefore Irma, ED data were collected daily directly from patients’ computerized medical files that were filled in during medical consultations at ED. Among the collected variables, the diagnosis was categorized according to the 10th revision of the International Classification of Diseases (ICD-10). This surveillance system was completed by aggregated data of Emergency Medical Services (EMS), also including medical diagnosis coded using the ICD10.Because of the sudden disruption in hospital departments due to hurricane, electronic transmission was stopped. To replace it, ED data collection turned temporary into paper-forms and several epidemiologists were sent in Saint-Martin and Saint-Barthélemy to collect data directly from the ED physicians. This system remained until the end of October when connections and data transmission were restored.Because of destruction of medical structures, dispensaries were opened in different strategic areas of the island, 3 in Saint-Martin and none in Saint-Barthélemy. General practitioners have progressively reopened their practice (8 GP’s in Saint-Martin and 5 in Saint-Barthélemy) and patient's data were collected and integrated into the surveillance system.Based on a literature review and former experience, the main pathologies identified for the health risk assessment were: (1) somatic pathologies directly or indirectly related to the hurricane (trauma, wounds, cuts, burns, secondary infection); (2) infectious diseases related to the lack of hygiene partly due to damaged water and electricity networks and unavailable health care structures (gastroenteritis, food infections, respiratory diseases, skin infections, tetanus and other pathologies that may occur in the longer term linked to the incubation period especially leptospirosis and hepatitis A); (3) chronic pathologies by discontinuity of care (renal insufficiency, diabetic, cardio-respiratory decompensation, etc.); (4) pathologies related to animal bites and mosquito bites (vector-borne diseases); (5) psychological and / or psychiatry disorders.Then in the French West Indies, from September 11 to October 29,2017, data were routinely analyzed to detect and follow-up various expected or unusual variations of one or more pathology of the above list.ResultsThe following week after Irma (2017-37), the weekly number of ED visits compared to the mean activity observed in normal situation has increased: 1225 ED visits vs. 313 in 2017-35 in Saint-Martin and 227 ED visits vs. 94 ED visits in 2017-35 in Saint-Barthélemy. ED activity has gradually decreased to finally return to a based-activity as observed before the hurricane at the end of October.From September 11 to October 29, 25% of recorded emergency consultations in Saint-Martin island were trauma, wounds, burns and cuts. As in Saint-Martin, 42% of emergency visits in Saint-Barthélemy were pathologies directly or indirectly related to the passage of Irma (trauma, wounds, etc). Others major causes of ED visits were for treatment renewal (diabetes, renal insufficiency, etc.) and gyneco-obstetric activity because general practitioners had stopped their activity.In dispensaries and general practitioners, the most common pathology was gastroenteritis (11% in Saint-Martin) over the entire period of surveillance. At the beginning of the surveillance, skin infections were the most frequently found (20%) in Saint-Martin and psychological disorders (3%) in Saint-Bartélemy, while at the end respiratory infections were the most frequent (6%) in both islands.No increase in visits for chronic diseases, food-borne diseases, acute respiratory or diarrhea illness were detected. No autochthonous confirmed cases of cholera, leptospirosis, vector-bone disease, hepatitis A or typhoid fever had been reported, due to the destruction of the laboratory.ConclusionsSyndromic surveillance in the French West Indies allowed the epidemiologists to assess rapidly the health impact of hurricane in Saint-Martin and Saint-Barthélemy.The well-established relations between French National Public Health Agency and local professionals of both affected islands allowed to temporary switch from an electronic into a paper-based data transmission without any interruption of data analysis.Although several cluster suspicions have been investigated (especially of gastroenteritis, scabies, etc), no massive outbreak was detected. Then even with a degraded system, syndromic surveillance allowed to reinsure authority of the absence of major health impact due to Irma.References1-Caserio- Schönemann C, Bousquet V, Fouillet A, Henry V. Le système de surveillance syndromique SurSaUD ®. Bull Epidemiol Hebd 2014 ;3-4 :38-44.

Help in detecting diabetes may come from an unlikely source like a dentist as an allied health team, as it is rightly said ‘oral cavity is the mirror of the body system’. They may diagnose undetected cases of diabetes and may refer to a physician for further evaluation and treatment. Research studies have found a link between periodontal (gum) disease and diabetes. Symptoms of the disease often appear in the mouth, while almost one-third of people with diabetes have severe periodontal disease. This is believed to be a result of the diabetic patient’s greater susceptibility to developing infections. Conversely, severe periodontal disease may increase the risk of developing diabetes, and may make it more difficult to manage blood sugar levels. However, studies have found that patients who receive treatment for periodontal disease may be able to control the condition with less insulin. Dentists often detect symptoms of diabetes during routine oral health examinations. Foamy saliva, unusually dry and irritated tissue, poor periodontal conditions inside the mouth are tell-tale signs of the condition. And, diabetic patients often lose more teeth compared to patients without the disease. Proper and effective management of patients with diabetes requires that the practice evaluate all aspects of patient interaction. Systems need to be customized so that all procedures and patient communication scripts are implemented consistently to meet the distinct needs of patients with diabetes. Hence based on above findings the present study was planned for clinical evaluation of the tooth loss in periodontal disease in diabetic patients. The present study was planned in Department of Public Health Dentistry, Buddha Institute of Dental Sciences, Patna ,Bihar for a period of six months from January 2019 to June 2019. Total 40 patients were evaluated during this period . Out of that 20 cases are of Diabetic patients were enrolled in first group and another second group consist of 20 control patients without any diseases. The data generated from the present study concludes that there is significant difference in teeth loss amongst diabetics and non-diabetics. People with diabetes should be aware about the periodontal complications associated with it and should go for regular dental visits. Therefore it is the need of the hour to educate the dentists, general physicians and specialists about the association of systemic diseases with oral health and vice versa as many of the systemic diseases may be prevented and improved by improving oral hygiene. Keywords: Tooth Loss, Periodontal Disease, Diabetic Patients, etc.