Asia Pacific Family Medicine - Latest Articles

Women's impressions of their inpatient birth care as provided by family physicians in the Shizuoka family medicine training program in Japan

Mariko Yokota — 2013-05-22T00:00:00Z

Background: Even though Japan faces serious challenges in women's health care such as a rapidly aging population, attrition of obstetrical providers, and a harsh legal climate, few family medicine residency training programs in Japan include training in obstetrics, and the literature lacks research on women's views of intra-partum pregnancy care by family physicians.FindingsIn this exploratory study, we conducted semi-structured qualitative interviews with five women who received their admission, intrapartum, delivery and discharge care from family medicine residents in the obstetrics ward of a community training hospital. Four women had vaginal births, and one had a Cesarean section. Three were primiparous, and two multiparous. Their ages ranged from 22--33. They found value in family physician medical knowledge and easy communication style, though despite explanation, some had trouble understanding the family physician's scope of work. These women identified negative aspects of the hospital environment, and wanted more anticipatory guidance about what to expect physically after birth, but were enthusiastic about seeing a family doctor after discharge. Conclusions: These results demonstrate the feasibility of family medicine residents providing inpatient birth care in a community hospital, and that patients are receptive to family physicians providing that care as well as care after discharge. Women's primary concerns relate mostly to hospital environment issues, and better understanding the care family physicians provide. This illustrates-areas for family physicians to work for improvements.

Prevalence of insomnia and its impact on daily function amongst Malaysian primary care patients

Abu-Hassan Zailinawati — 2012-11-27T00:00:00Z

Background: Insomnia is a common public health problem and the prevalence and impact of insomnia in primary care attendees is not well documented in the Asian population.ObjectivesTo determine the prevalence of self-reported insomnia symptoms amongst adult primary care attendees and the association with socio-demographic factors; to ascertain the impact of insomnia on daily functioning and to describe the psychological profile of patients with insomnia. Methods: In this cross-sectional survey, 2049 adult patients (≥18 year old) attending seven primary care clinics in Peninsular Malaysia, completed the questionnaire asking about symptoms of insomnia (defined according to the International Classification of Sleep Disorders and DSM IV criteria) daytime impairment and psychological symptoms (assessed by Hospital Anxiety and Depression Scale). Results: The response rate was 86.2%. A total of 60% reported insomnia symptoms, 38.9% had frequent insomnia symptoms (>3 times per week), 30.7% had chronic insomnia without daytime consequences and 28.6% had chronic insomnia with daytime dysfunction. Indian ethnicity (OR 1.79; 95%CI, 1.28-2.49), age ≥ 50 or older (OR 1.82; 95%CI, 1.10-3.01), anxiety symptoms (OR 1.65; 95%CI, 1.21-2.22) and depression symptoms (OR 1.65; 95%CI, 1.21-2.26) were risk factors for chronic insomnia with daytime dysfunction. Amongst those with chronic insomnia with daytime dysfunction, 47.8% had anxiety symptoms (OR, 2.01; 95%CI, 1.57-2.59) and 36.5% had depression symptoms (OR, 2.74; 95%CI, 2.04-3.68) based on HADs score. They also had tendency to doze off while driving and to be involved in road traffic accidents. Conclusions: A third of primary care attendees have insomnia symptoms and chronic insomnia, associated with significant daytime dysfunction and psychological morbidity. By identifying those at risk of having chronic insomnia, appropriate interventions can be commenced.

Primary care in the Asia-Pacific region: challenges and solutions

Richard Hays — 2012-10-05T00:00:00Z

This is an editorial for the journal written by the three co editors in chief. It does not need an abstract

Self-medication behaviors among Japanese consumers: Sex, age, and SES differences and caregivers' attitudes toward their children's health management

Ikuko Aoyama — 2012-09-11T00:00:00Z

Background: Since 2009, when the revised Pharmaceutical Affairs Act was enacted in Japan, self-medication practices have increased. Because the concept of self-medication was recently introduced in Japan, few studies exist on this topic. Therefore, it is necessary to explore how self-medication is practiced. This study examined Japanese consumers’ self-medication practices and attitudes toward over-the-counter (OTC) medicines based on their sex, age, and socioeconomic status (SES). Methods: The participants were 403 adults (M age = 41.1 years, SD = 16.22). A quota sampling method was employed based on age group, and participants completed an online questionnaire. Results: Participants in the 20–29 age group reported medical costs as an obstacle in seeing a doctor; in contrast, transportation was a mitigating factor for elderly people. Regarding SES, people at lower SES levels chose to rest instead of seeing a doctor or purchasing over-the-counter (OTC) medicines when sick. They also placed more value on national brand OTC medicines than private brands (likely due to advertisements). This finding suggests individuals with a low SES do not select OTC medicines based on their effects or ingredients. Regarding attitudes toward OTC medicines, Japanese participants seemed to be unaware of the potential for abuse and side effects associated with OTC medicines. Finally, in relation to caregivers’ self-medication practices for their children, the majority of participants reported taking their children to the hospital since children tend to receive free medical care. Furthermore, caregivers with a high educational background are more confident in being able to help manage their children’s health. Conclusions: Our results suggest that health and medical discrepancies among Japanese consumers pose new social problems. In Japan, universal health care is available, but the cost of receiving medical care is not completely free of charge. Thus, we hope that the government will attempt to meet the various needs of patients and support their well-being. Consumers also have to be more independent and aware of their health management, as self-medication practices will continue to play a more significant role in healthcare. More research is needed to find ways to teach Japanese consumers/patients of both the benefits and risks of over-the-counter (OTC) medicines.

General Practitioners' responses to global climate change - lessons from clinical experience and the clinical method

Grant Blashki — 2012-08-08T00:00:00Z

Background: Climate change is a global public health problem that will require complex thinking if meaningful and effective solutions are to be achieved. In this conceptual paper we argue that GPs have much to bring to the issue of climate change from their wide-ranging clinical experience and from the principles underpinning their clinical methods. This experience and thinking calls forth particular contributions GPs can and should make to debate and action.DiscussionWe contend that the privileged experience and GP way of thinking can make valuable contributions when applied to climate change solutions. These include a lifetime of experience, reflection and epistemological application to first doing no harm, managing uncertainty, the ability to make necessary decisions while possessing incomplete information, an appreciation of complex adaptive systems, maintenance of homeostasis, vigilance for unintended consequences, and an appreciation of the importance of transdisciplinarity and interprofessionalism.SummaryGeneral practitioners have a long history of public health advocacy and in the case of climate change may bring a way of approaching complex human problems that could be applied to the dilemmas of climate change.

Perception of picky eating among children in Singapore and its impact on caregivers: a questionnaire survey

Daniel Goh — 2012-07-20T00:00:00Z

Background: Picky eating is relatively common among infants and children, often causing anxiety for parents and caregivers. The purpose of this study was to determine the key aspects of picky eating and feeding difficulties among children aged 1 to 10 years in Singapore and the impact on their parents or caregivers. Methods: In this survey, 407 parents or grandparents who are the primary caregivers of children aged 1 to 10 years in Singapore were interviewed via telephone using a structured questionnaire of 36 questions. Respondents were randomly selected from the Singapore Residential Telephone Directory to meet a pre-set interlocked quota of race, sex, and age to represent the population. Quantitative data collected included demographics, body weight and height, respondents’ perceptions of the duration of picky eating, the child’s eating habits and perceived health status, respondents’ attitudes towards picky eating, coping strategies and the impact on family relationships. Bonferroni z-test and t-test were used to indicate significance across groups or demographics, while Pearson correlation coefficient was used to measure the strength of association between variables. Results: One-half of the respondents reported that the child was ‘all the time’ (25.1%) or sometimes (24.1%) a picky eater. When aided with a list of typical behaviours, the respondent-reported prevalence of picky eating or feeding difficulties occurring ‘all the time’ increased to 49.6%. The highest number of respondents first noticed the child’s picky eating behaviours or feeding difficulties as early as 1 year (20.0%). Children 3 to 10 years [p = 0.022], children of professional respondents (p = 0.019), and children with a family history of picky eating (p = 0.03) were significantly more likely to be picky eaters. Overall, all ‘picky eating’ and all ‘feeding difficulty’ behaviours occurring ‘all the time’ were significantly associated with caregiver stress when feeding (p = 0.000026 and p = 0.000055, respectively) and with a negative impact on family relationships (p = 0.011 and p = 0.00000012, respectively). Conclusions: The perceived prevalence and duration of picky eating behaviours and feeding difficulties are high. The impact on the respondent and family relationships appears to be significant in Singapore. Parental concerns about picky eating should be adequately assessed and managed in routine clinic consultations.

Reporting new cases of anaemia in primary care settings in Crete, Greece: a rural practice study

Christos Lionis — 2012-04-25T00:00:00Z

Background: Early diagnosis of anaemia represents an important task within primary care settings. This study reports on the frequency of new cases of anaemia among patients attending rural primary care settings in Crete (Greece) and to offer an estimate of iron deficiency anaemia (IDA) frequency in this study group. Methods: All patients attending the rural primary health care units of twelve general practitioners (GPs) on the island of Crete for ten consecutive working days were eligible to participate in this study. Hemoglobin (Hb) levels were measured by portable analyzers. Laboratory tests to confirm new cases of anaemia were performed at the University General Hospital of Heraklion. Results: One hundred and thirteen out of 541 recruited patients had a low value of Hb according to the initial measurement obtained by the use of the portable analyzer. Forty five (45.5%) of the 99 subjects who underwent laboratory testing had confirmed anaemia. The mean value of the Hb levels in the group with confirmed anaemia, as detected by the portable analyzer was 11.1 g/dl (95% Confidence Interval (CI) from 10.9 to 11.4) and the respective mean value of the Hb levels obtained from the full blood count was 11.4 g/dl (95% CI from 11.2 to 11.7) (P = 0.01). Sixteen out of those 45 patients with anaemia (35.6%) had IDA, with ferritin levels lower than 30 ng/ml. Conclusion: Keeping in mind that this paper does not deal with specificity or sensitivity figures, it is suggested that in rural and remote settings anaemia is still invisible and point of care testing may have a place to identify it.

Clinical audit of health promotion of vitamin D in one general practice

Marjan Kljakovic — 2012-04-02T00:00:00Z

Background: The clinical audit of vitamin D health promotion in one Australian general practice was undertaken by measuring health service use and serum 25-hydroxyvitamin D levels in 995 patients aged 45 to 49 years.FindingsOver 3 years, 486 (51%) patients had a Medicare funded Health Assessment. More women (54%) were assessed than men (46%) p = 0.010. Mean 25-OHD was higher for men (70.0 nmol/l) than women (60.3 nmol/l) p < 0.001. More patients had their weight measured (50%) than 25-OHD tested (28%).Among 266 patients who had a 25-OHD test, 68 (26%) had normal levels 80+ nmol/l, 109 (41%) were borderline 51-79 nmol/l, and 89 (33%) were low < 51 nmol/l. Mean 25-OHD was higher in summer (73.7 nmol/l) than winter (54.7 nmol/l) p < 0.001. Sending uninvited written information about 25-OHD had no effect on patients' subsequent attendance. Conclusions: Health promotion information about vitamin D was provided to 50% of a targeted group of patients over a one-year period. Provision of this information had no effect on the uptake rates of an invitation to attend for a general health assessment.

The effectiveness of face to face education using catharsis education action (CEA) method in improving the adherence of private general practitioners to national guideline on management of tuberculosis in Bandung, Indonesia

Nita Arisanti — 2012-03-27T00:00:00Z

Background: In many countries, private general practitioners are the first contact in health services for people with symptoms of tuberculosis. Targeting the private sector has been recommended in previous studies to improve tuberculosis control. A brief face-to-face intervention using Catharsis Education Action (CEA) method, repeated at periodic intervals, seems to change physicians' attitudes, beliefs and practice.The objective of the study was to determine the effectiveness of CEA method in improving the private general practitioners' (PPs) adherence to the national guideline on the management of tuberculosis patients in Bandung District, Indonesia.MethodA randomized controlled trial was done. For the intervention group, a session of the CEA method was delivered to PPs while brief reminder with provision of pamphlet was used for the comparative group. Results: A total of 82 PPs were included in the analysis. The intervention group showed some positive trends in adherence especially in the use of sputum as first laboratory examination (RR = 1.24) and follow up (RR = 1.37), though not reaching statistical significance. After intervention PPs in CEA group maintained the adherence, but PPs in pamphlets group showed deterioration (score before to after: -12.5). Conclusion: Face to face education using CEA method seems to be as effective as brief reminder with provision of pamphlet in improving the adherence. CEA offers additional information that can be useful in designing intervention programs to improve the adherence to guideline.

Impact of carpal tunnel syndrome on the expectant woman's life

Zatel Rozali — 2012-01-30T00:00:00Z

IntroductionCarpal Tunnel Syndrome is known to be a common complication during pregnancy especially during the third trimester.AimThis article focuses on its impact to the third trimester pregnant mothers with CTS. Methods: Third trimester pregnant mothers with no other known risk factors for CTS, were interviewed and examined for a clinical diagnosis of CTS. The severity of CTS was assessed by means of symptoms severity and functionality using the Boston Carpal Tunnel Questionnaire. Results: Out of 333 third trimester pregnant mothers, 82 (24.6%) were clinically diagnosed with CTS. Malay race was found to have significant correlation with the diagnosis of CTS (p = 0.024) and are two times more likely to get CTS during pregnancy (OR = 2.26) compare to the non-Malays. Bilateral CTS was two times higher (n = 58, 63.4%) than unilateral cases (n = 30, 36.6%), however no significant correlation between the two was found with severity (p = 0.284) or functional (p = 0.906). The commonest complaint was numbness/tingling during day time (n = 63, 76.8%). Majority of the CTS cases were mild (n = 66, 80.5%) and approximately one third (n = 28, 34.1%) had affected hand functions. All symptoms related to pain was found to have significant correlation with severity (p = 0.00, OR = 12.23) and function (p = 0.005, OR = 5.01), whereas numbness and tingling does not (Severity, p = 0.843, function, p = 0.632). Conclusion: This study shows that even though CTS in third trimester pregnancy is prevalent, generally it would be mild. However, function can still be affected especially if patients complain of pain.