Journal of General Practice

Background: African American women experience elevated risk for breast and cervical cancer compared to White women. Health risk behaviors and cancer screening practices are known to contribute to cancer disparities; however, little is known about the relationship between race, sexual orientation, and cancer risk. The objective of this paper is to report on engagement in a range of health risk behaviors associated with cancer and adherence to cancer screening guidelines among African American Women sexual minority women. Methods: This was a cross sectional descriptive study. Data were collected using a self-administered survey instrument. Participants (N=226) were a convenience sample of urban African American sexual minority women recruited as part of a community health needs assessment study. Results: Cancer risk behaviors were prevalent including high rates of obesity, physical inactivity, tobacco and alcohol use. Despite these health risk behaviors, perceptions of cancer risk were low. Eight-five percent of women over the age of forty reported ever having a mammogram and 69% reported having the screening examine in the previous year. The majority of participants reported ever having a Pap test but reports of past year screening were low (68%). Predictors of ever having a mammogram were older age and having a physician recommendation to screen. Past year mammography was associated with perceived cancer risk with those reporting higher perceived risk less likely to have been screened in the past year. None of our study variables were associated with adherence to cervical cancer screening guidelines. Conclusions: Study findings suggest the need for increased efforts to reduce cancer risk behaviors and to encourage adherence to routine cancer screening among African American sexual minority women. Provider recommendations play an important role in breast cancer screening adherence. Additional research is needed to better understand barriers and facilitators to adherence to cervical cancer screening in this population.

Background: Diabetes mellitus in sub-Saharan Africa is a chronic and debilitating disease with increasing morbidity and mortality. The increased morbidity and mortality could be attributed to poor approach to management. One of these poor approaches could be lack of continuity of care. Aim: To investigate the impact of provider continuity care on quality of care for adult patients with type 2 diabetes mellitus by comparing the quality of care of the adult patients managed on provider continuity basis and those managed by random care providers. Method: One hundred and twenty six adult patients with type 2 diabetes mellitus were recruited into the facilitybased on cross sectional descriptive study that lasted for four months. Sixty-three adult patients received provider continuity care and sixty-three adults received random care. The quality of care measures used in this study included fasting plasma glucose (FPG), glycosylated hemoglobin (HbAic) and blood pressure (BP) control. The data collected was analyzed using statistical package for social sciences (SPSS) software version 15. Results: Among the study patients, there were more females 72 (57.2%) than males 54 (42.8%). The commonly presented symptoms of polyuria and polydypsia were seen in 76.2% and 35.7% of the patients respectively. There was a significant difference in the glycaemic control using the fasting plasma glucose level between patients with provider continuity care and random care (5.62 ± 2.04 vs. 8.53 ± 3.18) (p<0.001) and in the quality of care between patients with provider continuity care and random care using HbAic standard respectively (p<0.011). There was no significant difference in terms of blood pressure control between provider continuity care and random care (p>0.365). Conclusion: This study found an association between provider continuity care and quality of care in adult patients with type 2 diabetes mellitus. Consequently, provider continuity care is judged to be more beneficial in the management of type 2 diabetes mellitus in our environment.

Non-invasive mechanical ventilation (NIV) was originally used in patients with acute respiratory compromises or exacerbations of chronic respiratory diseases, as an alternative to the endotracheal tube. Over the last thirty years NPPV has been also used during the night in patients with stable chronic lung disease such as obstructive sleep apnea, the overlap syndrome (COPD and obstructive sleep apnea), neuromuscular disorders, obesity-hypoventilation syndrome, and in other conditions such as sleep disorders associated with congestive heart failure (Cheyne-Stokes respiration). In this review we discuss the different types of NPPV, the specific conditions in which they can be used and the indications, recommendations and evidence supporting the efficacy of NIV. Obstructive sleep apnea syndrome (OSA) is characterized commonly by instability of upper airway during sleep, reduction or elimination of airflow, daytime hypersomnolence, sleep disruption. It is a risk factor for cardiovascular and cerebrovascular disorders including hypertension, myocardial infarction and stroke. Optimizing patient acceptance and adherence to non-invasive ventilation treatment is challenging. The treatment of sleep-related disorders is a life-threatening condition. The optimal level of treatment should be determinate in a sleep laboratory. Side effects directly affecting the patient’s adherence to treatment are known. The most common are nasopharyngeal symptoms including increased congestion and rhinorrhea; these effects are related to reduced humidity of inspired gas. Humidification of delivered gas may improve these symptoms. Sleep specialists should review the results of objective testing with the patient. Education of the patient concerning the nature of the disorder and treatment options is important. General education on the impact of weight loss, sleep position, alcohol avoidance, risk factor modification and medication effects should be discussed. The patient should be counseled on the risks and management of drowsy driving. Patient education should optimally be delivered as a part of a multidisciplinary chronic disease management team.

WONCA recently updated the European Definition of General Practice/Family Medicine [GP/FM]. Patient empowerment becomes one of the twelve characteristics of GP/FM, linked with person centered approach. This description of the characteristics of the discipline gives an explicit framework and describes the specific content of GP/FM. GP/FM is the specialty dedicated to primary health care, in a quality improvement perspective. Clinical decisions take into consideration of ambulatory clinical context, patient’s preferences in its living environment and current scientific data, in an EBM model. This definition is worth to be implemented in the three components of a medical discipline: care, teaching and research. Primary health care have to be developed because of their effectiveness and efficiency, and their ability to reduce health inequalities. The core professional competencies of GP/FM are clearly identified and must be taught the University. Primary care research must been larged to allow investigating different areas of expertise.

The objective of this study was to trace the profile of solid pharmaceutical forms prescription via feeding tubes in a hospital, and elaborate a table with data that may support the qualification of prescription and administration of drugs through feeding tubes. Through a retrospective analysis of patients’ prescription, 43 different solid dosage forms drugs administered through feeding tubes were listed. Moreover, it was found that an average of 3.3 ± 1.2 drugs was prescribed to be administered through this via per day per patient. Thirteen out of the 43 prescribed drugs had restrictions regarding their administration through feeding tubes. It was found that 86.7% of patients used at least one drug that could interact with enteral nutrition during the time that they remained hospitalized. This study allowed the diagnosis of a concerning cenario, where the quality of the patients’ pharmacotherapy may be impaired by the possible occurrence of drug-nutrient interaction.

Poverty is a global phenomenon, defined to include material, non-material, and a myriad of socio-cultural and political factors. Persons with disabilities (PWD) are among the poorest in most parts of the world. The link between poverty and disability is attributed to capitalism and socio-cultural factors such as discrimination. Development literature highlights the need for empowerment programs in changing the situation for PWD. The study combined emancipatory and case studies research approaches to gain in-depth understanding of Action on Disability and Development’s (ADD) empowerment programs to reduce poverty among PWD in Ghana. Data was collected from a total of four focus groups and six semi-structured individual telephone interviews from two districts (Saboba and Jirapa) in the Northern and Upper West regions respectively, and agency records. Evidence from the study shows that ADD’s empowerment programs have given PWD a voice to challenge the injustices, vulnerability, marginalization, social exclusion, powerlessness, and for that matter, the poverty they encounter in their daily lives. The study suggests that ADD’s programs have result in increased socio-economic and political participation of PWD. However, the study also suggests that, although PWD understand that they are their own change agents and must challenge the injustices they encounter and hence poverty; they also persistently seek to meet their immediate basic needs, given their poverty situation. Therefore, the need for complementary efforts in development work is imperative, especially, in developing countries where safety net programs are virtually nonexistent, and there is practically no accessible transportation, information, and education and health care facilities.

U.S. Department of Veterans Affairs (VA) physicians receive guideline reminders to prescribe medications to patients recuperating from cardiac surgery. We examined whether these electronic clinical reminders were associated with a) medication fill rates and b) 6-month risk-adjusted survival after coronary artery bypass graft (CABG) surgery. This retrospective cohort study analyzed the national VA Pharmacy Benefits Management System and the Continuous Improvement in Cardiac Surgery Program data from 10/1/1999 to 9/30/2005. Medication fill rates for a 6 month period prior to the active use of the electronic clinical reminder were compared with fill rates for a 12 month period after electronic reminder use. We found no significant difference in fill rates between the pre- and post-reminder periods. An analysis of variance (ANOVA) model tested whether medication fill rates were affected by electronic reminders. Apparent differences in fill rates before and after implementing clinical reminders disappeared after controlling for multiple comparisons using false discovery rate; therefore data was pooled across years (antihypertensive medications (AH), p = 0.80 and lipid-lowering agent medication (LL), p = 0.30). Changes in fill rates for AH and LL were similar to each other (p = 0.37). A Cox Proportional Hazard Regression model was used to determine the predictors of survival between the 6-month time period prior to the clinical reminder versus the 6-month time period after the reminder was actively used. The clinical reminders for both AHM and LLA were not significantly associated with survival (p = 0.45, hazard ratio = 2.2, confidence intervals 0.29-16). These results do not support the use of electronic clinical reminders in this setting. Instead, these findings support questioning the utility of individual electronic record clinical reminders.