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A functioning mentor–trainee relationship is of high importance in academia. Discrepancies in expectations between principal investigators (PIs) and trainees are a source of misunderstandings and conflicts, endangering scientific progress and career advancement. In this pilot study, we sought to explore the expectations of PIs and trainees, providing consensus data from physician‐scientists and junior researchers who attended an educational workshop, entitled "The EASL/AASLD Masterclass," in December 2017. Twenty‐three Masterclass attendees, comprising nine trainees (four Ph.D. candidates, five postdoctoral researchers) and 14 PIs, responded to an online survey. Both parties were asked to score 29 predefined statements of important expectations, enabling a comparative analysis for each statement between the groups. For the trainees, the success of the PI, either mirrored by successful mentoring or scientific work, as well as a clear road for academic development are of utmost importance. PIs did not prioritize these aspects, highlighting discrepancies of expectations. PIs prioritized trainee competence, reliability, and strong daily initiative/work ethic, qualities that were also recognized to be important by the trainee group but not to same degree as PIs. Conclusion:Discrepancies in expectations pose a preventable threat to the mentor–trainee relationship if considered and discussed beforehand. The discrepancy in the most common expectations between the two groups could have resulted from the fact that trainees prioritize outcomes of success while PIs focus on the necessary qualities leading to those outcomes.

In September 1978, the WHO convened a momentous International Conference on Primary Health Care in Alma-Ata, capital of the Soviet republic of Kazakhstan. This unprecedented gathering signalled a break with WHO's long-standing technically oriented disease eradication campaigns. Instead, Alma-Ata emphasised a community-based, social justice-oriented approach to health. Existing historical accounts of the conference, largely based on WHO sources, have characterised it as a Soviet triumph. Such reasoning, embedded in Cold War logic, contradicts both the decision-making processes in Geneva and Moscow that led the conference to be held in the Union of Soviet Socialist Republics (USSR) and the reality that the highest Soviet authorities did not consider it a significant ideological or political opportunity. To redress the omissions and assumptions of prior accounts, this article examines the Alma-Ata conference in the context of Soviet political and health developments, drawing from Soviet archival and published sources as well as WHO materials and interviews with several key Soviet protagonists. We begin by outlining the USSR's complicated relationship to WHO and the international health sphere. Next, we trace the genesis of the proposal for—and realisation and repercussions of—the primary healthcare (PHC) meeting, framed by Soviet, Kazakh, WHO and Cold War politics. Finally, we explore misjudgements and competing meanings of PHC from both Soviet and WHO perspectives, in particular focusing on the role of physicians, community participation and socialist approaches to PHC.

Background: Medication use during pregnancy is common. Pharmacists have an important role in improving medication use during pregnancy. There is a lack of empirical evidence on pharmacists' knowledge and practice characteristics towards medication use in pregnancy. Objectives: This study aimed to determine the knowledge and practice characteristics of pharmacists in Qatar about medicines use in pregnancy. Methods: A cross-sectional, questionnaire-based study was conducted over a period of 6 months in 2010. Questionnaires were distributed to 400 of 800 licensed pharmacists employed in Qatar (in government and private sectors). Data were collected on: demographics and practice characteristics of the pharmacists; their knowledge and perception about medication use in pregnancy; their confidence in dealing with pregnant women and physicians; and their source of the drug information. Results: of the 400 questionnaires distributed, 207 were returned (52% response rate). Most pharmacists (71%) had not participated in any educational activities on medication use in pregnancy. About 50% reported that < 10% of their workload involved dispensing medications to pregnant women. A lack of available resources and unknown pregnancy status were the main concerns about dispensing medication to pregnant women. The majority of the respondents had average knowledge about medication use in pregnancy. There was a significant association between knowledge, and continuing education and years of experience (P < 0.05). Conclusions: Pharmacists in Qatar had an average level of knowledge about medications use in pregnancy. Continuous educational programmes are needed for pharmacists in Qatar to enhance their knowledge and practice of medicine use during pregnancy.

The maternal mortality rate (MMR) is unconscionably high around the world, with women in low to middle income countries (LMICs) disproportionately passing away from potentially preventable causes. While this is a complicated and multifaceted problem, anesthesia has been identified as a contributing cause of death. From the moment the parturient enters the operating room, the anesthetist is responsible for their well-being. This integrative review was designed to further explore relationship between anesthesia and the MMR in LMICs. Twelve articles published within the last 15 years were selected through an extensive literature search using Medline and CINAHL. Each article was examined using the Polit and Beck (2017) assessment criteria followed by a cross table analysis. The results identified common themes across the studies including lack of infrastructure such as access to reliable power, water and oxygen, resources such as medications and basic anesthesia equipment, training focusing on maternal care and anesthesia and continuing education for providers. Knowing these deficiencies in anesthetic care, nurse anesthetists can assist in implementing changes to help reduce the MMR. Recommendations include encouraging hospitals and governments to make updating hospital infrastructure a priority, reaching out to groups such as the World Health Organization who help fund basic equipment such as pulse oximeters, establishing relationships with medical institutions in other regions to provide training and guidance, and focusing on the development of non-physician anesthetist programs to increase the number of proficient providers.

The emancipation of bioethics from new medical ethics is a result of the awakening of the role and the rights of patients. Thus, the appearance and realization of informed consent can be seen as an example of the mode in which the contemporary attitude towards medical practice has developed, starting from paternalism and ending in recent attempts for the establishment of a dialogue. Nevertheless, a more detailed analysis of the informed consent practice, with emphasis on the situation in Croatia, shows that this progress is more theoretical, and less related to everyday procedures with patients – encounters with physicians. In view of this, in his PhD thesis "Respecting Patients' Right to Information Regarding Medical Procedure during Hospital Treatment in Croatia" Luka Vučemilo shows that during their stay in hospitals patients do not fully realize their right to be informed. In this paper, we will emphasize the asymmetry in the physician's and the patient's perception of informed consent and its formal self-sufficiency. This will serve as confirmation of the fact that informing for the purpose of giving consent to particular medical treatment is not being implemented properly. In order to try to understand the problems concerning the realization of informed consent, in the conclusion of the paper, the same as in the beginning, in order to observe its appearance, we will once again attempt to extend our context and take into consideration the contemporary world-historical situation.

Purpose: To examine the association of source of social support and size of social support network on sedentary behavior among older adults. Design: Cross-sectional. Setting: National Health and Nutrition Examination Survey 2003 to 2006. Participants: 2519 older adults (60+ years). Measures: Sedentary behavior was assessed via accelerometry over a 7-day period. Social support was assessed via self-report. Sources evaluated include spouse, son, daughter, sibling, neighbor, church member, and friend. Regarding size of social network, participants were asked, "In general, how many close friends do you have?" Analysis: Multivariable linear regression. Results: After adjustment, there was no evidence of an association between the size of social support network and sedentary behavior. With regard to specific sources of social support, spousal social support was associated with less sedentary behavior (β = −11.6; 95% confidence interval: −20.7 to −2.5), with evidence to suggest that this was only true for men. Further, an inverse association was observed between household size and sedentary behavior, with those having a greater number of individuals in the house having lower levels of sedentary behavior. These associations occurred independent of moderate-to-vigorous physical activity, age, gender, race–ethnicity, measured body mass index, total cholesterol, self-reported smoking status, and physician diagnosis of congestive heart failure, coronary artery disease, stroke, cancer, hypertension, or diabetes. Conclusion: Spouse-specific emotion-related social support (particularly for men) and household size were associated with less sedentary behavior.

Thirteen years after the US invasion of Iraq, the healthcare system remains in shambles, due to inherited and emerging problems. A few solutions have been proposed to overcome these problems, and of all the proposed solutions, telemedicine is the one that can potentially overcome the problems of affordability and access. The Iraqi Telemedicine Centre undertook a study to investigate feasibility of applying telemedicine in Baghdad. The study explores hospitals' Internet services in terms of type, use, and access. Methods: A survey-based study was conducted by field visits and direct interviews with administrative representatives of fourteen randomly selected hospitals in Baghdad, eight of them are governmental and six are nongovernmental for-profit hospitals. Results: 71% (10/14) of the hospitals have access to the Internet via fibre optic cable through a commercial small business package plan. Six of the ten with Internet offer Wi-Fi to their physicians and potentially their patients, and five of these hospitals are nongovernmental for-profit hospitals. Five of the 14 hospitals were using some aspect of telemedicine and six of the hospitals were interested in participating in projects utilising telemedicine. These results are probably generalisable to the rest of Iraq, as the healthcare system and Internet services are the same. In conclusion, despite of all the challenges, telemedicine is feasible in Iraq, especially if it was affordable and the technology can operate on low-bandwidth Internet.

Die Erreichbarkeit von Infrastrukturen der Daseinsvorsorge spielt sowohl für Standort-entscheidungen als auch für die individuelle Lebenssituation der Bürger eine wichtige Rolle, denn Erreichbarkeitsverhältnisse bestimmen neben der Qualität des Infrastrukturangebots den regionalen Versorgungsgrad mit Infrastruktur. Damit sind sie ein wichtiger Faktor der regionalen Entwicklung. Auch für die Diskussion über die Sicherung der Daseinsvorsorge sind aktuelle Informationen über die Erreichbarkeit von Einrichtungen der Daseinsvorsorge notwendig, um sich vor dem Hintergrund des normativen Anspruches der Aufrechterhaltung gleichwertiger Lebensverhältnisse im Bundesgebiet ein realistisches Bild über die derzeitige Situation als Ausgangsbasis für ggf. notwendige Politikinterventionen machen zu können. Vor diesem Hintergrund befasst sich die vorliegende Studie mit der Abschätzung der regionalen Erreichbarkeit von Ärzten, Krankenhäusern, Apotheken und ambulanten Pflegediensten nach Sozialgesetzbuch Elftes Buch (SGB XI) in Deutschland als - insbesondere in ländlichen Räumen - wichtige Schlüsseldienstleistungen für die Versorgung der Bürger. Dazu wird auf Basis eines rasterbasierten GIS-Erreichbarkeitsmodells ein einfacher generischer Erreichbarkeitsindikator ermittelt, der Rückschlüsse auf die Grundversorgungssituation flächendeckend für Deutschland ermöglicht. ; Accessibility is as important for location decisions and regional development as it is for the individual life situation of the citizens. The reason is that accessibility determines the regional quality and provision of services of general interest. Considering the normative political claim to provide comparable living conditions in all regions of Germany actual empirically sound information about the accessibility of services of general interest are important in order to get an objective and realistic impression about the current situation which can function as input for future policy actions and interventions. The study focuses on the estimation of the regional availability of physicians, hospitals, public pharmacies and ambulant nursing services according to the Social Security Code, Book Eleven (SGB XI) by analysing the accessibility based on a raster-based GIS accessibility analysis. Thereby the study especially focuses on the availability of such services in rural areas.

BACKGROUND: Cardiovascular disease (CVD) is a major cause of disability and premature death. Despite European guidelines advocating the use of medical therapies in CVD, many patients still do not achieve the guideline-recommended treatment, which highlights the need for change and innovations in this field. This requirement has been widely recognised by the national ministries of health, several European cardiology societies, and the European Parliament, who support the initiation of strategies to improve and promote cardiovascular health. DISCUSSION: One of the key risk factors to recurrent cardiovascular events is the lack of adherence to medication and this has been added to the agenda of the European Commission. With the intention to improve treatment adherence in CVD, polypills have been investigated and numerous studies demonstrate that they significantly improve medication adherence, which contributes to the improvement of health outcomes. In Europe, the first cardiovascular polypill, developed by a public-private partnership (CNIC-Ferrer), recently became available for general prescription as a therapy for CVD prevention. This polypill significantly improves adherence, preventing fatal and non-fatal cardiovascular events, and appears to be a cost-effective strategy to improve sustainability of the health care systems in CVD. CONCLUSIONS: Given the importance of urgent and simple solutions to restraining the pandemic nature of CVD, the polypill approach should therefore be considered by physicians and public health systems as an available and innovative option to improve cardiovascular health.

Background: Immunization is the most cost-effective intervention for infectious diseases which are the major cause of morbidity and mortality worldwide. There is a scarcity of information on the vaccination status of young adults and the role of socioeconomic conditions in India. Objectives: Present study explored the adult vaccination status and influence of income and education of parents on adult vaccination status in university students from Mumbai, India. Methods: On the basis of the eligibility criterion 149 students were selected for the present study. A total of 8 vaccines namely Tdap/DTP, Varicella, MMR, Influenza, Pneumococcal, Hepatitis A, Hepatitis B and Meningococcal were included in this study for all the respondents. In addition to these vaccines, Human Papilloma Virus vaccine was also included for female respondents. Results: There were total of 149 (75 male and 74 females) respondents with the mean age of 21.5 years. The top 3 immunizations were Td/Tdap (97.3%), MMR (66.4%) and Hepatitis B (55%) among the respondents. Only 4 (5.5%) female respondents have been immunized against the HPV. Conclusions: Td/Tdap (97.3%) and MMR (66.4%) coverage was in line with the recommendations. For all the other vaccines the coverage was low varying from 5.5% to 35.4%. The vaccination coverage was better in respondents with higher educated and higher income parents. We suggest that patient education, planning by government for the implementation of policy for adult vaccination and involvement of physicians are must for better adult vaccination coverage.

Japan has been facing challenges relating to specifically defined rare diseases, called Nan-Byo in Japanese (literally 'difficult'+'illness'), and has already taken measures for them since 1972. This governmental support has surely benefited Nan-Byo patients; however, those suffering from medically unidentified conditions do not fall into this scheme and thus still confront difficulty in obtaining an examination, a diagnosis, and a treatment. To identify such rare and often undiagnosed diseases, we must integrate systematic diagnosis by medical experts with phenotypic and genetic data matching. Thus, in collaboration with Nan-Byo researchers and the Japanese universal healthcare system, the Japan Agency for Medical Research and Development launched the Initiative on Rare and Undiagnosed Diseases (IRUD) in 2015. IRUD is an ambitious challenge to construct a comprehensive medical network and an internationally compatible data-sharing framework. Synergizing with existing next-generation sequencing capabilities and other infrastructure, the nationwide medical research consortium has successfully grown to accept more than 2000 undiagnosed registrants by December 2016. We also aim at expanding the concept of microattribution throughout the initiative; that is, proper credit as collaborators shall be given to local primary care physicians, nurses and paramedics, patients, their family members, and those supporting the affected individuals whenever appropriate. As it shares many challenges among similar global efforts, IRUD's future successes and lessons learned will significantly contribute to ongoing international endeavors, involving players in basic research, applied research, and societal implementation.

This paper discusses findings from a high-level scan of the contextual factors and actors that influenced policies on team-based primary healthcare in three Canadian provinces: British Columbia, Alberta and Saskatchewan. The team searched diverse sources (e.g., news reports, press releases, discussion papers) for contextual information relevant to primary healthcare teams. We also conducted qualitative interviews with key health system informants from the three provinces. Data from documents and interviews were analyzed qualitatively using thematic analysis. We then wrote narrative summaries highlighting pivotal policy and local system events and the influence of actors and context. Our overall findings highlight the value of reviewing the context, relationships and power dynamics, which come together and create "policy windows" at different points in time. We observed physician-centric policy processes with some recent moves to rebalance power and be inclusive of other actors and perspectives. The context review also highlighted the significant influence of changes in political leadership and prioritization in driving policies on team-based care. While this existed in different degrees in the three provinces, the push and pull of political and professional power dynamics shaped Canadian provincial policies governing team-based care. If we are to move team-based primary healthcare forward in Canada, the provinces need to review the external factors and the complex set of relationships and trade-offs that underscore the policy process.

Medical tourism is a growing global industry in the world today, with Thailand being one of the top destinations of medical tourists. Since 2003, the Thai government has initiated the Medical Hub Policy which was intended to make Thailand "the center of excellence for medical services within the region." The policy has prompted large-scale development programs among private hospitals in Thailand, and the implementation of the policy is ongoing. However, besides the anticipated huge economic returns from the medical tourism sector, there are important concerns regarding poential health inequality among Thais as a result of it. This paper aims to highlight issues in health inequality such as reduced equitable access and quality of care due to medical tourism, and to suggest some implementable strategies that could be used to reduce them. Some of the issues causing health inequality are the public to private brain drain, rising costs of medical goods and services as well as quality of healthcare in public hospitals. Strategies proposed to overcome these shortcomings include the cross-utilization of facilities, national service for physicians, and industry-specific tax. In conclusion, strong political will is required to put in place concrete measures to prevent health inequality which is already growing in Thailand due to medical tourism. This will ensure that the economic gains of medical tourism are not offset by its social costs to the people of Thailand.

Tuberculosis (TB) afflicts 2.8 million citizens in India, representing more than 30 percent of the world's total burden. To control TB, complete adherence to treatment is crucial—under the World Health Organization's (WHO) Directly Observed Therapy Short-course (DOTS) strategy. In this strategy, patients are required to take up to 75 doses under supervision over six months at a treatment center or in the presence of an observer. However, the scarcity or inaccessibility of treatment centers and truthful observers in hard to-reach areas often results in high default rates. Missing a dose or interrupting treatment is extremely dangerous, since those who default can relapse, or much worse, develop the deadlier, drug-resistant strain of TB. A continuing social stigma for those who have TB is also linked to incomplete treatment and lack of follow-up. There is poor data collection as well. Since 2006, Operation ASHA (OpASHA) has helped deliver the Last-mile connection to TB treatment and prevention in India by leveraging existing government infrastructure to supplement the country's own efforts. OpASHA receives free medicines, diagnostic facilities and physician services from the national TB control program. Through a partnership with Microsoft Research, OpASHA has pioneered a biometric technology called eCompliance for treatment. OpASHA serves 10 million people in nine states across India, in addition to 2.2 million people in Cambodia. OpASHA has expanded to Cambodia, and its model has already been replicated in Uganda, Kenya, and the Dominican Republic.

AbstractUsing government reports produced by one of Ontario's pioneering women physicians and leading eugenic crusaders, Dr. Helen MacMurchy, this article interrogates the significance of disability as a central paradigm within first-wave feminism and its promotion of eugenic reforms. I examine how conceptualizations of race were reconstituted through the construct of disability to generate not only inter- but also intra-racial distinctions between differently classed white women. I argue that it was ultimately by leveraging a range of social categories —gender, class, race, and transgressive forms of sexuality—into a disabling paradigm that not only racialized women, but also poor white women were disempowered by eugenics.RésuméEn s'appuyant sur des rapports gouvernementaux produits par la Dre Helen MacMurchy, l'une des femmes médecins pionnières et des principales militantes eugénistes de l'Ontario, cet article interroge la signification du handicap comme paradigme central au sein du féminisme de la première vague et de sa promotion des réformes eugéniques. J'examine comment les conceptualisations de la race ont été reconstituées par le biais du concept du handicap pour générer des distinctions non seulement interraciales mais aussi intraraciales entre différentes classes de femmes blanches. Je soutiens que ce fut en fin de compte en rassemblant un éventail de catégories sociales—genre, classe, race et formes transgressives de sexualité—en un paradigme de handicap que non seulement les femmes racialisées, mais aussi les femmes blanches pauvres, ont été marginalisées par l'eugénisme.