Asia Pacific Family Medicine

Japan has low rates of cervical cancer screening and Human papilloma virus (HPV) vaccination. This research examines the effectiveness of a family medicine resident-led, intervention in increasing knowledge about HPV and cervical cancer in middle school-girls and increasing knowledge and intention to have cervical cancer screening in their mothers. We utilized a pre-test/post-test intervention design in three rural middle schools with 7th grade middle school-girls and their mothers. A school-based activity educated girls about HPV and cervical cancer. A home-based activity utilized a homework assignment for girls and their mothers. Pre/post intervention surveys were completed by the girls and their mothers. Major outcomes included changes in knowledge among girls and mothers and barriers to be screened for cervical cancer among mothers. Sixty-five students and sixty-three mothers completed the study. Two out five mothers were not in compliance with current screening recommendations. Identified barriers included: embarrassment (79%), poor access (56%), fear of having cancer (52%), and cervical cancer screening being an unknown procedure (46%). Forty-four percent of mothers deemed their daughters to be at risk for cervical cancer. Trusted sources of information included: doctors (97%), newspapers/television (89%), government (79%), the Internet (78%), and friends (62%). Student knowledge scores (7-point scale) improved significantly from pre- to post-intervention (4.8 vs. 5.9, p?<?0.001). Knowledge scores (14-point scale) among mothers also significantly improved (11.7 vs. 12.0, p?=?0.024). These data suggest a community-based intervention on a sensitive topic by family medicine residents can be implemented in middle schools, can improve school-girls' knowledge about HPV and cervical cancer, and can reach their mothers. Additional research could examine whether those intending to be screened receive screening and how to reach women who still resist screening.

Tomoko Ito

Remi Takenoshita

Keiichiro Narumoto

Melissa Plegue

Ananda Sen

Benjamin Franklin Crabtree

Michael Derwin Fetters

A community-based intervention in middle schools to improve HPV vaccination and cervical cancer screening in Japan

基于社区的中学干预措施以改善日本的HPV疫苗接种和宫颈癌筛查

One current strategy to overcome the issue of shortage of qualified health workers has focused on the use of community health workers in the developing countries to deliver health care services specifically to the most vulnerable communities in the rural areas. Timor-Leste is the one of the world's newest developing countries that has incorporated the traditional birth attendance in its health system through a family health promoter initiative in response to reproductive and child health, hence to improve primary health care delivery and increase number of healthcare workforce. The study utilized a non-systematic review of the literature using key words such as community health workers, traditional birth attendants, reproductive health, child health and health outcomes. A case study from Timor-Leste was also used. Traditional birth attendants have performed wide variety of tasks including outreach and case finding, health and patient education, referrals, home visits and care management. Evidence indicated that there were, to varying degrees, positive associations between traditional birth attendance training and maternity care. Traditional birth attendance training was found to be associated with significant increases in attributes such as knowledge, attitude, behavior, advice for antenatal care, and pregnancy outcomes. However, some challenges faced by traditional birth attendants' role in encouraging women to go to health center for preventive services would be the compliance and refusal of the referral. The implementation case study from Timor-Leste shows that integrating traditional birth attendance into a national healthcare system through Family Health Promoter program has been programmatic effective. It is recommended that the implementation should consider regular communication between health staff and community leaders in recruiting members of family health promoters, and the use of supportive supervision tools to identify weaknesses in the management of this initiative. In Timor-Leste, incorporating traditional birth attendance through family health promoter program has played crucial roles in delivering and increasing access to reproductive health services by women in rural communities of the nation. Whilst it requires a long-term commitment and good partnership, the current reduction in maternal mortality ratio in Timor-Leste is encouraging and serves to illustrate how this initiative aims to improve primary health care delivery and increase number of healthcare workforce.

Decio Ribeiro Sarmento

Traditional Birth Attendance (TBA) in a health system: what are the roles, benefits and challenges: A case study of incorporated TBA in Timor-Leste

传统接生员在卫生系统中的角色、益处与挑战：以东帝汶整合型接生员为例

The purpose of this study was to investigate differences in diabetes knowledge, attitudes and perceptions (KAP), self-care practices as related to assessment of chronic illness care among people with diabetes consulting in a family physician-led tertiary hospital-based out-patient clinic versus local government health unit-based health centers in the Philippines. People with diabetes consulting in the said primary care services were interviewed making use of questionnaires adapted from previously tested and validated KAP questionnaires and the patients’ assessment of chronic illness care (PACIC) questionnaire. Adherence to medications, diabetes diet, and exercise and the number of diabetes consultations were asked. Analysis of variance was used to determine differences in KAP, self-care practices, and PACIC and regression analysis was used to determine any associations of the abovementioned variables to the PACIC ratings. A total of 549 respondents were included in the study. Differences in knowledge, attitudes, perceptions, PACIC, utilization of health services, and adherence to medications and exercise were all statistically significant. Ratings for diabetes knowledge, positive attitudes, and the perceptions of support attitudes and the abilities to perform self care, and the proportions of those properly utilizing health services and adhering to medications and exercise were higher while ratings for negative attitudes, perceived support needs, perceived support received and PACIC were lower among those consulting in the family physician-led health service. Combining family medicine-based approaches with culturally competent diabetes care may improve knowledge, attitudes, perceptions and self-care practices of and collaborative care with people with diabetes.

Grace Marie V Ku

Guy Kegels

A cross-sectional study of the differences in diabetes knowledge, attitudes, perceptions and self-care practices as related to assessment of chronic illness care among people with diabetes consulting in a family physician-led hospital-based first line health service and local government health unit-based health centers in the Philippines

菲律宾家庭医生主导的医院基层医疗服务与地方政府卫生单位卫生中心就诊的糖尿病患者在糖尿病知识、态度、认知及自我护理实践方面的差异横断面研究：与慢性病护理评估相关

Primary care research is at a crossroad in South Pacific. A steering committee comprising a member of WONCA Asia Pacific Regional (APR) council and the President of Fiji College of General Practitioners garnered sponsorship from Fiji Ministry of Health, WONCA APR and pharmaceutical agencies to organize the event in October 2013. This paper describes the processes needed to set up a national primary research agenda through the collaborative efforts of local stakeholders and external facilitators using a test case in South Pacific.The setting was a 2-day primary care research workshop in Fiji. The steering committee invited a team of three external facilitators from the Asia-Pacific region to organize and operationalize the workshop. The eventual participants were 3 external facilitators, 6 local facilitators, and 29 local primary care physicians, academics, and local medical leaders from Fiji and South Pacific Islands. Pre-workshop and main workshop programs were drawn up by the external facilitators, using participants' input of research topics relating to their local clinical issues of interest. Course notes were prepared and distributed before the workshop. In the workshop, proposed research topics were shortlisted by group discussion and consensus. Study designs were proposed, scrutinized, and adopted for further research development.The facilitators reviewed the processes in setting the research agenda after the workshop and conceived the proposed 6E model. These processes can be grouped for easy reference, comprising the pre-workshop stages of "entreat", "enlist", "engage", and the workshop stages of "educe", "empower", and "encapsulate".The 6E model to establish a research agenda is conceptually logical. Its feasibility can be further tested in its application in other situation where research agenda setting is the critical step to improve the quality of primary care.

Ngiap Chuan Tan

Chirk Jenn Ng

Mitchell Rosemary

Khan Wahid

Lee Gan Goh

Developing a primary care research agenda through collaborative efforts – a proposed “6E” model

通过协作努力制定初级保健研究议程——提出的“6E”模型

Osteoporosis is a significant problem in rapidly ageing populations in Asian regions. It causes a significant personal and societal impact and increases the burden on health care services. Aim of this study is to determine the knowledge, beliefs and practices regarding osteoporosis among young females entering medical schools in Sri Lanka. This is a descriptive cross sectional study conducted amongst 186 female medical school entrants of the Faculties of Medicine, Universities of Colombo and Kelaniya from September to December 2010. A self administered questionnaire was used to assess knowledge, beliefs and practices on osteoporosis, including a food frequency chart to assess the calcium intake. The mean age was 20.7 +/− 2.1 years. Majority of the participants (51.6%, n = 96) had an average score (40–60) on the knowledge test, while 40.8% (n = 76) had a poor score (<40). However, in depth knowledge on risk factors, and protective factors was lacking. Perceived susceptibility for osteoporosis was low with only 13.9% (n = 26) of women agreeing that their chances of getting osteoporosis are high. The mean calcium intake was 528 mg/day and only 18.8% (n = 35) of the participants achieved the Recommended Daily Allowances (RDA) for Calcium. Exercise was grossly inadequate in the majority and only 13.6%( n = 23) engaged in the recommended exercises. Only 3.8% (n =7) of the participants currently engaged in specific behaviours to improve bone health while 10.8% (n = 20) had thought of routinely engaging in such behaviours. Although majority of participants had a modest level of knowledge on osteoporosis, there were gaps in their knowledge in relation to risk factors, protective factors and on the insidious nature of osteoporosis. Perceived susceptibility for osteoporosis was low. Practices towards preventing Osteoporosis were inadequate.

Risni Erandie Ediriweera de Silva

Muhamed Ruvaiz Haniffa

Kavinda Dimuthu Kumara Gunathillaka

Inoshi Atukorala

Endahandige Deepthi Prasadth Samant Fernando

Wagawatta Liyanage Sugandhika Padmi Perera

A descriptive study of knowledge, beliefs and practices regarding osteoporosis among female medical school entrants in Sri Lanka

斯里兰卡女性医学院新生骨质疏松症知识、信念和实践的描述性研究

Abstract&#x0D; Background&#x0D; Self-therapy with various medications is a commonly practised form of children self-care among parents throughout the world, with the prevalence and pattern differing from country to country. Parental knowledge, attitudes, and practices (KAP) regarding self-medication of their children need to be taken into consideration because children are more sensitive to adverse consequences of medication. This study was designed to assess Palestinian parents’ KAP towards self-medication for their children.&#x0D; Methods&#x0D; A descriptive, cross-sectional study was conducted in Palestine from October 2016 to February 2017, using a face-to-face interview questionnaire format, which was adapted from previous studies in this field. Data was collected by convenient sampling. The parents answered a questionnaire covering socio-demographic and economic variables; medication information; knowledge, attitudes, and practices regarding self-medication; and the toxicity of medications used for self-therapy.&#x0D; Results&#x0D; Among the 500 respondents interviewed, the total parents of 357 (73.4%) accepted using medications as self-therapy for their children. The most common reason for using self-medication was previous experience (54.6%). The medications most often used in such self-therapy are antipyretics (95%), followed by skin creams (46%) and anti-cough and anti-influenza medication (44.2%). Parental knowledge about toxicity was found to be inadequate knowledge. For example, around 70% of parents believe that paracetamol and multivitamin are not fatal in cases of overdose.&#x0D; Conclusions&#x0D; Self-medication of children is common among parents in Palestine. There has been a high tendency for parents to self-medicate their children, in particular with antipyretics. Moreover, antibiotics have been used without prescriptions by a large proportion of parents. As such, specific guidelines for appropriate self-therapy should be established. We must encourage pharmacists to educate parents on how to self-medicate medicine in proper doses and at the correct time, as well when the dose reaches a toxic level.

Sa'ed Zyoud

Rawan M. Shtaya

Dana Q. Hamadneh

Shyma N. Sawalmeh

Hiba A. Khadrah

Rasha R. Zedat

Abdullah Othman

Waleed M. Sweileh

Rahmat Awang

Samah W Al-Jabi

Parental knowledge, attitudes, and practices towards self-medication for their children: a cross-sectional study from Palestine

家长对儿童自我用药的知识、态度和实践：来自巴勒斯坦的横断面研究

Background. Plantar cutaneous conditions are the most common causes of foot discomfort limiting ambulation. Identification of indwelling foreign bodies is greatly facilitated by dermoscopy, allowing early detection of the character of the underlying pathological etiology. Furthermore, polarized dermoscopy provides ideal conditions of illumination and three- dimensional visualization of the involved site, without direct contact with the cutaneous surface. This unprecedented report describes its implementation for a solitary hair implanted into plantar skin. Case Presentation. A patient presented with localized plantar discomfort diagnosed as a soft tissue reaction to an embedded single human hair, folded and rooted inside the epidermis. Under magnified vision the phenomenon was characterized, the hair was extracted, the source was manipulated with a hypodermic needle and the lesion was removed with ensuing complete resolution. Conclusions. Previous reports of hair slivers embedded inside the skin were attributed to barbers or animal grooming and the treatment was dictated by the severity of the complications. In this relatively mild case the intervention was greatly facilitated by therapeutic dermoscopy. Therapeutic dermoscopy is advocated for use to evaluate and treat many diverse body surfaces, especially the plantar skin as it raises the likelihood of successful treatment of embedded foreign bodies. Precisely how a single hair may become lodged into normal plantar skin remains to be explained

Sody Naimer

Polarized Dermoscopy Facilitates Diagnosis and Treatment of Plantar Pseudohirsutism

偏振皮肤镜有助于足底假性多毛症的诊断和治疗

Background: Older adults who have health conditions with good prognoses typically fall outside the scope of efforts encouraging advance care planning. We developed group and individual versions of an advance care planning program for use in primary care.&#x0D; Methods: We conducted a quasi-experimental trial in a rural family clinic in Japan. Medically stable patients aged ≥65 years were invited to watch an educational video on advance care planning, followed by an individual (n=46) or group-based (n=63) discussion. Advance directive completion was tracked over four months. Participants completed baseline and follow-up questionnaires and reported occurrence of family discussions about advance care planning and attitudes toward advance care planning. Group discussions were recorded and thematically analyzed to identify barriers and facilitators to engaging in advance care planning.&#x0D; Results: Advance directive completion rates were high for both intervention versions but did not significantly differ between arms (85.7% vs. 80.4%, p=0.45). Only one-fifth of patients in both arms discussed advance care planning with their family after the intervention (20.7% and 21.7%, p=0.89). Patients in the group arm rated their experience slightly higher than those in the individual arm (4.2 and 3.9 out of 5, p=0.023). Qualitative analysis of group discussions revealed that patients were affected by their perceptions of societal norms that prioritize family consensus over patient autonomy; however, these perceptions influenced advance care planning behaviors in inconsistent ways.&#x0D; Conclusions: Group-based advance care planning intervention among medically stable older patients is as effective as an individually-focused discussion in promoting advance directive completion. Future research is needed on ways to enhance patients’ ability to discuss advance care planning with their family members.

Shuji Tsuda

Mary R. Janevic

Kota Shikano

Tomoko Matsui

Tsukasa Tsuda

Group-based educational intervention for advance care planning in primary care: a quasi-experimental study in Japan

基于群体的教育干预在初级保健中进行预先护理规划：一项在日本进行的准实验研究

Background: On May, 13 2019, a food poisoning outbreak of diarrhoeal B. cereus associated with contaminated chicken satay occurred in Tegalkenongo village involving villagers after attending mass iftar in a mosque. Health office of Bantul District revealed two attendances were hospitalized in the hospital of PKU Muhammadiyah after consuming food served during mass iftar. Based on the information, we immediately conducted an epidemiological investigation to make sure of the existence of the outbreak.&#x0D; Objectives: This study aimed to investigate the causative agents, source of food poisoning and mode of food poisoning transmission in Tegalkenongo Village.&#x0D; Methods: A retrospective cohort study was used in the epidemiological investigation during one week from 13 May 2019 – 20 May 2019.&#x0D; Results: Based on the investigation, Of the 303 villagers involved in the event, 188 villagers were ill with the median age of cases was 38 years old, the average incubation period was 8 hours, and the predominate symptoms were diarrhea (93.62%), nausea (84.57%), and abdominal cramps (64.89%). Contaminated chicken satay was determined as the source of contamination with adjusted Risk Ratio (aRR) was 4.36; 95% CI 1.1538, 16.5285. Initial epidemiological features and cultures from food items served in the event and stool sample of one patient suggested that the causative agent was Bacillus Cereus which was supported by Klebsiella Pneumoniae.&#x0D; Conclusion: Based on the field investigation result related to symptoms and incubation period and laboratory identification, we conclude that the causative agent was diarrhoeal B. cereus.&#x0D; Keywords: Food poisoning, Bacillus cereus, Klebsiella pneumoniae

Kornelius Son

The Food poisoning outbreak caused by diarrhoeal Bacillus Cereus in Tegalkenongo Village, Bantul, Yogyakarta, Indonesia: a retrospective study

印尼日惹班图尔特加尔肯农戈村由腹泻型蜡样芽孢杆菌引起的食物中毒暴发：回顾性研究

China was the first country where the novel coronavirus appeared. General Practitioners (GPs) in China are at the forefront of tackling the spread of the virus. While the health sector in China has been under scrutiny globally, many articles have been disseminated within the country about the response. GPs in China are keen to share their experiences with GP colleagues, as other countries go through similar experiences. The hope is that by sharing our experiences, our international colleagues can benefit from what worked well and what went less well.&#x0D; Coronavirus started spreading from Wuhan in Hubei Province in late 2019. As in many parts of China, Wuhan is a hospital-oriented health service, as the family medicine system is not yet fully implemented. The surge of patients to hospitals quickly overwhelmed the health system in Wuhan and surrounding towns and cities, as patients sought testing and treatment, and in the process helped to spread the virus more quickly. The experience has put the spotlight on the ineffectiveness of hospitals as the first port of call for this and other types of virus.

Shanzhu Zhu

Donald Li

Sharing experience from Chinese General Practitioners to International colleagues on how to tackle COVID-19

中国全科医生向国际同行分享应对新冠疫情的经验

ISSN	1444-1683, 1447-056X
h-index	19

Publication Information	Publisher: BioMed Central Ltd，Publishing cycle: ，Journal Type: journal，Open Access Journals: No
Basic data	Year of publication: 2020，Proportion of original research papers: 0.00%，Self Citation Rate:N.A.， Gold OA Rate: 0.00%

Asia Pacific Family Medicine

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