Zeitschrift für Allgemeinmedizin

Introduction: Point of care testing for C-reactive protein (CRP) has shown promise as a measure to reduce unnecessary antibiotic prescribing in respiratory tract infections (RTI) and has been adopted into NICE guidelines, but its use in primary care is still controversial. We aimed to evaluate the effect of CRP testing on the prescription of antibiotics and the outcome of patients in general practice with acute cough/RTI.

Methods: We undertook a case-control study with POC testing with CRP in intervention group (Oct 16-Jan 17) and compared this to similar cohort of patients from a year previously coded with exact diagnosis.

Results: A total of 207 patients were included: 69 in the intervention group and 138 in the control group.

The two groups were similar in clinical characteristics. In the intervention group, the antibiotic prescribing rate was 31.6%, which was significantly lower than that in the control group (59.9%) (P=0.003).

The recovery rate, as recorded by the GPs, was 94.9% and 93.8% in the intervention and control groups, respectively. Referral to Emergency Department for children under 12 was also reduced significantly in the intervention group (4.4%) when compared to the control group (6.5%; P=0.00479).

Conclusion: The study showed that CRP testing in patients with acute cough/RTI may reduce antibiotic prescribing and referral to pediatric ED, probably without compromising recovery.

Pollution of the environment is a serious health concern faced by humanity which needs immediate tackling to protect our future generations. It is not an issue which should be left only to the Government or Environmentalists to deal with, each one of us have a responsibility to do our part. This health hazard is exacerbated by the fact that we are going away from nature’s ways which is leading to life threatening diseases and unhealthy body. The new generation is so engrossed in social media that they are losing touch with the surroundings and themselves. Satya is a bold step towards addressing this problem and strives to bring people closer to nature and in the process bringing about self-realization and self-healing.

Background: Breastfeeding is known to be an important factor in the overall growth and development of children. Breastfeeding is thought to lead to enhance cognitive and language development of a child. However, this association has not yet been scientifically and statistically established. This study aimed to explore this association in children under 3 years of age.

Methods: This was a secondary data-analysis of the baseline data of “Balochistan – Early Childhood Development Project”. The final sample comprised of 604 children less than 3 years of age. The children were selected by three-stage stratified random sampling from three districts of Balochistan province; Gwadar, Quetta and Qilla Saifullah. The data for the duration of breastfeeding was categorized as less than 6 months, from 6 months to 12 months and greater than 12 months. The age appropriate language and cognitive development of children was assessed through the CDA (Care for development Appraisal) tool. We applied multivariate logistic regression model for the analysis.

Results: In unadjusted analysis, children breastfed for more than 12 months were at an advantage for cognitive and language development (cOR=2.91, cOR=2.8; p<0.05; respectively). After adjusting for a range of co-variates this developmental advantage decreased to aOR=2.42 for cognition and aOR=2.44 for language respectively (p<0.05).

Conclusions: The duration for which the child is breast-fed is integral for his language and cognitive development. Based on our findings we recommend that breastfeeding should be promoted for more than 12 months to bring out the maximum benefit in the language and cognitive development of a child.

Ascitic hernia is still a thorny task but sometimes it may severely influence patients to live a simple but quality or functional life. Herein, we discuss regarding a 37-year-old man with a basketball like indirect inguinal ascitic hernia who was bedridden due to large volume of cirrhotic ascites. All conservative therapies seemed to be only little efficient, only surgery could save him. Based on our past decade's successful experience, where we used to apply an improved technique (Hernia-Roof/Hernia-Sac-Top (HST) approach) to solve scrotum ascitic hernia, aiming to strengthen resistant degree of groin area with little damage to its natural structure. Our technique has been confirmed a practical method in China, and reported in many Chinese version of journals. The technique has three advantages below:

1) Ascites was preoperatively managed to ensure the incision wound.

2) The hernia orifice was entirely exposed and closed with suture completely for the first time.

The hernia sac itself, the lower mesh and the orifice-closed were fixed together via 3-D skills. The patient stood up again like a true man. Now he has been followed up in outpatient doctor's office since 10 years, No complications were found. After that, more cases including emergency cases were successfully performed. It is inspiring and has educational value for both patients and surgeons.

Purpose: Patients presenting with multiple problems during a single general practice consultation have been anecdotally referred to as ‘shopping list patients’. The aims of this study were to explore the factors that could help general practitioners develop effective strategies to manage these patients.

Methods: This is a questionnaire based study with a total sample size of (n=66). The study timeframe was July 2012 to Jan 2013 and the response rate was 82.5%.

Results: Irrespective of age or gender, most patients admitted to presenting to the GP with multiple problems approximately 30% of the time. Lack of timely access to GP appointments was the main reason cited by the majority of patients for presenting with multiple problems.

Conclusions: Improving access to GP appointments would reduce patients presenting with multiple problems during a single consultation. The reasons and explanations should be patient centered.

The findings from the research above may facilitate GP’s to increase levels of patient/GP satisfaction and safety, optimize rapport, reduce complaints, help to manage time more effectively (reduce late running of appointments) and increase practice productivity.

Gastrointestinal motility disorders are relatively common in children and adolescents. The diagnosis is often difficult and time-consuming as the etiology of the problems includes different pathological entities such as enteric neuropathies, myopathies and collagenopathies. Hirschsprung's disease (HD) is one of the most common and best recognized disorders, particularly in infants. Whereas, desmosis of the colon is a rare condition characterized by total or focal lack of connective-tissue net of the circular and longitudinal muscles without any abnormalities within enteric nervous system (ENS). Its diagnosis is based on full-thickness intestinal biopsy or post-operative material followed by histological staining with pricrosirius red. We present two adolescent girls who were familiar related (the same mother, different fathers) and both of them suffered from chronic constipations. HD was excluded in these cases and surgical removal of impaired part of intestines was performed. Material from post-operative specimens proved desmosis of the colon in each patient.

Instrumental vaginal delivery is a key element of essential obstetric care, and scaling up its use in resource poor countries through training and supply of appropriate equipment is likely to contribute significantly to reduce maternal and newborn morbidity and mortality and objective of the study was to assess complications of instrumental vaginal delivery and associated factors. A two years retrospective cross sectional analytical study was conducted from July 2013 to June 2015 in the obstetric department of Shire, Suhul General Hospital, North-West zone, Tigray Ethiopia. Records of 357 mothers managed with operative vaginal delivery were retrieved, 224 (62.7%) were rural residents. Low instrumental vaginal delivery was the most common type of practiced station (208, 58.3%) but mid instrumental delivery is highly associated with complications [AOR 95% CI 12.2 (4.79-31, 4)]. Fetal distress was the most common indication of operative vaginal deliveries, 158 (44.3%) as well as the commonest cause of low 1st minute Apgar score, 97 (54.8%). More than half of mothers were assisted with forceps, 187 (52.4%), and it was the, commonest cause for perineal tear (67.4%) and significantly associated with feto maternal complications [AOR 95% CI 1.73 (1.07-2.80)]. Even though forceps had higher maternal complications, vacuum extraction has higher fetal complications. We conclude that obstructed labor (OL), mid pelvic instrument application, increases in birth weight and forceps application were significantly associated with feto maternal complications.

Introduction: Motivation of health professionals is one of the key ways to ensuring efficient provision of health services. Improving the motivation of health workers in rural and remote areas is of greatest concern to all countries worldwide. Even though factors influencing health worker motivation are well established in the literature, little is known about the motivational factors that are of relevance to different categories of rural health workers in developing countries.

Objectives: Employing questionnaire survey, we studied 252 health employees of a rural healthcare organization in Northern Ghana to understand the motivational factors that are considered most important by rural health workers, and to determine if these factors are valued differently by different cadres of health professionals.

Results: Our findings showed financial rewards as the number one motivator; followed by promotion, growth and development; job security; acknowledgement, praise and recognition; and working environment in that order. Different cadres of the rural health professionals valued the motivational factors differently: doctors were motivated by their working environment; nurses by promotion, growth and development; pharmacists and pharmacy technicians by praise, acknowledgement and recognition; and support staff and laboratory technicians by financial rewards.

Conclusion: Motivational factors should be applied to different cadres of rural health workers differently.

The purpose of this study was to contribute to the revision of the International Classification of Diseases (ICD-10) by exploring how mental health service users and their relatives conceive the influence of the contextual factors, as described in Chap. 21 of the ICD-10, on a) the onset of a mental or behavioral disorder; b) the resurgence of such a disorder; and c) the recovery process. In individual interviews, the 18 main categories of contextual factors proposed by the ICD-11 (beta draft) were discussed through the Contextual Factors Questionnaire (CFQ) by 28 participants who completed the CFQ individually.

This paper presents the results from a t-test that was performed on the data set to assess whether the means for two groups who completed the CFQ were statistically different from each other (p≤ 0.05). On one hand, we found significant differences between users and family members for A) Housing or the environment (p=0.01), and B) Personal finances (p=0.04); and for C) Water or nutrition (p=0.05) between male and female participants, on the other hand. In light of the fact that Social or cultural environments were considered to be the most influential of all 18 contextual factors by all aggregated participants, this suggests that male-female differences are related to social norms concerning gender, rather than discrete biological sex categories.