1.  Title: IAPAC recommendations to the Obama administration for the US response to the global HIV pandemic [editorial] Source: Journal of the International Association of Physicians in AIDS Care. 2009 Jan-Feb;8(1):13-20. Abstract: Includes the text from a January 5, 2009 letter from the International Association of Physicians in AIDS Care (IAPAC) to the Obama-Biden Presidential Transition Team outlining top-line recommendations for the administration's response to the global HIV pandemic. Recommendations are made for HIV care and treatment, HIV prevention, HIV testing, Human resources, Access to treatment, and PEPFAR. Language: English Keywords: UNITED STATES OF AMERICA | SUMMARY REPORT | PHYSICIANS | RECOMMENDATIONS | HIV PREVENTION | TITLE 19 MEDICAL ASSISTANCE | AIDS | TREATMENT | CARE AND SUPPORT | HIV TESTING | HUMAN RESOURCES | Developed Countries | North America | Americas | Health Personnel | Delivery of Health Care | Health | HIV Infections | Viral Diseases | Diseases | Public Assistance | Grants | Financial Activities | Economic Factors | Medical Procedures | Medicine | Health Services | Laboratory Examinations and Diagnoses | Examinations and Diagnoses Document Number: 331305 |
| 2. Peer Reviewed Title: Emergency contraception: knowledge and attitudes of family physicians of a teaching hospital, Karachi, Pakistan. Author: Abdulghani HM; Karim SI; Irfan F Source: Journal of Health, Population, and Nutrition. 2009 Jun;27(3):339-44. Abstract: This study was conducted to assess the knowledge of family medicine providers and their attitudes towards emergency contraception in a teaching hospital in Karachi, Pakistan. A 21-item questionnaire containing the demographic profile of respondents and questions concerning knowledge of and attitudes towards emergency contraception was distributed among participants. In total, 45 interviews were conducted, with a response rate of 100%, with faculty physicians (33%), residents (27%), medical officers (40%), 36% male and 64% female physicians; of them, the majority (64%) were married. Although the large majority (71%) of the respondents reported considerable familiarity with emergency contraception, objective assessment revealed deficiencies in their knowledge. About 38% of the participants incorrectly chose menstrual irregularity as the most common side-effect of progestin-only emergency contraception pills, and only 33% answered that emergency contraception was not an abortifacient while 42% were unsure. Forty percent of the physicians prescribed emergency contraception in the past. The large majority (71%) of the physicians were familiar with emergency contraception, yet deficiencies in knowledge inaccuracies were identified. Barriers to its use were identified as 'it will promote promiscuity' (31%), religious/ethical reasons (27%), liability (40%), teratogenicity (44%), and inexperience (40%). Overall attitudes regarding emergency contraception were positive; however, most (82%) physicians were unsatisfied with their current knowledge of emergency contraception, and there was a discrepancy between perceptions of physicians and actual knowledge. Interventions providing education to family physicians regarding emergency contraception is strongly recommended. Language: English Keywords: PAKISTAN | RESEARCH REPORT | CROSS SECTIONAL ANALYSIS | PHYSICIANS | EMERGENCY CONTRACEPTION | ATTITUDES | KNOWLEDGE | PERCEPTION | FAMILY PLANNING | Developing Countries | Asia, Southern | Asia | Research Methodology | Health Personnel | Delivery of Health Care | Health | Contraception | Psychological Factors | Behavior | Sociocultural Factors Document Number: 341579 |
| 3. Peer Reviewed Title: [Opinions by physicians from the Family Health Program on four health care priorities proposed by the Agenda for Commitment to Comprehensive Child Health and Reduction of Infant Mortality] Perspectivas de medicos do Programa Saude da Familia acerca das linhas de cuidado Author: Alves e Silva AC; Villar MA; Wuillaume SM; Cardoso MH Source: Cadernos De Saude Publica. 2009 Feb;25(2):349-58. Abstract: The aim of this study was to understand how physicians from a team in the Brazilian Family Health Program perceive their work in child health, as compared to the program's principles outlined in the Agenda for Commitment to Comprehensive Child Health and Reduction of Infant Mortality, under the Ministry of Health. The backdrop was the strategy for implementation of primary care under the Unified National Health System (SUS). Semi-structured interviews were held, and the material was submitted to content analysis. According to the findings, in general the Agenda is being met. However, there are difficulties with referral and counter-referral; the measures proposed by the Family Health Program require medical and sociological competence and face problems inherent to biomedical training; the infrastructure and inputs are precarious; and the training provided does not prepare physicians sufficiently for a more comprehensive approach. In conclusion, the primary care model in Brazil requires adjustments to the country's reality, and partnerships that transcend the system are necessary. Language: Portuguese Keywords: BRAZIL | RESEARCH REPORT | PHYSICIANS | CHILD HEALTH | SELF-PERCEPTION | INFANT MORTALITY | PRIMARY HEALTH CARE | PROGRAM EVALUATION | South America, Eastern | South America | Latin America | Americas | Developing Countries | Health Personnel | Delivery of Health Care | Health | Perception | Psychological Factors | Behavior | Mortality | Population Dynamics | Demographic Factors | Population | Health Services | Programs | Organization and Administration Document Number: 342669 |
| 4. Peer Reviewed Title: Contraceptive failure with Depo-ProveraŽ [letter] Author: Bhathena R Source: Journal of Family Planning and Reproductive Health Care. 2009 Apr;35(2):130. Abstract: I have a concern regarding the recent case report where a 28-year-old woman was given a subsequent (second) injection of Depo-ProveraŽ by a practice nurse when she attended after 13 weeks, and when no precautions were advised, nor documentation done. The patient subsequently again reported with a positive pregnancy test and opted for a termination of pregnancy. My personal feeling is that although by and large consultation times are often too short for practising doctors to cover all aspects of counselling at all times, when a patient is using a contraceptive method outside the terms of the product licence, to ensure that optimal service is offered and also in view of the remote possibility of litigation following failure of the method, it should be mandatory for the practising doctor to also get involved and appropriately counsel, and to adequately document such an episode. (full-text) Language: English Keywords: INDIA | RESEARCH REPORT | CLINICAL RESEARCH | CASE STUDIES | WOMEN IN DEVELOPMENT | PHYSICIANS | NURSES AND NURSING | DEPO-PROVERA | CONTRACEPTION FAILURE | ABORTION | REFERRAL AND CONSULTATION | COUNSELING | TIME FACTORS | FAMILY PLANNING EDUCATION | Asia, Southern | Asia | Developing Countries | Research Methodology | Studies | Economic Development | Economic Factors | Health Personnel | Delivery of Health Care | Health | Medroxyprogesterone Acetate | Contraceptive Agents, Progestin | Contraceptive Agents, Female | Contraceptive Agents | Contraception | Family Planning | Contraceptive Usage | Fertility Control, Postconception | Program Activities | Programs | Organization and Administration | Clinic Activities | Population Dynamics | Demographic Factors | Population | Education Document Number: 330946 Notification |
| 5. Peer Reviewed Title: Twenty or thirty microgram ethinyloestradiol in an oral contraceptive: Does it make a difference in the mind and the daily practice of gynaecologists and general practitioners? Author: Bitzer J; Frey B; von Schonau M; Sabler N; Tschudin S Source: European Journal of Contraception and Reproductive Health Care. 2009 Jun 5;:1-10. Abstract: Objectives Currently, evidence-based guidelines concerning the use of oral contraceptives (OCs) containing either 20 or 30 mug ethinyloestradiol (EE) and the same progestogen, are lacking. We wanted to identify whether Swiss gynaecologists and general practitioners (GPs) have specific criteria on which they base their prescribing habit. Methods Two questionnaires were submitted to 158 physicians. The first one contained a list of possible criteria relevant for decision making and a description of specific clinical situations. The second one concerned actual patients who received either a 20 mug (Yasminelle(R)) or a 30 mug (Yasmin(R)) OC containing the same progestogen drospirenone. Results The most relevant criteria for decision making (in hierarchical order) were family history of venous thromboembolic disease (VTE), headache, smoking, age beyond 35, stability of the menstrual cycle, breast tenderness, body mass index, irregular bleeding and acne. The 20 mug dosage was preferred for women older than 35, those smoking more than 15 cigarettes per day, those with a family history of VTE, and those complaining of breast tenderness or headache. The 30 mug dosage was preferred for patients with a history of irregular bleeding, a family history of osteoporosis, expected poor compliance and acne. Conclusion Swiss gynaecologists and GPs do not preferentially prescribe the lowest possible dosage of EE. They use indirect markers they consider relevant for differential prescribing. For some markers, there is inconsistency, indicating that preferences for 20 mug and 30 mug preparations may be influenced by other factors. Language: English Keywords: SWITZERLAND | RESEARCH REPORT | PHYSICIANS | WOMEN | CLIENTS | DECISION MAKING | TOBACCO USE | HEADACHE | ORAL CONTRACEPTIVES | ETHINYL ESTRADIOL | CONTRACEPTIVE AGENTS, SIDE EFFECTS | THROMBOEMBOLISM | AGE FACTORS | ADMINISTRATION AND DOSAGE | Developed Countries | Europe, Central | Europe | Health Personnel | Delivery of Health Care | Health | Demographic Factors | Population | Program Activities | Programs | Organization and Administration | Behavior | Signs and Symptoms | Diseases | Contraceptive Methods | Contraception | Family Planning | Contraceptive Agents, Estrogen | Contraceptive Agents, Female | Contraceptive Agents | Embolism | Vascular Diseases | Population Characteristics | Drugs | Treatment | Medical Procedures | Medicine | Health Services Document Number: 341601 |
| 6. Peer Reviewed Title: Trends in prenatal care settings: Association with medical liability. Author: Coco AS; Cohen D; Horst MA; Gambler AS Source: BMC Public Health. 2009 Jul 22;9(1):257. Abstract: ABSTRACT: BACKGROUND: Medical liability concerns centered around maternity care have widespread public health implications, as restrictions in physician scope of practice may threaten quality of and access to care in the current climate. The purpose of this study was to examine national trends in prenatal care settings based on medical liability climate. METHODS: Analysis of prenatal visits in the National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey, 1997 to 2004 (N = 21,454). To assess changes in rates of prenatal visits over time, we used the linear trend test. Multivariate logistic regression modeling was developed to determine characteristics associated with visits made to hospital outpatient departments. RESULTS: In regions of the country with high medical liability (N = 11,673), the relative number, or proportion, of all prenatal visits occurring in hospital outpatient departments increased from 11.8% in 1997-1998 to 19.4% in 2003-2004 (p < .001 for trend); the trend for complicated obstetrical visits (N = 3,275) was more pronounced, where the proportion of prenatal visits occurring in hospital outpatient departments almost doubled from 22.7% in 1997-1998 to 41.6% in 2003-2004 (p = .004 for trend). This increase did not occur in regions of the country with low medical liability (N = 9,781) where the proportion of visits occurring in hospital outpatient departments decreased from 13.3% in 1997-1998 to 9.0% in 2003-2004. CONCLUSIONS: There has been a shift in prenatal care from obstetrician's offices to safety net settings in regions of the country with high medical liability. These findings provide strong indirect evidence that the medical liability crisis is affecting patterns of obstetric practice and ultimately patient access to care. Language: English Keywords: UNITED STATES OF AMERICA | RESEARCH REPORT | STATISTICAL REGRESSION | PHYSICIANS | HIGH RISK WOMEN | ETHNIC GROUPS | ANTENATAL CARE | MEDICAL LIABILITY | OBSTETRICS | PHYSICIAN'S OFFICE | HOSPITALS | PROGRAM ACCESSIBILITY | HEALTH INSURANCE | TITLE 19 MEDICAL ASSISTANCE | Developed Countries | North America | Americas | Data Analysis | Research Methodology | Health Personnel | Delivery of Health Care | Health | Reproduction | Cultural Background | Population Characteristics | Demographic Factors | Population | Maternal Health Services | Maternal-Child Health Services | Primary Health Care | Health Services | Medicine | Health Facilities | Program Evaluation | Programs | Organization and Administration | Financial Activities | Economic Factors | Public Assistance | Grants Document Number: 342287 |
| 7. Title: Radiology services for children in HIV- and TB-endemic regions: scope for greater collaboration between radiologists and clinicians caring for children. Author: Dramowski A; Morsheimer MM; Frigati L; Schaaf HS; Rabie H; Sorour G; Cotton MF Source: Pediatric Radiology. 2009 Jun;39(6):541-4. Abstract: There is limited literature documenting the interaction between radiologists and clinicians caring for children, especially in regions where HIV and tuberculosis (TB) are endemic. The dual burden of these diseases in resource-limited settings creates unique challenges for radiographic interpretation and utilization. This review aims to heighten awareness of issues confronting radiologists and clinicians caring for children and to encourage greater collaboration between these two disciplines in HIV- and TB-endemic regions. The Child-Friendly Healthcare Initiative is discussed, emphasizing opportunities to promote child friendliness in radiology services. Language: English Keywords: GLOBAL | CRITIQUE | PHYSICIANS | HIV INFECTIONS | TUBERCULOSIS | CHILD HEALTH SERVICES | EXAMINATIONS AND DIAGNOSES | INTERPERSONAL COMMUNICATION | TECHNOLOGY | PRIVACY | STANDARDS | Health Personnel | Delivery of Health Care | Health | Viral Diseases | Diseases | Infections | Maternal-Child Health Services | Primary Health Care | Health Services | Medical Procedures | Medicine | Communication | Economic Factors | Behavior | Research Methodology Document Number: 342187 |
| 8. Title: A survey of mothers' comfort discussing contraception with infant providers at well-child visits. Author: Fagan EB; Rodman E; Sorensen EA; Landis S; Colvin GF Source: Southern Medical Journal. 2009 Mar;102(3):260-4. Abstract: OBJECTIVE: To determine whether mothers feel comfortable with their infants' providers discussing contraception with them at their infants' well-child checks. METHODS: A cross-sectional survey was conducted using a convenience sample of 114 mothers presenting at a community family medicine residency program for well-child visits among infants up to 17 months old. RESULTS: Almost all mothers (87%) felt comfortable talking with their infants' providers about contraception and were likely to accept the advice of their infants' providers to see their own doctors regarding contraception (83%) or to use a prescription from their infants' providers for contraception (75%). CONCLUSION: Many mothers miss or delay their postpartum visits but see their infants' doctor multiple times within the first year. Mothers are comfortable talking with infant providers about contraception. By discussing contraception with mothers at well-child visits, physicians may encourage mothers to use contraception and prevent unintended pregnancies. Language: English Keywords: UNITED STATES OF AMERICA | RESEARCH REPORT | CROSS SECTIONAL ANALYSIS | MOTHERS | INFANT | CLINICS | PHYSICIANS | CLINIC VISITS | CONTRACEPTION | POSTPARTUM | INFORMATION | PROVIDERS WITH CLIENTS | Developed Countries | North America | Americas | Research Methodology | Parents | Family Relationships | Family Characteristics | Family and Household | Sociocultural Factors | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Health Facilities | Delivery of Health Care | Health | Health Personnel | Service Statistics | Program Activities | Programs | Organization and Administration | Family Planning | Puerperium | Reproduction | Health Services Document Number: 330896 |
| 9. Peer Reviewed Title: The effect of changes in health sector resources on infant mortality in the short-run and the long-run: a longitudinal econometric analysis. Author: Farahani M; Subramanian SV; Canning D Source: Social Science and Medicine. 2009;68:1918-1925. Abstract: While countries with higher levels of human resources for health typically have better population health, the evidence that increases in the level of human resources for health leads to improvements in population health is limited. We use a dynamic regression model to obtain estimates of both the short-run and long-term effects of changes in physicians per capita, our measure of health system resources, on infant mortality. Using a dataset of 99 countries at 5-year intervals from 1960-2000, we estimate that increasing the number of physicians by one per 1000 population (roughly a doubling of current levels of provision) decreases the infant mortality rate by 15% within 5 years and by 45% in the long-run with half the long-run gain being achieved in 15 years. We conclude that the long-run effects of heath system resources are substantially larger than previously estimated. Our results suggest, however, that countries that have delayed action on the Millennium Development Goal of reducing infant andchild mortality rate by two-thirds by 2015 (relative to 1990) may have difficulty meeting this goal even if they rapidly increase resources now. Language: English Keywords: GLOBAL | RESEARCH REPORT | LONGITUDINAL STUDIES | PHYSICIANS | HUMAN RESOURCES | INFANT MORTALITY | HEALTH SERVICES | CHANGES | Studies | Research Methodology | Health Personnel | Delivery of Health Care | Health | Economic Factors | Mortality | Population Dynamics | Demographic Factors | Population | Social Change | Sociocultural Factors Document Number: 340203 |
| 10. Peer Reviewed Title: Depo-Provera and skeletal health: reviewing the evidence; developing and disseminating a consensus [editorial] Author: Guilbert ER; Kaunitz AM Source: Contraception. 2009 Mar;79(3):165-6. Abstract: Since the approval of injectable medroxyprogesterone acetate (DMPA, Depo-ProveraŽ) in the United States in 1992 and Canada in 1997 and the subsequent "black box" warnings in both countries, DMPA has been the object of more than a hundred publications, including many focusing on its impact on bone mineral density. Apart from these scientific publications, articles in the Canadian lay media have raised concerns, potentially influencing clinician behavior and women's contraceptive choices and usage. (excerpt) Language: English Keywords: CANADA | CRITIQUE | RECOMMENDATIONS | CLINICAL RESEARCH | WOMEN | PHYSICIANS | DEPO-PROVERA | INJECTABLES | CONTRACEPTIVE PREVALENCE | COUNSELING | FAMILY PLANNING POLICY | SKELETAL EFFECTS | PEER REVIEW | OSTEOPOROSIS | Developed Countries | North America, Northern | Americas | Research Methodology | Demographic Factors | Population | Health Personnel | Delivery of Health Care | Health | Medroxyprogesterone Acetate | Contraceptive Agents, Progestin | Contraceptive Agents, Female | Contraceptive Agents | Contraception | Family Planning | Contraceptive Methods | Contraceptive Usage | Clinic Activities | Program Activities | Programs | Organization and Administration | Population Policy | Social Policy | Policy | Political Factors | Sociocultural Factors | Physiology | Biology | Evaluation Document Number: 341130 |
| 11. Peer Reviewed Title: The use of depot-medroxyprogesterone acetate in contraception and its potential impact on skeletal health. Author: Guilbert ER; Brown JP; Kaunitz AM; Wagner MS; Berube J; Charbonneau L; Francoeur D; Gilbert A; Gilbert F; Roy G; Senikas V; Jacob R; Morin R Source: Contraception. 2009 Mar;79(3):167-77. Abstract: BACKGROUND: In the fall of 2007, the controversy about the contraceptive use of depot-medroxyprogesterone acetate (DMPA) and its potential impact on skeletal health reached the media in the province of Quebec, Canada, thereby becoming a matter of concern for the lay public and physicians. In order to discuss this subject openly, the National Institute of Public Health of Quebec (INSPQ) organized a scientific meeting on February 15, 2008, with targeted physicians delegated by their medical associations in the fields of general practice, obstetrics and gynaecology, rheumatology, orthopaedic surgery, physiatry and endocrinology. STUDY DESIGN: Participants reviewed the scientific literature using the study classification method according to the level of evidence, reviewed published guidelines of medical societies and organizations on the subject and reached a consensus position. This manuscript presents a review of the literature and describes the consensus position of the targeted medical associations. RESULTS: The consensus position adopted by all the targeted medical associations determined that DMPA was a cost-effective contraceptive option that must be considered in the light of the clinical situation and preference of each woman. Candidates for injectable contraception should be informed that the use of DMPA is associated with a slight decrease in bone mineral density (BMD), which is largely, if not completely, reversible. There should not be an absolute limit to the length of time that the DMPA contraceptive is used, regardless of the woman's age. Monitoring BMD is not recommended among users of DMPA for contraceptive purposes. Finally, the consensus statement declared that, although supplements of calcium and vitamin D are beneficial for skeletal health for women in general, such supplementation should not be recommended solely based on a woman's use of DMPA. CONCLUSION: Given the scientific evidences, DMPA use remains a valid contraceptive option for women. Its potential impact on BMD must be balanced against the significant individual, familial and social consequences of unintended pregnancy. Language: English Keywords: CANADA | CONFERENCES AND CONGRESSES | LITERATURE REVIEW | CLINICAL RESEARCH | CLASSIFICATION | PHYSICIANS | DEPO-PROVERA | MEDROXYPROGESTERONE ACETATE | SKELETAL EFFECTS | SIDE EFFECTS | PANEL DISCUSSION | CONTRACEPTIVE SAFETY | TIME FACTORS | AGE FACTORS | CONTRAINDICATIONS | North America, Northern | Americas | Developed Countries | Research Methodology | Health Personnel | Delivery of Health Care | Health | Contraceptive Agents, Progestin | Contraceptive Agents, Female | Contraceptive Agents | Contraception | Family Planning | Physiology | Biology | Treatment | Medical Procedures | Medicine | Health Services | Group Meeting | Communication | Safety | Public Health | Population Dynamics | Demographic Factors | Population | Population Characteristics Document Number: 330061 |
| 12. Title: Late termination of pregnancy: a comparison of obstetricians' experience in eight European countries. Author: Habiba M; Da Fre M; Taylor DJ; Arnaud C; Bleker O; Lingman G; Gomez MM; Gratia P; Heyl W; Viafora C Author: EUROBS Study Group Source: BJOG. 2009 Sep;116(10):1340-9. Abstract: OBJECTIVE: To compare the experience and attitude of obstetricians in Europe towards late termination of pregnancy and the factors affecting their responses. DESIGN: Cluster sampling cross-sectional survey. All neonatal intensive care unit (NICU)-associated maternity units were recruited (census sampling) in Luxembourg, the Netherlands and Sweden. In France, Germany, Italy, Spain and the UK, units were selected at random. In every recruited unit, all obstetricians with at least 6 months' experience were invited to participate. SETTING: NICU-associated maternity units in eight European countries. POPULATION: Obstetricians with at least 6 months' clinical experience. METHODS: An anonymous, self-administered questionnaire was used. Multinomial logistic analysis was used to identify factors predicting the obstetricians' views about modifying the law governing late termination in their country. MAIN OUTCOME MEASURE: Obstetricians' experience of late termination of pregnancy and views about national policies. RESULTS: One hundred and five units and 1530 obstetricians participated (response rates 70 and 77% respectively). The most common indications for late termination were congenital anomalies and women's physical health. Feticide was not common except in France, Luxembourg and the UK. Active euthanasia of a liveborn was practiced in France and the Netherlands. Obstetricians in Germany were more likely to feel that late termination should be more severely restricted, the opposite was true in Spain and the Netherlands. In Italy, there was dissatisfaction with current status, but opinion was divided, reflecting views on both sides of the debate. CONCLUSIONS: This research outlines current practice in a difficult and sensitive area and suggests the need for more discussion and support for all those who were involved. Language: English Keywords: EUROPE | RESEARCH REPORT | SAMPLING STUDIES | PHYSICIANS | OBSTETRICS | ABORTION | PREGNANCY, THIRD TRIMESTER | EUTHANASIA | ULTRASONICS | ATTITUDES | QUESTIONNAIRES | NEONATAL DISEASES AND ABNORMALITIES | ETHICS | RELIGIOUS ASPECTS | Developed Countries | Studies | Research Methodology | Health Personnel | Delivery of Health Care | Health | Medicine | Health Services | Fertility Control, Postconception | Family Planning | Pregnancy | Reproduction | Mortality | Population Dynamics | Demographic Factors | Population | Medical Procedures | Psychological Factors | Behavior | Diseases | Sociocultural Factors | Religion Document Number: 342944 Notification |
| 13. Title: The number of procedures required to achieve optimal competency with male circumcision: findings from a randomized trial in Rakai, Uganda. Author: Kiggundu V; Watya S; Kigozi G; Serwadda D; Nalugoda F; Buwembo D; Settuba A; Anyokorit M; Nkale J; Kighoma N; Ssempijja V; Wawer M; Gray RH Source: BJU International. 2009 Aug;104(4):529-32. Abstract: OBJECTIVE: To assess the number of procedures required to achieve optimal competency (time required for surgery with minimal adverse events) in Rakai, Uganda, and thus facilitate the development of guidelines for training providers, as male circumcision reduces the acquisition of human immunodeficiency virus (HIV) in men and is recommended for HIV prevention. PATIENTS AND METHODS: In a randomized trial, 3011 men were circumcised, using the sleeve method, by six physicians who had completed training, which included 15-20 supervised procedures. The duration of surgery from local anaesthesia to wound closure, moderate or severe surgery-related adverse events (AEs), and wound healing were assessed in relation to the number of procedures done by each physician. RESULTS: The median age of the patients was 24 years. The number of procedures per surgeon was 20-981. The mean time required to complete surgery was approximately 40 min for the first 100 procedures and declined to 25 min for the subsequent 100 circumcisions. After controlling for the number of procedures there was no significant difference in duration of the surgery by patient HIV status or age. The rate of moderate and severe AEs was 8.8% (10/114) for the first 19 unsupervised procedures after training, 4.0% for the next 20-99 (13/328) and 2.0% for the last 100 (P for trend, 0.003). All AEs resolved with management. CONCLUSION: The completion of more than 100 circumcisions was required before newly trained physicians achieved the optimum duration of surgery. AEs were higher immediately after training and additional supervision is needed for at least the first 20 procedures after completing training. Language: English Keywords: UGANDA | RESEARCH REPORT | CLINICAL TRIALS | PHYSICIANS | HIV PREVENTION | MALE CIRCUMCISION | COMPLICATIONS | TRAINING PROGRAMS | SUPERVISION | ANESTHESIA | STANDARDS | TIME FACTORS | Africa, Eastern | Africa, Sub Saharan | Africa | Developing Countries | Clinical Research | Research Methodology | Health Personnel | Delivery of Health Care | Health | HIV Infections | Viral Diseases | Diseases | Medical Procedures | Medicine | Health Services | Education | Management | Organization and Administration | Treatment | Population Dynamics | Demographic Factors | Population Document Number: 342642 |
| 14. Peer Reviewed Title: The health worker shortage in Africa: are enough physicians and nurses being trained? Author: Kinfu Y; Poz MR; Mercer H; Evans DB Source: Bulletin of the World Health Organization. 2009 Feb 10;87:225-230. Abstract: Objective: To estimate systematically the inflow and outflow of health workers in Africa and examine whether current levels of pre-service training in the region suffice to address this serious problem, taking into account population increases and attrition of health workers due to premature death, retirement, resignation and dismissal. Methods: Data on the current numbers and types of health workers and outputs from training programmes are from the 2005 WHO health workforce and training institutions' surveys. Supplementary information on population estimates and mortality is from the United Nations Population Division and WHO databases, respectively, and information on worker attrition was obtained from the published literature. Because of shortages of data in some settings, the study was restricted to 12 countries in sub-Saharan Africa. Findings: Our results suggest that the health workforce shortage in Africa is even more critical than previously estimated. In 10 of the 12 countries studied, current pre-service training is insufficient to maintain the existing density of health workers once all causes of attrition are taken into account. Even if attrition were limited to involuntary factors such as premature mortality, with current workforce training patterns it would take 36 years for physicians and 29 years for nurses and midwives to reach WHO's recent target of 2.28 professionals per 1000 population for the countries taken as a whole -and some countries would never reach it. Conclusion: Pre-service training needs to be expanded as well as combined with other measures to increase health worker inflow and reduce the rate of outflow. Language: English Keywords: AFRICA | RESEARCH REPORT | PHYSICIANS | NURSES AND NURSING | HEALTH PERSONNEL | BRAIN DRAIN | RETIREMENT | DEATH | UNEMPLOYMENT | EMPLOYMENT | HUMAN RESOURCES | Developing Countries | Delivery of Health Care | Health | International Migration | Migration | Population Dynamics | Demographic Factors | Population | Employment Status | Socioeconomic Status | Socioeconomic Factors | Economic Factors | Mortality | Macroeconomic Factors Document Number: 340208 |
| 15. Peer Reviewed Title: The Pediatric AIDS Corps: responding to the African HIV/AIDS health professional resource crisis. Author: Kline MW; Ferris MG; Jones DC; Calles NR; Mizwa MB; Schwarzwald HL Source: Pediatrics. 2009 Jan;123(1):134-6. Abstract: Health professional capacity for delivery of HIV/AIDS care and treatment is severely constrained across sub-Saharan Africa. African health professional expertise in pediatrics is in particularly short supply. Here we describe a Pediatric AIDS Corps program that was designed to place pediatricians and other physicians in Africa on a long-term basis to expand existing health professional capacity for pediatric and family HIV/AIDS care and treatment. In the first 2 years of this program, 76 physicians were placed in 5 African countries that have been hit hard by HIV/AIDS. Enrollment of HIV-infected children in care more than quadrupled over a 24-month period, to 26 590. We believe that this pilot program can serve as a model for larger-scale efforts to immediately expand access for African children and families to life-saving HIV/AIDS care and treatment. Language: English Keywords: AFRICA, SUB SAHARAN | EVALUATION REPORT | RECOMMENDATIONS | PILOT PROJECTS | CHILDREN | PERSONS LIVING WITH HIV/AIDS | PHYSICIANS | HUMAN RESOURCES | CAPACITY BUILDING | HIV INFECTIONS | TREATMENT | PROGRAM DESIGN | TRAINING PROGRAMS | PROGRAM ACCESSIBILITY | DELIVERY OF HEALTH CARE | Africa | Developing Countries | Evaluation | Studies | Research Methodology | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Persons Living With HIV/AIDS | Viral Diseases | Diseases | Health Personnel | Health | Economic Factors | Program Sustainability | Programs | Organization and Administration | Medical Procedures | Medicine | Health Services | Education | Program Evaluation Document Number: 328038 |
| 16. Title: Knowledge about breastfeeding among a group of primary care physicians and residents in Puerto Rico. Author: Leavitt G; Martinez S; Ortiz N; Garcia L Source: Journal of Community Health. 2009 Feb;34(1):1-5. Abstract: Physicians have an essential role in promoting, protecting, and supporting breastfeeding as the ideal method of infant feeding. They are in an important position to promote breastfeeding but report difficulty in advising mothers with lactation problems. The purpose of this study is to assess knowledge about breastfeeding among primary care physicians and residents and identify potential barriers to its promotion. One hundred seventy-seven residents and physicians answered an anonymous questionnaire. The participants recognized breastfeeding benefits but 26% did not encourage exclusive breastfeeding. Mastitis, breast abscess, and the use of medications by the mother were considered contraindications to breastfeeding. Temporary breastfeeding discontinuation and bilirubin levels measurement were the preferred recommendations for the jaundiced infant. Most physicians received training in breastfeeding benefits although they report fair knowledge in myths, techniques, and contraindications. Physicians demonstrated to recognize breastfeeding benefits, but formal education is needed to eliminate barriers to breastfeeding promotion and support. Language: English Keywords: PUERTO RICO | RESEARCH REPORT | PHYSICIANS | KNOWLEDGE | PRIMARY HEALTH CARE | HEALTH FACILITIES | BREASTFEEDING | HEALTH EDUCATION | MATERNAL HEALTH | Caribbean | Americas | Developed Countries | Health Personnel | Delivery of Health Care | Health | Sociocultural Factors | Health Services | Infant Nutrition | Nutrition | Education Document Number: 330862 |
| 17. Title: Emergency contraception: Knowledge, attitude and prescription practice among doctors in different specialties in Hong Kong. Author: Lo SS; Kok WM; Fan SY Source: Journal of Obstetrics and Gynaecology Research. 2009 Aug;35(4):767-74. Abstract: Aim: Few studies have evaluated doctors' knowledge, attitudes and practices as regards emergency contraception (EC). Some studies have reported inadequate knowledge, bias and wrong prescriptions by doctors. This article compares the prescription pattern, attitude and knowledge of EC in Hong Kong doctors in different specialties. Methods: Questionnaires were mailed to family physicians, obstetrician-gynecologists and doctors working in family planning clinics to ascertain their attitudes to EC. Those who provided EC described the types of EC used, whether drugs were given in advance and answered a 12-question knowledge test. Those who did not provide EC stated why. Results: A total of 443 completed questionnaires were analyzed: 70.9% of doctors agreed that the benefits of EC outweigh its risks and 61.2% agreed that doctors should discuss it with clients. Advanced provision was supported by 54.2% of doctors but reduced to 32.5% if the target client was a girl aged 16 or below. Even fewer doctors (40.2%) supported the over-the-counter sales of EC pills. In the knowledge test, family planning doctors scored 10.45 out of 12 and obstetrician-gynecologists in private practice had the lowest score of 6.08. Family planning doctors used levonorgestrel pills while private family physicians and obstetrician-gynecologists used Yuzpe. Among 352 doctors who provided EC, only 21.7% of private family physicians and 15.9% of private obstetrician-gynecologists prescribed it in advance. Conclusions: Only doctors working in family planning clinics were competent in their knowledge of emergency contraception and up to date with current practice. Although half of the doctors supported advanced provision, few implemented it. Most doctors did not support advanced provision to young girls nor the over-the-counter sales of EC pills. Language: English Keywords: HONG KONG | RESEARCH REPORT | KAP SURVEYS | PHYSICIANS | EMERGENCY CONTRACEPTION | PRESCRIPTIONS | CONTRACEPTIVE DISTRIBUTION | OBSTACLES | LEVONORGESTREL | ETHINYL ESTRADIOL | IUD | QUESTIONNAIRES | AGE FACTORS | Developed Countries | Asia, Eastern | Asia | Surveys | Sampling Studies | Studies | Research Methodology | Health Personnel | Delivery of Health Care | Health | Contraception | Family Planning | Distributional Activities | Program Activities | Programs | Organization and Administration | Contraceptive Agents, Progestin | Contraceptive Agents, Female | Contraceptive Agents | Contraceptive Agents, Estrogen | Contraceptive Methods | Population Characteristics | Demographic Factors | Population Document Number: 342776 |
| 18. Title: UK centres for Implanon removal [letter] Author: Mansour D Source: Journal of Family Planning and Reproductive Health Care. 2009 Apr;35(2):130. Abstract: Mea culpa -when writing the article on the UK provision for removal of non-palpable contraceptive implants I forgot to include Dr Martyn Walling in Table 1. Martyn has the UK's greatest experience in removing deep implants and is based at Lincolnshire PCT, Orchard House, Greyleas, Sleaford NG34 8PP, UK. He is very happy to accept written referrals sent to this address. Martyn has also been working as an independent practitioner, travelling the length and breadth of the UK, training doctors to locate and remove non-palpable implants. (full-text) Language: English Keywords: UNITED KINGDOM | DIRECTORY | PHYSICIANS | CONTRACEPTIVE IMPLANTS | REFERRAL AND CONSULTATION | PHYSICIAN'S OFFICE | TRAINING ACTIVITIES | Developed Countries | Europe, Western | Europe | Health Personnel | Delivery of Health Care | Health | Contraceptive Methods | Contraception | Family Planning | Program Activities | Programs | Organization and Administration | Health Facilities | Training Programs | Education Document Number: 341649 |
| 20. Peer Reviewed Title: Unsafe abortions common in Colombia despite law change. Author: Moloney A Source: Lancet. 2009 Feb 14;373(9663):534. Abstract: Despite Colombia's high court move to liberalize abortion laws in 2006, many women are still putting their lives at risk by having backstreet terminations. Language: English Keywords: COLOMBIA | RESEARCH REPORT | KAP SURVEYS | WOMEN IN DEVELOPMENT | PHYSICIANS | ABORTION LAW | ABORTION | CULTURE | KNOWLEDGE | CATHOLICISM | ATTITUDES | SOCIOECONOMIC STATUS | Developing Countries | South America, Northern | South America | Latin America | Americas | Surveys | Sampling Studies | Studies | Research Methodology | Economic Development | Economic Factors | Health Personnel | Delivery of Health Care | Health | Fertility Control, Postconception | Family Planning | Sociocultural Factors | Christianity | Religion | Psychological Factors | Behavior | Socioeconomic Factors Document Number: 330425 Notification |
| 21. Title: Concerns, attitudes, and practices of orthopaedic surgeons towards management of patients with HIV/AIDS in Nigeria. Author: Obalum DC; Eyesan SU; Ogo CN; Enweani UN; Ajoku JO Source: International Orthopaedics. 2009 Jun;33(3):851-4. Abstract: The increasing number of people living with HIV/AIDS is causing concern among surgeons over risk of occupationally acquired HIV infection. This may influence their attitude to such patients. The purpose of this study was to develop a cross-sectional survey of orthopaedic surgeons to assess their concerns, attitudes, and practices towards management of HIV-positive patients in Nigeria. All respondents were males, 55 (73.3%) of them indicated concern over the risk of occupational acquisition of HIV infection and 37 (49.3%) had examined or operated on at least one HIV/AIDS patient. Sixty (79.9%) were willing to be tested for HIV and 51 (67.9%) were previously tested. Fifty-seven (75.9%) would order preoperative HIV screening of high risk patients, and 67 (89.3%) would operate on HIV-positive patients. Most orthopaedic surgeons in Nigeria would operate on HIV-positive patients. Language: English Keywords: NIGERIA | RESEARCH REPORT | CROSS SECTIONAL ANALYSIS | CLIENTS | PHYSICIANS | PERSONS LIVING WITH HIV/AIDS | STAFF ATTITUDE | SURGERY | OCCUPATIONAL HEALTH | MANAGEMENT | Developing Countries | Africa, Western | Africa, Sub Saharan | Africa | Research Methodology | Program Activities | Programs | Organization and Administration | Health Personnel | Delivery of Health Care | Health | HIV Infections | Viral Diseases | Diseases | Attitudes | Psychological Factors | Behavior | Treatment | Medical Procedures | Medicine | Health Services Document Number: 342674 |
| 22. Peer Reviewed Title: Ethical and social issues facing obstetricians in low-income countries. Author: Ogwuegbu CC; Eze OH Source: Clinical Obstetrics and Gynecology. 2009 Jun;52(2):237-49. Abstract: A review of publications on ethical and social issues from low-income countries was done with the aim of highlighting the major ethical and social issues facing obstetricians in these countries. Low-income countries were identified using the World Health Organization income group classification of member nations. Obstetricians in low-income countries face a wide range of special social and ethical issues that reflect the peculiarities of their practice environment characterized by poverty, low education, deep attachment to tradition and culture, low social status of women, and high levels of physician's paternalism. Language: English Keywords: DEVELOPING COUNTRIES | CRITIQUE | LITERATURE REVIEW | PHYSICIANS | OBSTETRICS | ETHICS | POVERTY | SOCIOCULTURAL FACTORS | WOMEN'S STATUS | MATERNAL HEALTH SERVICES | UTILIZATION OF HEALTH CARE | DECISION MAKING | INFORMED CONSENT | EDUCATIONAL STATUS | HARMFUL TRADITIONAL PRACTICES | Health Personnel | Delivery of Health Care | Health | Medicine | Health Services | Socioeconomic Factors | Economic Factors | Maternal-Child Health Services | Primary Health Care | Behavior | Socioeconomic Status | Traditional Health Practices | Culture Document Number: 342174 |
| 23. Peer Reviewed Title: Support for provision of early medical abortion by mid-level providers in Bihar and Jharkhand, India. Author: Patel L; Bennett TA; Halpern CT; Johnston HB; Suchindran CM Source: Reproductive Health Matters. 2009 May;17(33):70-79. Abstract: Medical abortion has the potential to increase the number, cadre and geographic distribution of providers offering safe abortion services in India. This study reports on a sample of family planning providers (263 mid-level providers, 54 obstetrician-gynaecologists and 88 general physicians) from a 2004 survey of health facilities and their staff in Bihar and Jharkhand, India. It identified factors associated with mid-level provider interest in training for early medical abortion provision, and examined whether obstetrician-gynaecologists and general physicians supported non-physicians being trained to provide early medical abortion and what factors influenced their attitudes. Findings demonstrate high levels of mid-level provider interest and reasonable physician support. Among mid-level providers, being male, having a more permissive attitude towards abortion and current provision of abortion using any pharmacological drugs were associated with greater interest in attending training. Mid-level providers based in private health facilities were less likely to show interest. More permissive attitude towards abortion and current medical abortion provision using mifepristone-misoprostol were inversely associated with obstetrician-gynaecologists' support for non-physician provision of medical abortion. General physicians based in private/other health facilities were less supportive than those in public facilities. Study findings strengthen the case for policymakers to expand the pool of cadres that can legally provide safe abortion care in India. Spanish Abstract: Los servicios de aborto con medicamentos tienden a aumentar el número, tipo y distribución geográfica de prestadores de servicios de aborto seguro en la India. Este estudio informa sobre una muestra de proveedores de planificación familiar (263 de nivel intermedio, 54 gineco-obstetras y 88 médicos generales), de una encuesta realizada en 2004 con personal y establecimientos de salud en Bihar y Jharkhand, en la India. Se identificaron los factores asociados con el interés de los profesionales de nivel intermedio en recibir capacitación en la prestación de servicios de aborto con medicamentos temprano, y se examinó si los gineco-obstetras y médicos generales apoyaban la capacitación del personal no médico en estos servicios, así como los factores que influyeron en sus actitudes. Los resultados demuestran altos niveles de interés por parte de los prestadores de nivel intermedio y considerable apoyo de los médicos. Entre los prestadores de nivel intermedio, ser hombre, tener una actitud más permisiva hacia el aborto y proporcionar servicios de aborto con fármacos, se asociaron con mayor interés en la capacitación. Los prestadores de nivel intermedio en establecimientos privados tendían a mostrar menos interés. Las actitudes más permisivas hacia el aborto y la práctica de abortos con mifepristona-misoprostol estaban asociadas inversamente con el apoyo de los gineco-obstetras a la práctica de abortos con medicamentos por personal no médico. Los médicos generales en establecimientos privados brindaron menos apoyo que aquéllos en establecimientos públicos. Estos resultados confirman que los formuladores de políticas deben ampliar el grupo de prestadores de servicios de aborto seguro y legal en la India. French Abstract: L'avortement médicamenteux peut accroître le nombre, le type et la distribution géographique des prestataires de services d'avortement médicalisé en Inde. Cette étude porte sur un échantillon de prestataires de planification familiale (263 cadres moyens, 54 gynécologues-obstétriciens et 88 médecins généralistes) interrogés pour une enquęte de 2004 sur les établissements de santé et leur personnel au Bihar et Jharkhand, Inde. Elle a répertorié les facteurs associés avec l'intéręt des cadres moyens pour une formation ŕ l'avortement médicamenteux précoce et a examiné si les gynécologues-obstétriciens et les médecins généralistes soutenaient la formation de non-médecins ŕ ces services et quels facteurs influençaient leurs attitudes. Les conclusions montrent des niveaux élevés d'intéręt de la part des cadres moyens et un soutien raisonnable des médecins. Le fait d'ętre un homme, d'avoir une attitude plus permissive ŕ l'égard de l'avortement et de pratiquer des avortements pharmaceutiques était associé ŕ un plus grand intéręt des cadres moyens pour la formation. Les cadres moyens basés dans des établissements privés avaient moins de probabilités d'ętre intéressés. Une attitude plus permissive ŕ l'égard de l'avortement et la pratique d'avortements avec la mifépristone et le misoprostol était inversement associée au soutien que les gynécologues-obstétriciens apportaient ŕ la pratique d'avortements médicamenteux par des non-médecins. Les médecins généralistes basés dans des établissements privés ou autres étaient moins favorables que ceux des centres publics. Les conclusions de l'étude confirment que les décideurs doivent élargir le groupe de prestataires qui peuvent légalement pratiquer des avortements médicalisés en Inde. Language: English Keywords: INDIA | RESEARCH REPORT | SAMPLING STUDIES | STATISTICAL REGRESSION | FIELD WORKERS | NURSE-MIDWIVES | PARAMEDICAL PERSONNEL | PHYSICIANS | ABORTION | RU-486 | MISOPROSTOL | TRAINING PROGRAMS | ATTITUDES | Asia, Southern | Asia | Developing Countries | Studies | Research Methodology | Data Analysis | Health Personnel | Delivery of Health Care | Health | Fertility Control, Postconception | Family Planning | Hormone Antagonists | Hormones | Endocrine System | Physiology | Biology | Prostaglandins, Synthetic | Prostaglandins | Education | Psychological Factors | Behavior Document Number: 342016 Notification |
| 24. Title: A survey of New Zealand RANZCOG Fellows on their use of the levonorgestrel intrauterine device in adolescents. Author: Paterson H; Miller D; Devenish C Source: Australian and New Zealand Journal of Obstetrics and Gynaecology. 2009 Apr;49(2):220-5. Abstract: BACKGROUND: The levonorgestrel intrauterine device (LNG-IUD) is an established treatment for adult women. Although it is being used in adolescents, there is little published research in this age group to date. Recent reviews and editorials have challenged the long-held views that intrauterine devices should not be used in young women. AIMS: This study aimed to identify the patterns of use, including indications and contraindications of the LNG-IUD in adolescents by RANZCOG Fellows practising in New Zealand. METHODS: A postal survey of New Zealand RANZCOG Fellows on their use of the LNG-IUD in females aged 10-19 years. RESULTS: There was a 72% response rate. Half of the respondents had inserted the LNG-IUD in adolescents. Non-inserters identified a significantly greater number of contraindications than inserters (chi2, P < 0.0001). Over half of those respondents who had inserted a device in an adolescent did so fewer than three times per year. Intellectual disability and endometriosis, both unlicensed indications, were the two most commonly identified circumstances for insertion by respondents. CONCLUSIONS: Patterns of insertion of the LNG-IUD in adolescents by RANZCOG Fellows in New Zealand differ and there was equipoise over its use. Further research is required to establish the efficacy, safety and acceptability of the LNG-IUD in adolescents. Language: English Keywords: NEW ZEALAND | RESEARCH REPORT | SURVEYS | PHYSICIANS | ADOLESCENTS, FEMALE | IUD, HORMONE RELEASING | LEVONORGESTREL | CONTRAINDICATIONS | INSERTION | ENDOMETRIOSIS | MENTAL RETARDATION | QUESTIONNAIRES | Oceania | Developed Countries | Sampling Studies | Studies | Research Methodology | Health Personnel | Delivery of Health Care | Health | Adolescents | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | IUD | Contraceptive Methods | Contraception | Family Planning | Contraceptive Agents, Progestin | Contraceptive Agents, Female | Contraceptive Agents | Treatment | Medical Procedures | Medicine | Health Services | Diseases | Intelligence | Personality | Psychological Factors | Behavior Document Number: 342382 |
| 25. Peer Reviewed Title: Confronting the legal risks of prescribing the contraceptive patch with ongoing litigation. Author: Phelps JY; Kelver ME Source: Obstetrics and Gynecology. 2009 Mar;113(3):712-6. Abstract: Recent changes in U.S. Food and Drug Administration (FDA) labeling and news reports of lawsuits resulting in million-dollar settlements understandably may deter gynecologists from prescribing the transdermal contraceptive patch Ortho Evra (Ortho-McNeil Pharmaceutical, Inc., Titusville, NJ). Gynecologists who, with all good intentions, prescribe an FDA-approved drug such as the contraceptive patch potentially could find themselves liable for an adverse drug reaction. Although much of the current focus by plaintiff attorneys and the news media is on the contraceptive patch, no prescription contraceptive method is without medical risks to the patient or legal risks to the prescribing gynecologist. The purpose of this commentary is to provide an overview of the medical-legal controversies and pitfalls in prescribing the contraceptive patch as well as to outline how gynecologists can avert legal liability by providing proper informed consent. Despite FDA labeling changes and ongoing litigation, with proper informed consent, the contraceptive patch still may be the best choice for many patients who prefer the convenience of a weekly patch over a daily oral contraceptive. Also, regardless of the contraceptive option chosen, the principles of providing and documenting proper informed consent in medical records are applicable not only to providing quality care to patients, but also to protecting the legal interests of the prescribing gynecologist. By documenting proper informed consent in medical records, gynecologists should feel more at ease in prescribing the contraceptive method that best fits their individual patients' needs, even in the presence of ongoing litigation. Language: English Keywords: UNITED STATES OF AMERICA | CRITIQUE | RECOMMENDATIONS | EVALUATION | PHYSICIANS | LITIGATION | RISK ASSESSMENT | PRESCRIPTIONS | CONTRACEPTIVE AGENTS, FEMALE | ADMINISTRATION AND DOSAGE | USFDA | SIDE EFFECTS | INFORMED CONSENT | RECORDS | Developed Countries | North America | Americas | Health Personnel | Delivery of Health Care | Health | Political Factors | Sociocultural Factors | Distributional Activities | Program Activities | Programs | Organization and Administration | Contraceptive Agents | Contraception | Family Planning | Drugs | Treatment | Medical Procedures | Medicine | Health Services | USPHS | Government Agencies | Organizations | Information Processing | Information Document Number: 330700 |
| 26. Peer Reviewed Title: Confronting the legal risks of prescribing the contraceptive patch with ongoing litigation. Author: Phelps JY; Kelver ME Source: Obstetrics and Gynecology. 2009 Jun;113(6):1367-8. Abstract: As former Senior Medical Officer in the Division at the Center for Drug Evaluation and Research at the U.S. Food and Drug Administration (FDA), which handled the original approval for Ortho Evra (norelgestromin/ethinyl estradiol [E2], Ortho Women's Health & Urology, Raritan, NJ), Dr. Patsner's insider perspective is informative and a worthwhile contribution. However, we respectfully disagree with his comments that "physicians should be aware that even the best informed consent likely will provide little or no shield if they are sued in a medical malpractice action for prescribing the patch . . ." and that ". . . ob-gyns should steer clear of the product." We stand firm that providing proper informed consent is critical not only to providing quality patient care but also to deterring potential lawsuits against physicians prescribing the contraceptive patch. Additionally, despite litigation, we believe that the contraceptive patch should remain an option for many patients. The two primary causes of action that plaintiff attorneys may pursue against physicians prescribing the contraceptive patch are 1) medical negligence for breaching the standard of care by prescribing the contraceptive patch and 2) failure to provide informed consent by not warning patients of the risks of the contraceptive patch. As long as the contraceptive patch remains U.S. Food and Drug Administration-approved, it will be difficult for plaintiff attorneys to prevail in arguing that a physician breached the standard of care by prescribing the contraceptive patch, unless it was prescribed to a patient with a known contraindication to the contraceptive patch. The vast majority of patients seeking birth control do not have known medical contraindications to the contraceptive patch. The best way to negate the other potential cause of action-failure to provide informed consent-is to provide and document informed consent in the medical records. Once informed consent is documented in the medical records, there is the legal presumption in favor of the physician that the medical records are accurate and that the patient was provided proper informed consent. However, this is a rebuttable presumption, and an injured patient will be given the opportunity to dispute that she was not properly informed of the risks and that she would not have chosen the contraceptive patch as a means of contraception if she had been properly informed of the risks. Nevertheless, the legal presumption remains that the information documented in the medical records is accurate. By documenting proper informed consent in the medical records, physicians should be more comfortable in prescribing the contraceptive method they believe best fits the needs of their patients, regardless of ongoing litigation and controversies surrounding a contraceptive product. (full-text) Language: English Keywords: UNITED STATES OF AMERICA | TEXAS | CRITIQUE | USFDA | PHYSICIANS | PRESCRIPTIONS | CONTRACEPTION | PRODUCT APPROVAL | INFORMED CONSENT | Developed Countries | North America | Americas | USPHS | Government Agencies | Organizations | Political Factors | Sociocultural Factors | Health Personnel | Delivery of Health Care | Health | Distributional Activities | Program Activities | Programs | Organization and Administration | Family Planning | Legislation | Health Services Document Number: 341195 |
| 27. Peer Reviewed Title: Validation of an Integrated Management of Childhood Illness algorithm for managing common skin conditions in Fiji. Author: Steer AC; Tikoduadua LV; Manalac EM; Colquhoun S; Carapetis JR; Maclennan C Source: Bulletin of the World Health Organization. 2009 Mar;87(3):173-9. Abstract: OBJECTIVE: To assess the sensitivity of an Integrated Management of Childhood Illness (IMCI) algorithm to detect common skin conditions in children in Fiji. METHODS: We collected data from the assessments of children aged between 2 months and 5 years who presented to one of two health clinics. Every child was assessed by a nurse trained in the use of the IMCI algorithm and also an expert paediatrician. We used a kappa statistic to measure agreement between the nurse/algorithm assessment method and the paediatrician's diagnosis. FINDINGS: High sensitivity for identifying skin problems (sensitivity: 98.7%; 95% confidence interval, CI: 95.5-99.9) was found for the algorithm applied by IMCI-trained nurses, who were able to identify the one child with a severe skin infection and all three children with periorbital cellulitis. Sensitivity was high for the classification of abscess/cellulitis (sensitivity: 95%; 95% CI: 75.1-99.9) and infected scabies (sensitivity: 89.1%; 95% CI: 77.8-95.9), but lower for identification of impetigo, fungal infection and, in particular, non-infected scabies. CONCLUSION: The IMCI skin algorithm is a robust tool that should be incorporated into the IMCI after some modifications relating to scabies and impetigo. Its use by primary health-care workers will reduce the burden of skin diseases in children in Fiji through improved case identification and management. The algorithm should be considered in other countries where skin diseases in children are a priority, particularly in the Pacific region. Language: English Keywords: FIJI | EVALUATION REPORT | NURSES AND NURSING | PHYSICIANS | DERMATOLOGICAL EFFECTS | CHILD HEALTH SERVICES | INTEGRATED PROGRAMS | SIGNS AND SYMPTOMS | PHYSICAL EXAMINATIONS AND DIAGNOSES | TREATMENT | TRAINING ACTIVITIES | Developing Countries | Oceania | Evaluation | Health Personnel | Delivery of Health Care | Health | Physiology | Biology | Maternal-Child Health Services | Primary Health Care | Health Services | Programs | Organization and Administration | Diseases | Examinations and Diagnoses | Medical Procedures | Medicine | Training Programs | Education Document Number: 342353 |
| 28. Peer Reviewed Title: Surgeons and HIV: South African attitudes. Author: Szabo CP; Dhai A; Veller M; Kleinsmidt A Source: South African Medical Journal. 2009 Feb;99(2):110-3. Abstract: OBJECTIVES: The HIV status of surgeons, in the context of the informed consent obtained from their patients, is a contentious matter. We surveyed the views of practising surgeons in South Africa regarding aspects of HIV and its impact on surgeons. DESIGN: A cross-sectional survey of surgeons who were members of the Association of Surgeons of South Africa, regarding their attitudes to the preceding issues. RESULTS: The salient findings included the view that a patient-centered approach requiring HIV status disclosure to patients would be discriminatory to surgeons and provide no clear benefit to patients, and that HIV-positive surgeons should determine their own scope of practice. CONCLUSION: Patient-centered approaches and restrictive policies, related to this issue, do not accord with clinician sentiment. In the absence of comparable local or international data, this study provides clinicians' views with implications for the development of locally relevant policies and guidelines. Language: English Keywords: SOUTH AFRICA | SUMMARY REPORT | CROSS SECTIONAL ANALYSIS | PHYSICIANS | SURGERY | PERSONS LIVING WITH HIV/AIDS | CLIENTS | ATTITUDES | INFORMED CONSENT | Developing Countries | Africa, Southern | Africa, Sub Saharan | Africa | Research Methodology | Health Personnel | Delivery of Health Care | Health | Treatment | Medical Procedures | Medicine | Health Services | HIV Infections | Viral Diseases | Diseases | Program Activities | Programs | Organization and Administration | Psychological Factors | Behavior Document Number: 341325 |
| 29. Peer Reviewed Title: Intervention to train physicians in rural China on HIV/STI knowledge and risk reduction counseling: preliminary findings. Author: Wang D; Operario D; Hong Q; Zhang H; Coates TJ Source: AIDS Care. 2009 Apr;21(4):468-72. Abstract: We evaluated an intervention to train physicians in rural China on knowledge of HIV/STI prevention, diagnosis, treatment options, and HIV/STI behavioral risk reduction counseling. This paper reports preliminary findings related to feasibility and acceptability of the program. Using a pre-post design, 69 physicians were recruited from rural county hospitals and participated in a 10-day group training program, followed by two months of clinical fieldwork and two additional weeks of training. Physicians completed baseline and six-month assessments. Patients' cohorts, recruited from clinic waiting areas of participating physicians, completed baseline and six-month HIV/STI risk assessments. Physicians reported increased knowledge of HIV biology and pathology, epidemiology, host immune response, opportunisitic infection and syndromic management, antiretroviral therapy, risk reduction counseling, and stigma reduction following the training. Patients reported improved knowledge of HIV, reduced HIV stigma, higher rates of HIV testing, and improved condom use at follow-up. The findings suggest that training physicians on HIV/STI-related knowledge and risk reduction counseling is a promising strategy for reducing HIV/STI epidemics in rural China. Language: English Keywords: CHINA | RURAL AREAS | EVALUATION REPORT | PROVIDERS WITH CLIENTS | PHYSICIANS | TRAINING PROGRAMS | HIV PREVENTION | SEXUALLY TRANSMITTED DISEASE PREVENTION | KNOWLEDGE | RISK REDUCTION BEHAVIOR | COUNSELING | PROGRAM ACCEPTABILITY | Asia, Eastern | Asia | Developing Countries | Geographic Factors | Population | Evaluation | Health Services | Delivery of Health Care | Health | Health Personnel | Education | HIV Infections | Viral Diseases | Diseases | Sexually Transmitted Diseases | Reproductive Tract Infections | Infections | Sociocultural Factors | Behavior | Clinic Activities | Program Activities | Programs | Organization and Administration | Program Evaluation Document Number: 341835 |
| 30. Title: [Cross-sectional study on rates and influential factors of standard medication for antiretroviral therapy in preventing mother-to-child transmission of HIV] Author: Wang YZ; Li Y; Jiang CQ; Zheng M; Zhang Y; Xiong YH; Yang YY; Luo KM Source: Zhonghua Yu Fang Yi Xue Za Zhi /Chinese Journal of Preventive Medicine. 2009 Apr;43(4):277-81. Abstract: OBJECTIVE: To understand the status of standard medication of antiretroviral therapy and identify its correlationship with preventing mother-to-child transmission of HIV (PMTCT). METHODS: Qualitative and quantitative methods for measuring of standard medication towards antiretroviral therapy of PMTCT were used in a cross-sectional study of 167 pregnant women who had accessed to PMTCT services and 57 physicians providing service from January 2005 to June 2007 in 5 HIV epidemic counties in Yunnan province. RESULTS: A total of 167 mothers were recruited, of which 65.87% (110/167) demonstrated for standard medication. The percentage of rational selection of antivirus-therapy regimen was 88.02% (147/167). HIV positive mothers with rational using medicine during labor covered 81.37% (131/161). 87.42% (146/167) of women demonstrated good compliance. The main correlations with the standard medication level of HIV positive pregnant women and their infants were as follows: diagnose time (OR = 2.617; 95% CI: 1.184 - 5.783), place of delivery (OR = 0.064; 95% CI: 0.007 - 0.607), minorities (OR = 0.344; 95% CI: 0.162 - 0.730), understanding of HIV women for antiretroviral therapy (OR = 6.843; 95% CI: 1.449 - 32.312), and doctors' cognition about the regimen for antiretroviral therapy was not enough; 5 key knowledge points (purpose of PMTCT, the consequence of not requiring standard medication, the effect of knowing regimens, the relationship of CD4 levels and selected regimens, the side effect of the relevant medicine) score rate was 47.72% (136/285). CONCLUSION: The proportions of standard medication in PMTCT antiretroviral therapy were not high. Standard medication might be associated with multiple factors from doctors, patients and society. It is necessary to make some steps to improve standard medication of antiretroviral therapy in PMTCT. Language: Chinese Keywords: CHINA | RESEARCH REPORT | CROSS SECTIONAL ANALYSIS | PREGNANT WOMEN | PHYSICIANS | PREVENTION OF MOTHER-TO-CHILD TRANSMISSION | ANTIRETROVIRAL THERAPY | HIV TRANSMISSION | HIV PREVENTION | MATERNAL-CHILD HEALTH SERVICES | ANTIRETROVIRAL DRUGS | ADMINISTRATION AND DOSAGE | STANDARDS | PROGRAM EVALUATION | Asia, Eastern | Asia | Developing Countries | Research Methodology | Population Characteristics< |