Differences in triage and medical confidentiality between prisons of Belgium and the Netherlands

Objectives: The aim of this study is to describe the opinions of prison doctors, and to compare the primary health care in prisons between Belgium and the Netherlands. Methods: Structured interviews, audio-recorded and transcribed verbatim, were conducted with prison doctors in Dutch-speaking prisons in Flanders/Belgium and in the Netherlands. Two investigators analysed the content of the interviews and discussed each individual interview. Results: In total 37 interviews were conducted in 28 prisons (14 in each country). In Belgium, 14 of 17 prison doctors, compared to 1 of 12 in the Netherlands, experienced higher time pressure during their consultations in prison, compared to their private medical work (P < 0.001). In the Netherlands, compared to Belgium, there is more access to psychiatric support (14/14 vs 11/22, P = 0.002), psychological care (13/13 vs 7/22, P < 0.001), and interpreter facilities (15/22 vs 0/14, P < 0.001). Prison doctors in both countries agree that the possibility for a strictly personal encounter with the patient - without the presence of other medical staff - can be very useful (21/22 in Belgium vs 15/15 in the Netherlands). In Belgium, individual consultations with the detainee are not possible. Conclusions: Compared to the situation in the Netherlands, the medical work of prison doctors in Belgium is characterized by time pressure and lack of psychiatric and psychological support. The absence of interpreter facilities in Belgium handicaps the quality of the primary health care in prisons. In addition, the lack of private encounters with a doctor in Belgian prisons violates the patient rights of the detainee

Stimulating preventive procedures in primary care : effect of PIUPOZ program on the delivery of preventive procedures

Introduction: Educational meetings are one of the most frequently used strategies to change doctors' professional behavior; however, their effectiveness as a single intervention is limited. This study evaluated the effect of a multifactorial intervention, based on interactive workshops, on the GPs' knowledge and the delivery rates of preventive procedures in primary care. Material and methods: The study population comprised 106 GPs working in the Wielkopolska region recruited to the PIUPOZ program (Improving Quality in Primary Care). The intervention in the program consisted of lectures, interactive workshops and an audit, before and three months after the training. Trained medical students directly observed GPs to register which of 12 studied preventive procedures were performed during the consultation in patients aged 40+. Results: A total of 1060 consultations were recorded, during which 4899 preventive procedures were delivered: 2115 before and 2784 after workshops. The mean number of preventive procedures per patient before and after workshops was 3.84 and 5.25 respectively (p < 0.0001). The most commonly performed preventive procedures were blood pressure, blood glucose and lipid profile measurement. Mean number of correct answers for 16 questions in the initial knowledge test was 8.7 and 12.7 in the final test (p < 0.0001). Conclusions: The observed number of delivered preventive procedures was below the recommended range. Preventive procedures based on laboratory tests were performed more often than lifestyle counseling

Registration of HIV risk factors in the Electronic Medical Record (EMR): what do GPs in Flanders prefer?

There is an increase of HIV-diagnoses in Belgium among men who have sex with men. GPs take a key position in discussing sexuality with their patients. They have an overall picture of their patients health, including the health risks (e.g. smoking). Yet it is unclear whether GPs are aware of the (extent of) sexual risk behaviour and the sexual orientation of their patients before problems occur. However, at least the awareness of sexual risk behaviour and/or the sexual orientation of patients seems to be necessary for the prevention of HIV. This study explores the views of GPs in Flanders regarding the discussion and registration of HIV risk factors in primary care

Collecting and registering sexual health information in the context of HIV risk in the electronic medical record of general practitioners: a qualitative exploration of the preference of general practitioners in urban communities in Flanders (Belgium)

Background and aim: Current health-care delivery requires increasingly proactive and inter-professional work. Therefore, collecting patient information and knowledge management is of paramount importance. General practitioners (GPs) are well placed to lead these evolving models of care delivery. However, it is unclear how they are handling these changes. To gain an insight into this matter, the HIV epidemic was chosen as a test case. Methods: Data were collected and analysed from 13 semi-structured interviews with GPs, working in urban communities in Flanders. Findings: GPs use various types of patient information to estimate patients’ risk of HIV. The way in which sexual health information is collected and registered, depends on the type of information under discussion. General patient information and medical history data are often automatically collected and registered. Proactively collecting sexual health information is uncommon. Moreover, the registration of the latter is not obvious, mostly owing to insufficient space in the electronic medical record (EMR). Conclusions: GPs seem willing to systematically collect and register sexual health information, in particular about HIV-risk factors. They expressed a need for guidance together with practical adjustments of the EMR to adequately capture and share this information

Registration of sexual orientation in the electronic medical record in family practice: opinions of general practitioners (GPs) in Flanders

Background: Discussing sexual health is a sensitive issue in family practice, these data are often unknown and it is unclear if GP’s know the sexual orientation of patients[1]. Although homosexuals are a minority, they are prominently present in the HIV-population in Belgium[2]. Sexual culture among gay men is not only an individual matter, but embedded in a broader gay community. GP’s, as leading medical actor of community care, may support the continuity of (primary) health care by identifying patients at risk and develop targeted interventions. Aim: Exploring the view of GP’s in Flanders regarding a systematic registration of the sexual orientation and other risk factors for HIV. Methodology: An interview guide got drawn up through literature review, group conversations among the authors and feedback from experts. Data were collected and analysed from 13 semi structured interviews of GP’s, living in urban communities in Flanders. Results: Most GP’s see the Electronic Medical Record (EMR) as a valuable tool and communicator. However, there is no appropriate place to record patients' sexual information or –orientation. Currently GP’s acquire this information from signals of the patient, collecting this information actively outside a clinical context is uncommon. Yet it seems that with appropriate support, GP’s are willing to systematically collect information about HIV risk factors. Conclusion: GP’s underline the relevance of knowing the sexual orientation of patients; some of them even favour systematic registration in the EMR to organize optimal care and prevention. GP’s are of the opinion they have an important role to play in this matter

The attractiveness of family medicine among Polish medical students

Background: In many developed countries tuning supply and demand of medical doctors is a continuous challenge to meet the ever changing needs of community and individual patients. The long study period for medical doctors creates the opportunity to observe the current career preferences of medical students and evolution in time. Objectives : To investigate the career choices of Polish students in different stages of their medical education. Methods : Medical students at five Polish medical universities were questioned about their career aspirations in the first, third and sixth year. Results : A total of 2020 students were recruited for the survey. Among first year students 17% preferred family medicine as final career option, compared to 20% in the third year, and 30% in the sixth year (significant trend, P < 0.0001). In particular, female students prefer family medicine: 71% women versus 62% women in the group with a preference for a non-family medicine orientation (P = 0.008). Medical students rejecting a career as a family doctor stated that the impossibility to work in a hospital environment was the determining factor. Conclusion: The opportunity for professional development seems to be an important determining factor in the choice of a medical specialty in Poland. The proportion of Polish students choosing family medicine increases during their progress in medical education, with one third of students interested in a career in family medicine by year six

Metal mining and birth defects : a case-control study in Lubumbashi, Democratic Republic of the Congo

Background Widespread environmental contamination caused by mining of copper and cobalt has led to concerns about the possible association between birth defects and exposure to several toxic metals in southern Katanga, Democratic Republic of the Congo (DRC). We therefore aimed to assess the possible contribution of parental and antenatal exposure to trace metals to the occurrence of visible birth defects among neonates. Methods We did a case-control study between March 1, 2013, and Feb 28, 2015, in Lubumbashi, DRC. We included newborns with visible birth defects (cases) and healthy neonates born in the same maternity ward (controls). Mothers were interviewed about potentially relevant exposures, including their partners' jobs. Various trace metals were measured by inductively coupled plasma mass spectrometry in maternal urine, maternal blood, umbilical cord blood, placental tissue, and surface dust at home. Multivariable logistic regression analyses were done to calculate adjusted odds ratios and their 95% CIs (CI). Findings Our study included 138 neonates with visible birth defects (about 0.1% of the 133 662 births in Lubumbashi during the study period) and 108 control neonates. Potential confounders were similarly distributed between cases and controls. Vitamin consumption during pregnancy was associated with a lower risk of birth defects (adjusted odds ratio 0.2, 95% CI 0.1-0.5). Mothers having paid jobs outside the home (2.8, 1.2-6.9) and fathers having mining-related jobs (5.5, 1.2-25.0) were associated with a higher risk of birth defects. We found no associations for trace metal concentrations in biological samples, except for a doubling of manganese (Mn; 1.7, 1.1-2.7) and zinc (Zn; 1.6, 0.9-2.8) in cord blood. In a separate model including placentas, a doubling of Mn at the fetal side of the placenta was associated with an increased risk of birth defects (3.3, 1.2-8.0), as was a doubling of cord blood Zn (5.3, 1.6-16.6). Interpretation To our knowledge, this is the first study of the effects of mining-related pollution on newborns in sub-Saharan Africa. Paternal occupational mining exposure was the factor most strongly associated with birth defects. Because neither Mn nor Zn are mined in Lubumbashi, the mechanism of the association between their increased prenatal concentrations and birth defects is unclear