A comparative study of patient satisfaction with mental health services in Armenia and Moldova

American University of Armenia, Yerevan, The 6th International Medical Congress for Students and Young Doctors, May 12-14, 2016Introduction: Mental health is just as important as physical health to the overall well-being of individuals, societies and countries. It is accountable for 12% of the global burden of disease whereas global budgets of the majority of the countries allocate less than 1% of their total health expenditure to mental health care. Morbidity rates for psychiatric diseases in Republic of Armenia have increased from 228 per 100.000 general population in 2006 to 243.6 in 2009. Whereas the prevalence of mental and behavior disorders among the population of Republic of Moldova has grown from 2,599 per 100 000 people to 2,649 in 2009. This qualitative research study examines and compares patient satisfaction with mental health care services in Armenia and Moldova. Methods: An exploratory qualitative study on patient satisfaction with mental health care services was conducted in Yerevan and Chisinau. The study collected data via in-depth interviews. The study population included caregivers of 18 to 65 years old mentally ill patients. A semi-structured in depth interview guide was developed in English, and translated into Armenian and Romanian. A trained interviewer for Armenia conducted 21 in-depth interviews and one focus group, while for Moldova the student investigator conducted 24 in-depth interviews. Detailed notes were taken during the interview and later transcribed in English. The transcripts were coded by words, phrases and ideas, and analyzed by hand. Several ethics committees approved the study.Results and discussion: Four domains expressing the main concerns that the participants had, that influenced their patients’/relatives’ satisfaction and revealing information that would be more helpful to improve the quality of care in mental health were: financial access, commodities in hospital, medical staff qualifications and attitudes, and overall satisfaction of patient and relative. Part of the similarities between Armenia and Moldova is the fact that participants and patients were overall satisfied with the services, despite the shortage of drugs at times, additional expenses it caused and uncomfortable conditions within the hospital

Smoking behavior, attitudes, and cessation counseling among healthcare professionals in Armenia

Abstract Background Smoking cessation counseling by health professionals has been effective in increasing cessation rates. However, little is known about smoking cessation training and practices in transition countries with high smoking prevalence such as Armenia. This study identified smoking-related attitudes and behavior of physicians and nurses in a 500-bed hospital in Yerevan, Armenia, the largest cancer hospital in the country, and explored barriers to their effective participation in smoking cessation interventions. Methods This study used mixed quantitative and qualitative methods. Trained interviewers conducted a survey with physicians and nurses using a 42-item self-administered questionnaire that assessed their smoking-related attitudes and behavior and smoking cessation counseling training. Four focus group discussions with hospital physicians and nurses explored barriers to effective smoking cessation interventions. The focus group sessions were audio-taped, transcribed, and analyzed. Results The survey response rate was 58.5% (93/159) for physicians and 72.2% (122/169) for nurses. Smoking prevalence was almost five times higher in physicians compared to nurses (31.2% vs. 6.6%, p  Conclusions This study was the first to explore differences in smoking-related attitudes and behavior among hospital physicians and nurses in Yerevan, Armenia. The study found substantial behavioral and attitudinal differences in these two groups. The study revealed a critical need for integrating cessation counseling training into Armenia’s medical education. As nurses had more positive attitudes toward cessation counseling compared to physicians, and more often reported having cessation training, they are an untapped resource that could be more actively engaged in smoking cessation interventions in healthcare settings.</p

Minimally invasive surgery for pediatric trauma - A multicenter review

© Mary Ann Liebert, Inc. 2015. Introduction: The published experience with minimally invasive techniques to treat injured children is currently small. In this multicenter case series, we aimed to characterize the contemporary role of minimally invasive surgery (MIS) in pediatric trauma. Materials and Methods: After obtaining Institutional Review Board approval at six pediatric regional trauma centers in the United States, a retrospective review was conducted on children who have undergone thoracoscopy or laparoscopy for the management of trauma over the past 13 years. Results: There were 200 patients with a mean age of 9.6±4.2 years, and 73% were male. Laparoscopy was performed for 187 (94%) and thoracoscopy for 8 (4%), whereas 5 (2%) patients had both, for a total of 205 MIS procedures. Conversion to open surgery occurred in 36% (n=73). Median operative time was 77 (range, 16-369) minutes. Of the 132 procedures completed without conversion, 81 (61%) were diagnostic, whereas the remaining were therapeutic, including the repair of bowel injuries (n=20), distal pancreatectomy (n=5), splenectomy (n=2), repair of traumatic abdominal wall hernias (n=2), evacuation of hemothorax (n=3), and other thoracoscopic or laparoscopic interventions (n=19). Procedures that required conversion were most commonly for bowel injury (n=56). Patients with peritonitis were most likely to require conversion to an open procedure (77.4%). Mean time to a regular diet was 4.2±8.6 days, and mean hospital stay was 6.3±6.5 days. Postoperative complications occurred in 19 patients, long-term sequelae in 10 patients, and permanent disability in 2 patients. There were no deaths or missed injuries. Conclusions: In the stable pediatric trauma patient, laparoscopy and thoracoscopy can be performed safely and effectively for both diagnostic and therapeutic purposes

Assessing cognitive impairment in an ethnically diverse cohort of oldest-old: the life after 90 study.

BackgroundThough dementia rates vary by racial or ethnic groups, it is unknown if these disparities remain among those aged 90 or older.AimsTo test this hypothesis, we used baseline clinical evaluation of 541 ethnically and racially diverse individuals participating in the LifeAfter90 Study to assess how associations between core demographic characteristics and measures of physical and cognitive performance differ across the racial/ethnic groups.MethodsParticipants in this study were long-term non-demented members of Kaiser Permanente Northern California. They were clinically evaluated and diagnosed with normal or impaired cognition (mild cognitive impairment and dementia) through an in-person comprehensive clinical assessment consisting of a detailed medical history, physical and neurological examination, functional, and cognitive tests.ResultsThe average age at enrollment was 93.0 ± 2.6&nbsp;years, 62.4% female and 34.2% non-Hispanic White. At initial evaluation 301 participants had normal cognition and 165 had mild cognitive impairment (MCI) and despite screening, 69 participants were determined to have dementia. Age, education, 3MS, FAQ and CDR scores were significantly associated with cognitive impairment (normal versus MCI and dementia), but not gender. There was a significant univariate association between race/ethnicity and cognitive impairment (p &lt; 0.02) being highest among Black (57.4%) and lowest among Asian (32.7%) individuals. After adjustment for age, gender, and education, however, prevalence of cognitive impairment was not influenced by race or ethnicity.ConclusionOur results confirm the ability to reliably assess clinical diagnosis in a diverse sample of very old individuals