Politics ahead of patients: The battle between medical and chiropractic professional associations over the inclusion of chiropractic in the American Medicare System

Health care professions struggling for legitimacy, recognition, and market share can become disoriented to their priorities. Health care practitioners are expected to put the interests of patients first. Professional associations represent the interests of their members. So when a professional association is composed of health care practitioners, its interests may differ from those of patients, creating a conflict for members. In addition, sometimes practitioners’ perspectives may be altered by indoctrination in a belief system, or misinformation, so that a practitioner could be confused about the reality of patient needs. Politicians, in attempting to find an expedient compromise, can value a “win” in the legislative arena over the effects of that legislation. These forces all figure into the events that led to the acceptance of chiropractic into the American Medicare system. Two health care systems in a political fight lost sight of their main purpose: to provide care to patients without doing harm. Dans leur recherche de légitimité, de reconnaissance et d’une juste part sur le marché de la santé, les professionnels de la santé peuvent perdre de vue leurs priorités. Ces praticiens doivent donner préséance aux intérêts des patients tandis que les associations professionnelles représentent ceux de leurs membres. Lorsqu’une association professionnelle regroupe des praticiens de la santé cependant, ses intérêts s’opposent parfois à ceux des patients, créant ainsi un conflit pour les membres. De plus, les praticiens peuvent être endoctrinés par un système de valeurs ou mal informés, au point de se tromper dans l’évaluation des besoins réels des patients. De leur côté, les politiciens peuvent préférer une « victoire » dans l’arène législative à une juste appréciation des impacts d’une loi. Ces forces ont toutes participé aux évènements qui ont mené à l’acceptation de la chiropraxie par le système américain Medicare. Dans cette bataille politique, deux systèmes de santé ont négligé leur principal objectif : soigner des patients sans leur nuire

Birth preparedness and complication readiness among women in Surulere Local Government Area, Lagos State, Nigeria

Background: The progress in maternal and newborn care over the years has been remarkable. In Nigeria many births are still not  attended to by skilled birth attendants (SBA). Hence maternal and newborn mortality remain high. Birth preparedness and complications readiness (BCPR) is a key intervention towards improving these indices, recommended by the World Health Organization and adopted by the governments of many nations including Nigeria. Every pregnant woman faces the risk of sudden, unpredictable complications that could end in death or injury to herself or to her infant. This study, therefore, aims to address this risk by assessingknowledge, attitude and practice associated with BPCR among women in Surulere Local Government Area in Lagos, Nigeria. Methodology: The study was a descriptive crosssectional study among 216 , selected by multi-stage sampling technique. Data was collected through a using a pretested, interviewer-administered questionnaire and analysis was carried out using Microsoft Excel 2010 and Epi Info 7 statistical software. The level of significance was predetermined at p<0.05. Results: Overall, 46.3% of respondents had good knowledge of the danger signs that could occur before, during or after delivery. Over  half of the women (52.3%) had a positive attitude towards BPCR, while 62.0% of the respondents practiced a good level of birth preparedness and readiness for any complication that might arise during pregnancy and delivery. Good knowledge was associated with level of education (p<0.001), occupation (p=0.022) and number of children (p=0.046). Knowledge was significantly associated with attitude (<0.001) but not practice. Conclusion: The study showed that the respondents had poor knowledge of BPCR and positive attitude towards it. Many of them were  not birth prepared nor complications ready. Interventions aimed at increasing BPCR practices should be focused on educating women, increasing awareness through health education and providing skilled maternal and newborn care services