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PubMed2001

Operative photography in gynaecological endosurgery.

OBJECTIVES: To define the attitude of patients, doctors and nurses to operative photographs captured at gynaecological endosurgery, and to determine the value of these photographs in patient education. DESIGN AND SETTING: Postal questionnaire survey of specialists, general practitioners, nurses and patients at a tertiary referral hospital in south-west Sydney. PARTICIPANTS: All patients who underwent endoscopic gynaecological surgery between 1 February and 1 May 1998, and for whom good quality operative photographs were available, and medical and nursing staff randomly selected from lists of practitioners within the Southwest Sydney Area Health Service. MAIN OUTCOME MEASURES: Opinions on whether operative photodocumentation assists patients in understanding their condition; the value to patients of these records; whether operative photographs assist referring doctors in subsequent management of patients; the use of operative photographs in medical records or as personal records for patients; whether photographs may lead to anxiety or be used in medicolegal action. RESULTS: All patients believed operative images were valuable in helping them understand their condition. 19 of 20 specialists (95%), 85 of 123 general practitioners (69%) and 23 of 28 nursing staff (82%) also believed that operative images assist patients in understanding their disease. Nearly all patients denied that operative images would create anxiety, and specialists, general practitioners and nurses also felt that the photographs would not cause anxiety. 78% of general practitioners expressed a desire to receive operative images. CONCLUSIONS: Photographic records of operative procedures are regarded as valuable by both referring doctors and their patients. Patients find photographs useful in understanding their disease.

Attitude of Health Personnel↗

PubMed1999

[Evaluation of factors related with glycemia control in type-2 diabetes mellitus].

OBJECTIVES: To analyse factors characteristic of the patient, supplier and process relating to Glucaemia control in type-2 Diabetes Mellitus (DM). DESIGN: A retrospective, observational study. SETTING: Semi-rural Health Centre. PATIENTS AND OTHER PARTICIPANTS: 162 patients, the whole of the sample selected at random from the list of the DM programme. 32 patients who did not meet the study's inclusion criteria were excluded. MEASUREMENTS AND RESULTS: Compliance with the different technical standards, with other variables relating to the patient (sex, age, BMI, year of diagnosis) and with doctor's training were measured. Also recorded was Glucaemia control through the Glycosilate Haemoglobin (HbA1c)level, with good and acceptable control defined as HbA1c less than 7.6%, and poor HbA1c control the same as or over 7.6%. There was highly significant correlation between the year of diagnosis of type-2 DM and HbA1c (r = 0.34). Patients with late DM complications also had higher HbA1c levels. In the disease's first five years of evolution, there was quite significant correlation (p = 0.034) between overall compliance with different technical standards and the HbA1c level. CONCLUSIONS: The variable most closely related to the level of metabolic control was the duration of the disease. The improvement in compliance with procedures in the first years of Diabetes diagnosis favours the patient's metabolic control.

Age Factors↗

PubMed1999

[Morbidity in the caregivers of patients confined to their homes].

OBJECTIVE: To study the presence of physical and psychological morbidity in the main carers of patients in home care programmes. DESIGN: A descriptive crossover study with a control group. SETTING: Primary care. PATIENTS: The study group consisted of 79 main carers of patients in the home care programme. The control group was 82 people, paired by age and sex, and chosen at random from the list of individual health cards. MEASUREMENTS AND MAIN RESULTS: 84.8% of carers were women, with mean age 58.7 +/- 11.6, and 45.1% were daughters of the invalid, with an average 7.6 +/- 7.9 years as carer. 78.5% had some chronic illness related to stress versus 59.8% in the control group (p = 0.01). 69.6% had psychological malaise connected with anxiety, and 43% connected with depression, versus 45.1% (p = 0.002) and 25.6% (p = 0.02), respectively, in the control group. There were no significant differences in mean frequency of attendance over the preceding 6 months between carers and controls (3.7 +/- 3.8 versus 3 +/- 4.6 times). CONCLUSIONS: There is a significantly greater amount of psychological malaise related to anxiety and depression among carers than in the control group. Many of them may be untreated. Carers have significantly more chronic illnesses, possibly related to stress, than the control group and receive little help in their work. However, they do not generate greater demand for medical care than the control group.

Aged↗

PubMed2001

How do teenagers and primary healthcare providers view each other? An overview of key themes.

BACKGROUND: Teenagers have often been asked for their opinions about health services. However, relatively few studies have involved quantitative and qualitative methods of assessing them. Furthermore, there have been no United Kingdom studies of providers' views on the health of teenagers or of providers' opinions about their role in teenage health. AIM: To determine how teenagers view primary care, to discover how primary care providers view teenage patients, and to note any differences in opinions between the two groups. DESIGN OF STUDY: Questionnaire survey, focus group discussions, and semi-structured interviews. SETTING: Two thousand two hundred and sixty-five teenage patients, 16 general practitioners (GPs), 12 practice nurses, and 12 general practice receptionists in South Wales valley communities. METHOD: Selected practices provided age-sex registers of patients aged between 14 and 18 years and questionnaires were sent to these patients. Focus groups were assembled from those teenagers who had completed and returned the questionnaire. Semi-structured interviews between one member of the study team and GP surgery staff, chosen randomly from staff lists in the selected surgeries. RESULTS: The teenagers reported a lack of knowledge of services available from primary care, a feeling of a lack of respect for teenage health concerns, poor communication skills in GPs, and a poor understanding of confidentiality issues. The providers did not always share these concerns and they also had differing views on communication and confidentiality issues. CONCLUSION: The data demonstrated important findings about how teenagers would like primary care services to be improved. There was an apparent gulf between teenagers' own opinions about health care and the opinions held by primary care providers.

Adolescent↗

PubMed2002

Physician attitudes and the use of office-based activities for tobacco control.

OBJECTIVES: This study explored family physicians' attitudes about smoking cessation counseling-its importance, their confidence in their ability to counsel, outcome expectations of counseling, perception of their influence on patient behavior types of counseling skills used, and the extent to which office-based activities are used to support their counseling. METHODS: A cross-sectional design using qualitative and quantitative analyses was used. Data, including information from participant observation of the environment, medical chart reviews, and in-depth interviews, were collected from 89 physicians, drawn randomly from a list of family physicians in Nebraska. RESULTS: All physicians felt that counseling was important, and most were confident with their ability to provide cessation counseling. Only one third of physicians had positive expectations regarding the outcome of this counseling or of their influence on patient behavior in general. The counseling skills most likely to be used were giving advice to quit, prescriptions for pharmaceutical aids, and discussing barriers and resources. Office-based strategies to support physician counseling were seldom used. CONCLUSIONS: Physician attitudes and tobacco-control activities present a complex picture of low expectations, little office support, and limited counseling skills combined with a strong belief in the professional responsibility to counsel. Motivation to increase skills or implement supportive systems could be expected to be low.

Attitude of Health Personnel↗

PubMed2002

Prevalence of dental caries in 12-13-year-old Jordanian students.

The purpose of this study was to determine the caries experience of 12-13-year-old 6th grade students in Jordan. A total of 694 students were selected randomly from a list of schools teaching 6th grade students in Irbid, Jordan. The data were collected by interview and clinical examination performed by two examiners. Dental examinations were done by using dental mirrors and probes under artificial light in classrooms and the diagnosis of dental caries was made by the criteria recommended by the World Health Organisation (1987). On average students had 24.4 sound teeth, 2.3 decayed teeth (D), 0.05 missing teeth (M) and 0.16 filled teeth (F). The mean DMFT index was 2.51. The D represents 92% of the DMF cases. Of the students examined 188 were caries free (27.1%). Of the 19,432 permanent teeth examined the highest frequency of dental caries (61%) and fillings (77%) was found in first molars, and these were the most commonly missing teeth (67%). Second molars and second premolars had the second and third highest frequencies respectively, whereas incisors and canines were the least affected teeth (< 2%).

Adolescent↗

PubMedDate not supplied

[Qualitative analysis of the perception of people who participate in a clinical trial, Navarra].

BACKGROUND: The objective of this study is to explore the perception that participants in a clinical trial have about the information disclosured by the physician, during patient recruitment and along the study as a preliminary stage for drafting a questionnaire. METHODS: Qualitative study by means of quasi-structure interviews to subjects of different features taken from a patients list obtained by randomized selection of participants in clinical trials approved within the 1998-1999 period. For conducting the interviews, a guide was prepared based on the recommendations of the Helsinki Declaration. RESULTS: Six (6) interviews were held with 7 individuals, as one married couple was interviewed. Most of the categories encountered belonged to the Helsinki Declaration. In addition, others being related to the fulfillment of expectations and to the balance of the risks/benefits done by the individuals for deciding to take part in the study. CONCLUSIONS: The patients were acceptably informed of the most points dealt with under the Helsinki Declaration. The existence of lacking areas having a major impact on the fulfillment of their expectations however having been revealed.

Adult↗

PubMed2002

Systematic review of clinical trials examining the effects of religion on health.

Using MEDLINE, (limited to the English language and the reference lists of the randomized controlled trials (RCTs), we assessed the impact of religion on health outcomes via systematic, critical review of the medical literature. All RCTs published from 1966 to 1999 and all non-RCTs published from 1996 to 1999 that assessed a relationship between religion and measurable health outcome were examined. We excluded studies dealing with non-religious spirituality, ethical issues, coping, well-being, or life satisfaction. We used the Canadian Medical Association Journal's guidelines for systematic review of the medical literature to evaluate each manuscript. Nine RCTs and 25 non-RCTs met these inclusion/exclusion criteria. Randomized controlled trials showed that intercessory prayer may improvehealth outcomes in patients admitted to a coronary care unit but showed no effect on alcohol abuse. Islamic-based psychotherapy speeds recovery from anxiety and depression in Muslims. Non-RCTs indicate that religious activities appear to benefit blood pressure, immune function, depression, and mortality.

Ethics, Medical↗

PubMed2003

Nutritional variation and cardiovascular risk factors in Tanzania--rural-urban difference.

OBJECTIVE: To assess the relationship between dietary factors and cardiovascular (CVD) risk factors in middle-aged men and women, in urban, rural and pastoral settings in Tanzania. DESIGN: Cross-sectional epidemiological study designed according to the protocol of the World Health Organisation (WHO) Cardiovascular Diseases and Alimentary Comparison (CARDIAC) study. SETTING: Three centres in Tanzania, namely Dar es Salaam (urban), Handeni (rural) and Monduli (pastoral population). SUBJECTS: The subjects, aged 47-57 years, were recruited randomly from administrative lists available from each centre. OUTCOME MEASURES: Blood pressure (BP) was measured using a centrally calibrated automatic BP machine (Khi machine). Dietary history of the participants was obtained using a standard questionnaire designed on the basis of a seven-day recall system. Height, weight, serum total cholesterol (TC) and high-density lipoprotein cholesterol (HDLC), haemoglobin A1c, sodium, potassium and magnesium were measured. RESULTS: The prevalence of hypertension (BP > or = 140/90 mmHg or antihypertensive drug use), obesity (body mass index (BMI) > or = 30 kg/m2) and hypercholesterolaemia (TC > 5.2 mmol/l) were lowest in the rural area. Consumption of green vegetables, milk, coconut milk, meat, and fish varied significantly between the three areas. Important determinants for BP among men were BMI (p < 0.001), and salt intake (p < 0.05). Among women, TC (p < 0.05), age (p < 0.05), BMI (p < 0.001) and coconut milk consumption (p < 0.001) were important BP determinants. Salt intake was positively associated with systolic BP (SBP) and diastolic BP (DBP) in men but not among women (both SBP and DBP p < 0.05 respectively). Dietary determinants of serum TC were meat, fish and green vegetable consumption. CONCLUSION: Differences in dietary habits contributed significantly to the urban-rural-pastoral variations in CVD risk pattern in Tanzania.

Age Distribution↗

PubMedDate not supplied

Opinions of pediatric dentists regarding their board certification process.

Despite frequently heard criticisms of the board certification process in pediatric dentistry, pediatric dentists have never been surveyed on this issue. To achieve a representative opinion, a formal survey was conducted during the summer and fall of 1990. The survey sample consisted of 300 practitioners selected randomly from the list of 4300 United States pediatric dentists. The survey form included demographic data, board status, general opinions about the process, and specific estimates of the reliability, validity, and utility of each of the five examination components. Comments were encouraged. A follow-up reminder was sent several weeks after the initial mailing. Ten forms were returned as undeliverable, reducing the sample to 290. In all, 150 forms were returned, for a return rate of 52%. One hundred and thirty-eight forms were completed and analyzed. This number included 54 pediatric Diplomates and 84 nonboarded pediatric dentists. The Written and Oral sections generally were rated more favorably than the Case History, Site Visit, and Simulation sections. Nonboarded respondents were significantly more critical of the process on every item, without exception. All differences exceeded the 0.01 level.

Attitude of Health Personnel↗

PubMed2004

Reproductive factors and risk of glioma in women.

OBJECTIVE: Glioma is the most common primary malignant brain tumor in adults, responsible for 75% of adult primary malignant brain tumors, yet aside from its association with ionizing radiation, its etiology is poorly understood. Sex differences in brain tumor incidence suggest that hormonal factors may play a role in the etiology of these tumors, but few studies have examined this association in detail. The objective of this study was to explore the role of reproductive factors in the etiology of glioma in women. METHOD: As part of a population-based case-control study, histologically confirmed primary glioma cases (n = 341 women) diagnosed between January 1, 1995 and January 31, 1997 were identified through clinics and hospitals in four Midwest U.S. states. Controls (n = 527 women) were randomly selected from lists of licensed drivers and Health Care Finance Administration enrollees. In-person interviews with subjects (81%) or their proxies (19%) collected reproductive history and other exposure information. RESULTS: Glioma risk increased with older age at menarche (P for trend = 0.009) but only among postmenopausal women. Compared with women who never breast-fed, women who breast-fed >18 months over their lifetime were at increased risk of glioma (odds ratio, 1.8; 95% confidence interval, 1.1-2.9). Women who reported using hormones for symptoms of menopause had a decreased risk of glioma compared with women who never used such hormones (odds ratio, 0.7; 95% confidence interval, 0.5-1.1). CONCLUSION: These results support the hypothesis that reproductive hormones play a role in the etiology of glioma among women.

Adult↗

PubMed2004

[Survey of chest physicians regarding COPD diagnosis and treatment].

A survey on COPD diagnostic procedures, treatment and management was conducted in a group of 517 chest physicians randomized from a list of the 1121 affiliates to the Asociación Argentina de Medicina Respiratoria. One hundred eighty-seven responses were obtained (36.2% of the questionnaires mailed). They treat an average of 53.3 COPD patients every month. Twenty-four percent of them had mild, 41.8% moderate and 33.8% severe disease (GOLD criteria). Only clinical criteria for diagnosis of COPD, clinical criteria + spirometry (S), and clinical criteria + S + chest X ray were used by 2.9, 23.4 and 73.7% of responders, respectively. Seventy percent of responders believed that chronic asthma without bronchodilator response must be included in the COPD definition. Only 14.1% of responders performed S in every office visit. Cardiac function was assessed using clinical criteria, electrocardiogram and echocardiogram by 90.6, 80.6 and 73.8% of responders, respectively, while 98.3% stated that they trained most of their patients in the inhalation technique. Metered Dose Inhaled was the first option for bronchodilators administration (64.8%) followed by nebulization (16.5%), dry powder inhalation (13.7%) and oral administration (4.8%). First option for chronic therapy in severe COPD patients was the association of anticholinergic drug (AC) + short acting beta2-agonists (SABA) (65.5%), AC alone (18.8%), long acting beta2-agonists (LABA) (9.7%), inhaled corticosteroids (IC) (3.5%) and SABA alone (2.8%). Corticosteroids and antibiotics were prescribed in severe COPD exacerbation by 92.5 and 70% of responders, respectively. First choice antibiotic formulation was beta-lactamics + beta-lactamase inhibitors in 39% of the responders followed by fluorquinolones in 23.7%, macrolides in 17.5% and beta-lactamics in 12.5%. Lastly, 12.7% of COPD patients received long-term domiciliary oxygen therapy. 59.3% of them were prescribed pulmonary rehabilitation, 94.1% vaccination against influenza and 91.4% pneumococcal vaccination. Thirty seven percent of the patients continued to smoke. Most of reponses regarding diagnosis and exacerbation treatment were in agreement with recommendations of international guidelines. For maintenance treatment the association of AC + SABA was commonly recommended as first option, whereas IC and LABA were rarely prescribed.

Argentina↗

PubMedDate not supplied

High prevalence of multiple coronary risk factors in Punjabi Bhatia community: Jaipur Heart Watch-3.

BACKGROUND: Studies among emigrant Indian populations have shown a high prevalence of obesity and many coronary risk factors in Bhatia community. To determine the prevalence of risk factors in this community within India we performed an epidemiological study. METHODS AND RESULTS: An ethnic-group sample survey to determine prevalence of cardiovascular risk factors was performed using community registers for enrollment. Methodology used was similar to Jaipur Heart Watch studies performed in 1995 and 2002. We invited 600 randomly selected subjects listed in Punjabi Bhatia community registers and could examine 458 (76.7%) persons (men 226, women 232). Evaluation for coronary risk factors, anthropometric measurements, blood pressure, electrocardiogram, fasting blood glucose and serum lipids was performed using standard definitions. Mean age was 43.2 +/- 14.6 years in men and 44.7 +/- 15.3 years in women. In both men and women there was a high prevalence of family history of coronary heart disease in 45 (19.9%) and 50 (21.6%), family history of diabetes in 96 (42.5%) and 77 (33.2%), sedentary habits in 82 (36.3%) and 73 (31.5%), smoking or tobacco use in 59 (26.1%) and 4 (1.7%), overweight or obesity (body mass index > or = 25 kg/m2) in 123 (54.0%) and 161 (69.4%), severe obesity (body mass index >30 kg/m2) in 47 (20.8%) and 75 (32.3%), truncal obesity (waist-hip ratio: men >0.9, women >0.8) in 175 (77.4%) and 186 (80.2%), increased waist (waist size: men >102 cm, women >88 cm) in 78 (34.5%) and 129 (55.6%), hypertension (blood pressure > or = 140/90 mmHg) in 116 (51.3%) and 120 (51.3%), diabetes in 40 (17.7%) and 33 (14.2%), hypercholesterolemia (total cholesterol > or = 200 mg/dl) in 75 (33.2%) and 67 (28.9%), high triglycerides in 55 (24.3%) and 34 (14.7%), low high-density lipoprotein cholesterol in 169 (74.8%) and 155 (66.8%), and the metabolic syndrome (defined by American National Cholesterol Education Program) in 84 (36.2%) and 111 (47.8%) respectively. Body mass index correlated significantly with (age-adjusted r2 value--men, women) waist diameter (0.52, 0.12), waist-hip ratio (0.21, 0.10), truncal obesity (0.54, 0.60), systolic blood pressure (0.19, 0.16), diastolic blood pressure (0.12, 0.16), hypertension (0.19, 0.31), and metabolic syndrome (0.28, 0.44) (p<0.05). There was a significant linear relationship of body mass index with the prevalence of hypertension, hypercholesterolemia, diabetes (women), and the metabolic syndrome (chi2 for trend p<0.05). Prevalence of these risk factors was the lowest in subjects with body mass index <20 kg/m2. A multivariate ordinal logistic regression analysis revealed that obesity was independently associated with multiple risk factors characterized by metabolic syndrome after adjustment for age, hypertension, and diabetes in both men (odds ratio 2.45, 95% confidence intervals 1.69, 3.57) as well as in women (odds ratio 2.93, 95% confidence intervals 1.86, 4.61) (p<0.01). CONCLUSIONS: There is a high prevalence of obesity, abdominal obesity, hypertension, diabetes, lipid abnormalities and the metabolic syndrome in this community that is significantly greater than reported studies in Jaipur and urban populations elsewhere in India. Obesity correlates strongly with multiple coronary risk factors of which it is an important determinant.

Adult↗

PubMedDate not supplied

Community organized food and nutrition education: participation, attitudes and nutritional risk in seniors.

UNLABELLED: Evergreen Action Nutrition (EAN) is a health promotion program designed to facilitate relatively healthy members of a seniors recreation center to maintain their nutritional health as they age. A main goal of this project was to demonstrate the feasibility and relevance of using the community organization approach to develop a nutrition education program for seniors. METHODS: Using the current membership list, seniors were randomly selected to receive a mailed baseline (n=247) questionnaire. A follow-up survey (n=251) was sent out to randomly selected members three years later to determine participation in EAN and reported behavior change. Although not the same individuals, responses were compared to baseline to determine changes in nutritional risk. Items from the Diet and Health Knowledge survey were compared by EAN participation. RESULTS: The program had a large reach with 162 survey respondents (64.5%) reporting some level of participation and 51% reporting "frequent" participation. Use of informal forms of education predominated (e.g. displays). Significant differences were found between baseline and follow-up for risk attributed to low intake of fruits and vegetables and frequency of eating, with EAN participants having reduced risk of low fruit and vegetable intake. Those participating in formal education (e.g. food workshops) reported more frequent changes in food practices than those participating in informal activities. EAN participants appear to have more healthy nutrition attitudes/beliefs. CONCLUSION: The community organization approach to program planning and delivery leads to the development of diverse and appropriate nutrition education activities for seniors. Informal and formal health promotion activities can be successfully implemented in recreation centers.

Aged↗

PubMedDate not supplied

[Environment and cognitive functions in a population 60 years and older].

AIM: The aim of the study was the evaluation of cognitive functions of town and village inhabitants. METHOD: One thousand people who were more than 60 years old were randomized from the list of inhabitants of Pruszcz Gdański city and another thousand from the communes: Pruszcz Gdański, Tratbki Wielkie i Pszczółki. The cognitive functions were assessed according to the MMSE (Mini Mental State Examination) which were next calculated according to an algorithm proposed by Mungas et al. RESULTS: Village inhabitants presented more severe cognitive impairment. The possible influence of education, sex and age are discussed.

Aged↗

PubMed1991

A population survey of respiratory symptoms in the elderly.

Reversible airways obstruction is not uncommon in the elderly, but may be overlooked because of the high prevalence of other disorders with a similar presentation. In a search for patterns of symptoms which might predict treatable airways obstruction, we carried out a survey of men and women aged 65 yrs and over. Postal questionnaires were completed by 2,161 subjects selected at random from the lists of three general practices. Almost 60% of the sample complained of one or more respiratory symptoms. Smoking was a more important risk factor than age, sex or social class, and was associated particularly with wheeze, morning phlegm and chest tightness on waking. Several groups of symptoms tended to cluster in the same individuals. The two most closely related were chest tightness and breathlessness in response to animals, dust and feathers. Responses to irritants tended to cluster according to the symptom produced (cough, breathlessness or wheeze) rather than the provoking stimulus (smoke, cold air, household chemicals or traffic fumes). There was no evidence for the existence of the "bronchial irritability syndrome" which has been linked with asthma in younger adults. The relationship of symptoms to respiratory function and bronchial reactivity will be reported in a further publication.

Age Factors↗

PubMed1995

[Diagnostic and therapeutic strategies in exacerbations of chronic bronchitis in city practice].

The consensus conference convened by the French Language Society for Infectious Disease at Lille in 1991 stressed the fact that two germs were most often the cause of exacerbation in chronic bronchitis (Streptococcus pneumoniae and Haemophilus influenzae) and that antibiotic therapy was the "safe solution" and that the first intention treatment should be either penicillin A, a first generation cephalosporin or a macrolide for the first 8-10 days. A chest x-ray was recommended if there was the slightest doubt about co-existing parenchymal disease with a reevaluation around the 7th day and a prescription of penicillin A plus a beta-lactamase inhibitor or a second or third generation cephalosporin in case of failure. The aim of this study was to assess the diagnostic and therapeutic attitudes of general practitioners when faced with exacerbation in chronic bronchitis in an adult of 60 without severe signs and to find out the antibiotic of first choice and also the antibiotic to be used if the first treatment failed. One hundred doctors were drawn at random from a list of general practitioners in Bordeaux. They were requested to reply to a questionnaire on the strategy of first choice antibiotic and the means of reassessment of the treatment after it had been instituted and the strategy used when faced with a patient who did not improve after the initial treatment.(ABSTRACT TRUNCATED AT 250 WORDS)

Anti-Bacterial Agents↗

PubMed1993

[General practitioners are carrying a heavy load of work, but they are satisfied with their choice of profession].

Seven hundred and seventy-six general practitioners (GPs) sampled randomly from the list of GPs in Denmark were asked about job satisfaction and professional attitudes by questionnaire. The majority (four-fifth) felt that they would decide to become GPs if they were to choose again. On the other hand, two-thirds complained about a workload which had negative effects on their family life. Low job satisfaction was associated with a preference for public employment instead of the current system of private practice. Dissatisfied GPs tended to believe that patients have too great expectations and present problems that they ought to solve themselves. They, also, felt that daily work didn't leave time for preventive medicine and they felt anxiety because of the risk of overlooking serious diseases.

Attitude of Health Personnel↗