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Despite an increase in female physicians in Swiss hospitals, most executive positions are still held by male physicians. This study aimed to identify obstacles and institutional factors influencing female physicians' careers and to evaluate ways to support their professional advancement. An online questionnaire on career obstacles, institutional support, and gender equality was distributed to female physicians employed at hospitals in German-speaking Switzerland. Statistical comparisons between subgroups were performed. The main obstacles reported were doubt in personal competence (39.8%) and lack of support from superiors (37.0%). Mentoring and connecting female physicians were identified as the most useful support options. Doubt in personal competence and a lack of institutional support hinder female physicians' careers. Mentoring programs, flexible employment options, and improved childcare can support their advancement to executive positions.
Emergency physicians frequently manage cases with legal implications. Accurate documentation, evidence preservation, and compliance with reporting requirements are essential, yet awareness of these duties may be incomplete. To describe awareness of medico-legal case management among Saudi Board Emergency Medicine physicians in Riyadh and explore associations with demographic and professional characteristics. This multicenter cross-sectional study included emergency medicine residents, specialists/registrars, and consultants from seven governmental and tertiary hospitals in Riyadh. A 10-item investigator-developed awareness questionnaire and five self-reported confidence items were administered electronically. The instrument was reviewed by five consultant emergency physicians for clarity, relevance, comprehensiveness, and clinical applicability; no pilot study, formal content validity index, Delphi process, or construct validity assessment was performed. For analysis, a "Yes" response to each awareness item was coded 1 and a "No" or "Don't know" response was coded 0, yielding a 0-10 index. Investigator-defined cutoffs of 0-3, 4-7, and 8-10 were used to label poor, moderate, and good awareness, respectively; these cutoffs have not been externally validated. Descriptive statistics, univariable tests, and multivariable linear regression with heteroscedasticity-robust standard errors were used. Of 576 submitted questionnaires, 276 incomplete submissions were excluded, and 300 complete responses were analyzed. The mean awareness index was 6.31 ± 1.59 (median, 6; observed range, 1-10). Correct responses varied across the 10 awareness items, ranging from 56.3% to 71.3%, with the lowest proportions observed for photographic documentation and legal consequences of failing to report suspected medico-legal cases, and the highest for workplace evidence-collection protocols. Internal consistency was low (Cronbach's alpha = 0.097), indicating that the awareness index should be interpreted as an exploratory summary of heterogeneous medico-legal domains. In the adjusted model, compared with consultants, R4, R3, and R2 residents had lower awareness scores, while managing two to five medico-legal cases per shift was associated with a slightly higher score than managing fewer than two cases. Previous report-writing training was not independently associated with awareness. Physicians demonstrated variable awareness across different medico-legal knowledge domains. As the investigator-developed awareness index demonstrated very low internal consistency, the overall score should be interpreted cautiously as an exploratory summary rather than a validated measure of a single construct. Future studies should prospectively validate a multidimensional instrument and evaluate competency-based medico-legal education.
Although interoperability advances and policy initiatives have expanded EHR functionality and were intended to streamline clinical workflows, many administrative tasks remain burdensome. To describe the prevalence and co-occurrence of three administrative burdens in family medicine and to assess associations of health information technology (health IT) and organizational resources with these burdens. Cross-sectional study PARTICIPANTS: In total, 8419 US family physicians completing American Board of Family Medicine certification requirements in 2024. Self-reported effort spent tracking down external health information and completing prior authorizations and time spent documenting clinical care outside regular office hours. Key independent variables included perceived EHR support for obtaining external information, ability to complete prior authorizations within the EHR, and use of documentation support tools including scribes, other staff, transcription tools, and EHR templates. Respondents were 46% female and 60% under age 50. More than three-quarters of physicians reported at least one substantial administrative burden, and 15% experienced substantial burden from all three activities. Satisfaction with EHR support for obtaining external information was associated with lower likelihood of substantial effort for that task (OR 0.47, P < 0.001), whereas ability to complete prior authorizations within the EHR was not associated with lower prior authorization burden. Use of staff support and EHR templates rated as helpful were associated with lower likelihood of substantial after-hours documentation (staff support OR 0.83, P < 0.001; templates OR 0.70, P < 0.001) and of experiencing the triple burden (templates OR 0.63, P < 0.001). Cross-sectional, self-reported data from a single physician specialty may limit generalizability. Administrative burdens remain common in family medicine. Interoperability and documentation supports may mitigate some burdens, whereas prior authorization burden persists despite current electronic capabilities. US Department of Health and Human Services, Office of the National Coordinator for Health IT.
This cross-sectional study assesses the interdependence of rural background and training as factors associated with rural practice among US physicians.
According to the 5th edition of the Japanese General Rule for Clinical and Pathological Studies on Prostate Cancer, clinical T2c is defined as"a tumor involving both lobes". It is not defined whether this refers only to continuous lesions spreading across both lobes or also includes small, non-continuous lesions present in both lobes. Furthermore, the General Rule stated that"it is generally understood that pathological findings from biopsies are not taken into consideration when determining T categories". We investigated how physicians interpret the General Rule and perform T classification in real-world clinical practice. We prepared five hypothetical cases with negative digital rectal examination findings but with lesions identified on magnetic resonance imaging (MRI) and conducted a questionnaire survey targeting board-certified urologists certified by the Japanese Urological Association. We received responses from 58 participants. Twenty-six participants (44.8%) diagnosed cases with discontinuous lesions in both lobes as cT2a, and 32 participants (55.2%) diagnosed them as cT2c. In addition, 41 participants (70.7%) diagnosed cases in which lesions were found in one lobe on MRI and cancer was detected in both lobes by biopsies as cT2a, while 17 participants (29.3%) diagnosed them as cT2c. Furthermore, three participants (5.2%) diagnosed cases in which cancer was detected by biopsies only from the contralateral side where lesions were found on MRI as cT1c, 49 participants (84.5%) diagnosed them as cT2a, and six participants (10.3%) diagnosed them as cT2c. In staging prostate cancer, the General Rule can have multiple meanings and there are cases in which even specialists disagree. Since T classification affects treatment strategies, it is desirable to have a uniform understanding based on a clear definition.
To elucidate the synergistic mechanism of "Two flowers therapy" - a Behçet's disease (BD) treatment regimen used in China for more than 30 years, namely Total Glucosides of Paeony (TGP)-colchicine - and its efficacy, safety in BD with mucocutaneous involvement. A retrospective clinical cohort study integrated with computational biology was performed. Five bioactive components were chosen, among which four were from TGP and one was colchicine; 31 overlapping BD-related targets were identified via multi-omics, finally 6 core genes confirmed. 355 BD patients were divided into combination group (CG, n=231) and monotherapy group (MG, n=124). Four active components of TGP (oxypaeoniflorin, albiflorin, benzoyl paeoniflorin, paeoniflorin) and colchicine constituted five bioactive compounds. A total of 837 BD-related targets were retrieved from GeneCards, with 31 overlapping targets between the five compounds and BD. A PPI network (31 nodes, 197 edges) was constructed, and core targets (MMP9, ICAM1, FGF2, TLR4, EGFR, NOS3) were identified. Molecular docking confirmed their high affinity: colchicine formed hydrogen bonds with EGFR, ICAM1, NOS3 (2.2-3.4 Å) and hydrophobic interactions with TLR4; TGP components formed 2-4 hydrogen bonds with EGFR, FGF2, MMP9 (2.2-3.9 Å). GO analysis involved inflammation- and immune-related biological processes; KEGG identified 10 enriched pathways (including Lipid and atherosclerosis, AGE-RAGE) regulating inflammation, immunity and vascular function. Clinically, CG had superior early (M1-M2) efficacy: oral ulcer prevalence was 0.0% vs. 21.0% (M1) and 0.0% vs. 100.0% (M2), genital ulcer prevalence 0.9% vs. 6.5% (M1) (all p<0.05). Both groups achieved complete ulcer resolution from M3. ESR in CG was significantly lower at M2 (p<0.001), with no CRP difference. CG had transient diarrhea; no drug-associated cytopenia was reported in either group. TGP combined with colchicine, a regimen used in China for more than 30 years, exerts therapeutic effects on BD by regulating core targets and inflammatory pathways. Clinically, this regimen more effectively controls early mucocutaneous lesion recurrence in BD patients, with good long-term efficacy and safety.
Heart failure (HF) palliative care communication is essential but difficult to train at scale because conventional role-play programmes require facilitators and standardized patients. Large language models (LLMs) have emerged as potential tools for scalable communication training. This pilot study aimed to evaluate the feasibility of a web-based LLM-driven communication training application and to explore its early educational signal on physicians' self-efficacy. This single-arm pilot study included physicians who completed one session using a Japanese-language web-based LLM application designed to simulate patients with advanced HF and provide automated framework-based feedback. The primary outcome was change in self-efficacy scores assessed by pre- and post-session questionnaires. Ten sessions were analysed. Physicians engaged in a mean of 7.6 ± 2.0 dialogue turns. Mean response time per model output and feedback generation were approximately 3 and 17 s, respectively. Significant improvements were observed in knowledge of palliative care communication (mean difference +1.7, adjusted P < 0.01) and confidence in HF palliative care communication (+1.2, adjusted P = 0.03). Other domains showed non-significant changes. This pilot study demonstrated the feasibility of a web-based LLM-simulated patient system and suggested an early educational signal in physicians' self-efficacy for HF palliative care communication. Our scalable LLM-driven communication training may complement traditional educational approaches with further evaluation in larger controlled studies. Trial registration number: UMIN000059988.
Hypertension affects about a third of the global population and stays poorly controlled in many patients despite effective treatments being available. Clinical inertia, meaning the failure to intensify or reassess therapy when it is indicated, is one contributor. Home blood pressure (BP) monitoring and other mobile health (mHealth) tools generate frequent readings, but this adds to the interpretive work asked of clinicians. How clinicians turn home BP readings into follow-up scheduling decisions has had little empirical study. To elicit and characterise clinician scheduling preferences for follow-up appointments in newly diagnosed hypertensive patients, using simulated home BP data, as a first step toward mHealth-based scheduling support. An online questionnaire presented 15 simulated clinical scenarios depicting newly diagnosed hypertensive patients with 7 days of home BP measurements, and was distributed to physicians in two rounds. Physicians indicated their preferred timing for follow-up (0-5 weeks). We analysed 555 scheduling decisions from 37 physicians using a linear mixed-effects model with a random intercept by physician, which accounts for within-physician correlation. On the same data used for model fitting, predictions correlated with stated decisions (Pearson r = 0.83; median absolute difference 0.1 weeks). This is an internal goodness-of-fit measure and not out-of-sample validation. The most recent follow-up BP was the dominant driver of scheduling. Above the 140 mmHg systolic threshold, higher BP was associated with earlier follow-up (0.13 weeks earlier per 1 mmHg increase; 95% CI 0.09-0.17). Consultants and non-consultants differed: non-consultants scheduled later follow-up at lower BP but earlier follow-up at higher BP. In simulated scenarios, clinicians appear to use a small set of interpretable rules, chiefly the recent BP value relative to 140 mmHg, when stating preferences for follow-up timing in newly diagnosed hypertensive patients. The formalised rules show meaningful variation between clinicians and give a methodological basis for mHealth scheduling tools. Because the scenarios were simplified and the model has not been tested out of sample, the findings should be read as hypothesis-generating. Whether algorithm-assisted scheduling improves clinical outcomes or reduces workload needs prospective evaluation in real-world settings.
In patients living with advanced dementia, the intensity of care during life-threatening infections remains controversial and marked by wide variation in practice. This international survey investigated physicians' and physicians-in-training's management choices for individuals with advanced dementia and the factors associated with those choices. Vignette-based survey. Twelve countries across five continents. We administered our vignette-based survey to medical students, residents and physicians. The survey elicited participants' views on whether antibiotics should be administered to an elderly patient with advanced dementia and very poor quality of life, presenting with bacterial pneumonia. We explored factors associated with treatment choices using univariable analysis and multiple logistic regression models. Of the 785 participants (age, mean (SD): 31.1 (11.5) years), one-third (31.2%) resided in the Region of the Americas, 21.9% in Europe, 16.2% in the Eastern Mediterranean region and 17.1% in China. In the univariable analysis, choice to treat was associated with younger age, country/WHO region (African region highest overall, European region lowest overall), stage of medical training (medical student most inclined to treat) and absence of medical assistance in dying (MAiD) legislation. Multivariable analyses provided evidence that country was the variable most strongly associated with the choice to treat with antibiotics (Cameroon, China, Saudi Arabia highest; Norway, Switzerland, Spain lowest), with the presence of MAiD legislation also strongly associated (OR 0.35, 95% CI 0.23 to 0.51). Age (OR 0.82, 95% CI 0.66 to 1.00) and religiosity level (OR 0.93, 95% CI 0.87 to 0.99) showed weaker associations with treatment decisions. Inclination to treat individuals with advanced dementia who develop pneumonia varies greatly between and within jurisdictions. Social factors (in particular country but also presence of MAiD legislation) proved the most prominent associations, with individual characteristics much less influential. These findings underscore the importance of contextual and cultural factors in value-sensitive clinical decisions. We registered the protocol at Open Science Framework (osf.io/6kfbt).
Military medicine operates in environments characterized by operational complexity, resource limitations, and unique clinical demands that differ from civilian medical practice. Despite these distinctions, military medical education is frequently embedded within broader medical curricula rather than being conceptualized as a distinct academic domain. This study aims to examine how military medical curricula are currently structured, implemented, and evaluated in the literature, and to identify key components that support the development of operationally ready military medical personnel. A systematic scoping review was conducted to identify peer-reviewed literature describing military medical education and training programs. Searches were performed across major academic databases using keywords related to military medicine, medical education, curriculum development, and training programs. Studies were screened according to predefined inclusion and exclusion criteria. Data were extracted and analyzed using qualitative content analysis to identify recurring curricular themes, instructional strategies, and competency domains relevant to military medical training. The review identified diverse approaches to military medical education across undergraduate, graduate, and continuing professional development contexts. Common curricular components included operational medicine training, trauma and emergency care simulation, leadership development, and preparation for austere and deployed environments. Simulation-based learning and competency-based frameworks were frequently used to address the unique operational demands faced by military physicians. However, significant variation exists in curriculum structure, standardization, and evaluation methods across institutions. The findings suggest that military medicine possesses distinctive educational requirements that support its recognition as a specialized curricular domain within medical education. Although current programs demonstrate innovative training approaches, the lack of standardized curricular frameworks and consistent evaluation strategies highlights the need for further development. Future research should focus on establishing core competencies, evaluating educational outcomes, and strengthening international collaboration in military medical education. Such efforts may contribute to improving the preparedness of military physicians and advancing the broader field of military medicine education.
The COVID-19 pandemic posed significant mental and physical challenges for healthcare professionals (HCPs), leading to increased stress and potential immune dysregulation. Yoga practice, has been suggested to enhance immunity and alleviate stress. This pilot study aimed to assess the impact of yoga intervention on immune markers, stress levels, and quality of life among HCPs actively working during the pandemic. A single-center, open label randomized controlled pilot study was conducted at tertiary care centre, with 36 participants. Physicians were randomly assigned to either a yoga intervention group (n=18) or a control group (n=18). The intervention included guided online yoga sessions for 12 weeks. Immunological markers (IL-6, IL-12, CRP, INF-gamma, TNF-alpha) were measured using ELISA at baseline and post-intervention. Stress levels and quality of life were assessed using the WHO-BREF questionnaire. Statistical analysis was performed Microsoft excel M365 software, employing t-tests. Significant improvements were observed in immune markers, particularly a reduction in IL-12 (p=0.0165) and CRP (p=0.001), alongside a marked increase in INF-gamma (p=0.001) in the yoga group. BMI significantly improved (p=0.0194), though stress levels and most quality-of-life domains remained unchanged, except for social relationships (p=0.0279). Correlation analysis suggested a strong relationship between BMI reduction and immune modulation. Yoga intervention demonstrated potential benefits in modulating immunological markers and improving BMI among physicians. While stress reduction was not significant, enhanced social relationships and immune function suggest yoga as a complementary approach for HCPs well-being during high-stress periods. Further large-scale studies are recommended to validate these findings.
Physician Assistants (PAs) are increasingly discussed as a potential component of ambulatory care teams in Germany, particularly in response to physician workforce shortages, rising clinical and administrative workloads, and the need for sustainable team-based care models. However, international experience suggests that the integration of PAs should not be viewed primarily as a simple workforce expansion strategy, but rather as a matter of patient safety, role clarity, supervision, and governance. Ambiguous professional titles, unclear delegation boundaries, inadequate physician oversight, and the use of PAs as substitutes for physicians in undifferentiated clinical encounters may create avoidable safety risks and undermine trust among patients and healthcare professionals. This narrative review summarizes relevant international evidence, recent safety-oriented regulatory developments, and the specific legal and organizational context of German ambulatory care. It also proposes a practical supervision framework for the safe integration of PAs into general practices, specialist practices, professional practice partnerships, and medical care centers. The proposed framework emphasizes six key domains: transparent role identification, clearly defined delegation boundaries, tiered supervision, structured escalation criteria, documentation standards, and continuous quality monitoring. PAs may contribute meaningfully to ambulatory care when integrated as supportive members of physician-led teams. Safe implementation requires that delegated practice remains clearly distinct from autonomous substitution, that physicians retain overall clinical responsibility, and that patients clearly understand the professional role of the individual providing their care.
Cardiovascular disease (CVD) is a major source of morbidity and mortality across the globe. Effective screening and risk stratification of patients can improve long‑term outcomes by allowing physicians to offer fine-tuned advice and treatments. Advances in technology have enabled the study of various biomarkers associated with CVD, allowing researchers to study the molecular processes underlying illness. In this study, we sampled recent advances in the application of Machine Learning (ML) techniques to transcriptome datasets of CVD patients in the hopes of progressing our understanding of underlying pathophysiology, improving our ability to detect disease, and refining our methods of risk stratification of patients. These studies suggest that ML algorithms may help identify complex relationships within high-dimensional datasets to isolate relationships within datasets that were previously missed, enhancing our understanding of disease. However, there are several challenges that need to be addressed before these innovations can reach the clinic. Researchers must verify their results via means that are readily obtainable for physicians and must adequately identify the indications for a particular test so they can integrate into preexisting workflows. We offer potential solutions and suggestions to these issues so that these approaches may eventually contribute to improved patient care.
Vegan diets during pregnancy are commonly discussed regarding nutritional risks, often without differentiating between heterogeneous vegan populations. Empirical evidence on clearly defined subgroups who maintain a vegan diet throughout pregnancy remains scarce. This study characterized a highly selected subgroup of pregnant women adhering to a vegan diet, focusing on supplement use, information sources, counseling experiences, and perceived risks of micronutrient deficiency and overdosing. An explorative, cross-sectional online survey was conducted as part of the Vegan Diet and Dietary Supplements Study (VedieS). The questionnaire was developed from a scientific literature review, pilot-tested, and distributed via vegan, nutrition-related, and health-focused organizations and social media across German-speaking regions. Individuals adhering to a vegan diet (defined as a strictly plant-based diet excluding all animal-derived products) participated. The analysis was restricted to those reporting a vegan diet during at least one pregnancy. Supplement use, information seeking, and counseling adequacy were analyzed descriptively. In total, 801 individuals participated. Participants were highly educated and predominantly from urban areas (76.3% tertiary education; 79.6% urban). Adherence during pregnancy was largely consistent (90.5%), and supplement use was nearly universal (99.1%) with high compliance (79.1%), targeting micronutrients critical in vegan pregnancies, including vitamin B12 (77.8%), omega-3 fatty acids (76.9%), folic acid (73.8%), and vitamin D (67.8%). Scientific literature, self-identified by participants, was the primary information source (80.3%), whereas professional counseling was less frequent and often perceived as insufficient. Although 74.7% informed their gynecologist, only 16.1% reported comprehensive counseling. Despite high motivation and self-directed information seeking, considerable uncertainty persisted regarding micronutrient dosage, particularly overdosing, with 40.4% perceiving dosage guidance as insufficient. External influences, including the social environment (46.3%) and physicians (34.2%), were relevant sources of uncertainty. Rather than a uniformly high-risk population, pregnant individuals following a vegan diet represent a highly informed and responsible subgroup whose main challenges relate less to dietary behavior than to structural gaps in professional counseling and access to consistent, evidence-based supplementation guidance. These findings underline the public health relevance of expanding nutrition training and counseling capacities among healthcare professionals and the need for clinical research using objective measures of nutritional status in vegan pregnancies.
Drug utilization worldwide is often associated with practicing self-medication of prescription or non-prescription drugs. Irresponsible behaviors in this field can lead to a variety of health risks. Assessing the extent of self-medication in population contributes to guiding decisions on future interventions to improve it. This study aimed to investigate self-medication patterns and attitudes of adult urban inhabitants in Croatian cities Zagreb and Rijeka. A cross-sectional study was conducted from April to May 2025 in urban community pharmacies involving 402 adult customers who filled out the questionnaire on their self-medication behaviors and attitudes, adverse events related to self-medication, and practices of storing medications at home. The data was analyzed using descriptive statistics. The Chi-square test was used to estimate association between sociodemographic features and self-medication practices. Most commonly self-medicated drugs were analgesics-antipyretics by 94.2% participants. Antimicrobials were self-medicated in 29.4% of cases, and anxiolytics in 24.0%. Higher educational levels were associated with stronger inclination to self-medicate in general (p = 0.034). Most commonly, respondents acquired over-the counter drugs for self-medication in pharmacies (75.3%). Women bought over-the-counter drugs and reported adverse drug reactions more frequently (p = 0.033 and p = 0.037, respectively). 77.5% of participants kept drugs in a designated area (home pharmacy), and 24% of participants could not estimate if drugs they kept at home were potentially toxic. The prevalence of reported self-medication was rather high, even with prescription drugs such as antibiotics and anxiolytics. Educational activities and practical interventions should be implemented to increase the awareness of potential risks of inappropriate self-medication and to strengthen responsible behavior in this aspect with family physicians and community pharmacists having the key role in the process.
Physicians operate at the intersection of 2 conflicting imperatives: the clinical mandate to avoid missed diagnoses and the ethical requirement to avoid unnecessary interventions. While advanced imaging can reduce diagnostic uncertainty, overuse introduces systemic inefficiencies, financial waste, and physical harm. This article argues that the solution lies in transitioning from an information maximization mindset to a satisficing framework, rooted in the theory of bounded rationality. Beyond biological risks, additional imaging often identifies insignificant incidental findings, triggering diagnostic cascades and psychological distress. Over-ordering may be motivated by defensive medicine, patient satisfaction pressures, and financial conflicts of interest. A satisficing framework clarifies when additional information is no longer needed. When satisficing, one stops acquiring information once current information is sufficient for action, whereas under a Value of Information (VOI) framework, one stops when the expected incremental benefit of additional information no longer exceeds its incremental costs and harms. Both frameworks reflect that the relationship between clinical utility and imaging data volume is nonlinear; eventually, incremental contributions diminish while cumulative costs continue to rise. Putting this approach into practice requires leveraging Clinical Decision Support Systems (CDSS), minimalist protocols, and increased visibility regarding opportunity costs. Robust safety protocols, including departmental reviews of exception rates and peer reviews, can be used to ensure that satisficing does not lead to increased diagnostic errors. Ultimately, quality in radiology should be defined by whether imaging appropriately informs management, rather than by the volume of data gathered. The goal is to provide the information necessary to act safely and effectively while recognizing when to stop.
Preparing physicians to care for older adults is essential to meet the growing demand for geriatric care in a healthcare system with a limited number of geriatric specialists and whose population is aging. Graduating medical students are expected to be competent in several fundamental geriatric assessment skills. Interactive, hands-on teaching methods allow for optimal student engagement and real-time feedback to foster skill development. We designed and implemented a Geriatrics Skills Session for third-year medical students based on the Geriatric 5 Ms. Students rotated through stations (i.e structured, focused learning activities) where they engaged in role-play, hands-on demonstrations, and small-group discussions. During academic years (AYs) 2021-2025, a total of 501 students participated. Post-session surveys showed high levels of satisfaction. Students completed two Direct Observations with standardized patients where the students were observed on their ability to take a history and perform a physician exam of a patient presenting with chief complaint of a fall (based on expected core competencies related to Mobility, one of the Geriatric 5 Ms). The session has been well-received by third-year medical students and can be easily adapted for learners at various levels, either in full or in parts.
Cervical cancer is expected to become the second leading cause of female cancer mortality in low- and middle-income countries, with the majority of critical cases projected to occur in these regions by 2050. This study aimed to identify the prevalence and determinants of knowledge and attitudes toward cervical cancer prevention, including Pap smear uptake and human papillomavirus (HPV) vaccination, while highlighting actionable gaps for intervention. A cross-sectional study was conducted using an online structured questionnaire, administered to Lebanese women aged 18-50 years. A knowledge score (KS) was calculated from true-or-false questions on risk factors, symptoms, and prevention. An attitude score (AS) assessed the proportion of women with a positive attitude toward cervical cancer prevention. Participants had a mean age of 28.5 years. The prevalence of women who had ever had a Pap smear was 18.6%, and HPV vaccination coverage was 17.9%. Bivariate analysis showed that HPV vaccination was significantly associated with younger age, being single, having a graduate degree, being a health care student/professional, perceiving income as sufficient, and never smoking. Binary logistic regression analysis indicated that only a KS above the mean and an AS above the mean remained significant predictors after adjustment. Physicians were the most influential incentive for vaccination, while lack of knowledge was the primary barrier. To improve HPV vaccination rates and reduce cervical cancer incidence in developing countries, strategies should focus on enhancing health care access and physician-patient communication. Targeted awareness campaigns addressing misconceptions and negative attitudes toward HPV vaccination are warranted to improve preventive practices and reduce disease burden.
Immigrants are at a heightened risk of developing inflammatory bowel disease (IBD) after relocating, and their interactions with the healthcare system differ from those of nonimmigrants. This study aimed to explore the challenges and perspectives of immigrants living with IBD regarding their healthcare. We recruited persons aged 18 or over with IBD, including those with and without an immigration history, to complete an anonymous online survey. Descriptive statistics were presented as frequencies, and cross-group comparisons were performed using the Chi-square test. We included 75 immigrants and 150 nonimmigrants with similar baseline demographics, with many indicating poorly controlled IBD. Immigrants were more likely to report no access to formal translation services during their appointments (24 [32%] vs 6 [8%]), despite many not speaking the same language as their gastroenterologist (31 [41.3%] vs 3 [2%]). Immigrants were more often unable to miss work for healthcare appointments (24 [32%] vs 17 [11.3%]). Many were diagnosed after immigration (58 [77.3%]). Despite this, 29 [38.7%] contacted physicians in their home countries and purchased medications from their countries of origin (8 [10.7%]). Most immigrants expressed concerns that "Western" foods in their current country of residence contributed to their flares (44 [58.7%]) compared to only 11 [14.7%] who were concerned about foods from their home country. Immigrants encounter significant obstacles in accessing healthcare, including communication, financial barriers, and cultural factors such as food preferences, which hinder their ability to receive the care they need.
Mondor's disease is a rare disease that presents as a superficial thrombophlebitis that most often occurs in breast tissue, but can also occur on the anterior chest wall, thoracoabdominal region, and even the penis. Mondor's disease generally presents as localized pain and a palpable cord-like structure. It is a benign and self-limiting disease that can be managed conservatively and typically resolves in about four weeks without any treatment. This condition is important to recognize clinically because it can easily be mistaken for lymphangitis, cellulitis, musculoskeletal chest wall pain, breast mass, or malignancy. We present the case of a 58-year-old female who presented to the family medicine clinic with a several-day history of bilateral breast pain. The patient had a prompt mammogram that was negative and breast ultrasound imaging that revealed a small thrombus in the left breast, suggesting Mondor's disease as the culprit. The patient was treated conservatively and provided with close breast ultrasound follow-up. The patient's symptoms improved and resolved over 12 weeks. This case highlights the importance for primary care physicians to remain attentive to red flags requiring further investigation and recognize Mondor's disease in primary care.