The family practitioner plays an important role in the detection and treatment of mental disorders. It is said that over half of all persons affected with mental illness are initially seen and treated by the non-psychiatrist in the outpatient setting rather than in the specialty mental health clinic. Objective: This paper aims to evaluate perceived level of confidence and competence of the primary care practitioner in the recognition, diagnosis, and management of mental disorders. Methods: A survey of family physicians and general practitioners using a thirteen (13)-point questionnaire during an annual convention of the Philippine Academy of Family Physicians (PAFP) was conducted. The questionnaire included items that attempted to quantify: exposure to psychiatry during residency and current medical practice; proportion of mental illness cases among total patient load; signs and symptoms that would be associated with mental illness; familiarity with standardized criteria for diagnosing mental illness i.e. schizophrenia and depression; familiarity with therapeutic medications; and perceived level of confidence in treating psychiatric cases. Results and Conclusion: The study implies that the family physician, although aware of the general signs and symptoms indicative of mental illness, is still hesitant in formulating a definitive diagnosis. Possible reasons for this attitude may be inadequate training in psychiatry as well as unfamiliarity and perceived difficulty with the DSM-IV.
Human ; Male ; Female ; MENTAL DISORDERS ; DIAGNOSTIC AND STATISTICAL MANUAL OF MENTAL DISORDERS ; PHYSICIANS, FAMILY

OBJECTIVES: This paper aims to evaluate the competence and confidence of the primary care practitioner in the recognition, diagnosis and treatment of mental disorders.
METHODOLOGY: A validated 13 point questionnaire which incorporated items from the DSM IV was given to the participants of the annual convention of the Philippine Academy of Family Physician held in Davao City Sept 8-10, 2000.
RESULTS: Four hundred eighty five family physicians returned the self administered questionnaire. Fifty one percent (248/ 485) claimed they would immediately refer patients to the psychiatrist while 28% (137/ 485) would initiate treatment on their own. Fourteen percent (68/ 485) and 10.9% (53/ 485) of the respondents indicated that they were familiar with the DSM IV criteria for schizophrenia and depression respectively; however only 11.3 % (55/485)were confident in using the criteria for diagnosis. Fortytwo percent (204/485) described schizophrenic patients as being irritable and aggressive, 30% (146/485) believed that hallucinations were the hallmark symptom, while 18% (88/485) considered bizarre behavior as the most significant indicator of schizophrenia. For depression the subjective feeling of sadness and worthlessness was most indicative of depression for the respondents (63% or 305), while 21% or 102 considered low self esteem or unstable self image as one of the criteria for depression and 16% or 78 thought of diminished interest or pleasure in all activities as the more important symptom to look for when diagnosing depression. Tricyclic antidepressants were still the preferred drug by most family physicians in treating depression (72% or 340) while 62% (301/ 485) prescribed benzodiazepines and 51% (248/ 485) also used the newer selective serotonin reuptake inhibitors. Patients with schizophrenia would be given typical psychotropic drugs like chlorpromazine or haloperidol more commonly (88% or 427), while 46% (224/ 485) had begun to prescribe atypical antipsychotic medications.
CONCLUSION:The family physician seems to be hesitant or unsure with their diagnosing or treating psychiatric patients though willing to administer psychotropic medications.

Human ; Male ; Female ; Psychiatry ; Physicians ; Schizophrenia ; Depression

Red cell alloimmunisation is defined as the development of antibodies in response to foreign red cell antigens through transfusion or pregnancy. In pregnant women even without the history of previous blood transfusion, this is possible through previous or current pregnancy with the presence of paternal red cell antigen inherited by the fetus. This study was aimed to determine the prevalence of red cell alloimmunisation among pregnant women without previous history of blood transfusion and the association with number of pregnancy and history of obstetric complications. This was a cross-sectional study in which 150 pregnant women were randomly selected from the antenatal clinic. Ten mls of peripheral blood was obtained for antibody screening using indirect antiglobulin test besides the routine antenatal screening. In this study, the majority (37.3%) of the women were primigravidae. Red cell alloantibodies were detected in two out of 150 (1.3%) patients which were subsequently identified as anti-C and anti-D. However none of the primigravida was alloimmunised. One woman of gravida 2 (2.9%) and gravida 3 (3.6%) each were positive for alloimmunisation. One of them also had a bad obstetric history. This study showed that the prevalence of red cell alloimmunisation among pregnant women was low in this centre. Nevertheless, red cell alloantibody screening test should be made available to reduce possible complications of alloimmunisation in mothers and fetuses.

INTRODUCTIONThe fi rst case of pandemic influenza A(H1N1) was detected in Singapore on 26 May 2009, 1 month after the fi rst cases of novel influenza A(H1N1) was reported in California and Texas in the United States. The World Health Organization declared the fi rst influenza pandemic of the 21st century on 11 June 2009.

MATERIALS AND METHODSConfirmed cases notified to the Ministry of Health between 27 May and 9 July 2009 were analysed. Various indicators of influenza activity were monitored throughout the study period. Estimates of the number of cases of H1N1-2009 were made using the number of polyclinic attendances for acute respiratory infection and influenza-like illness and the weekly prevalence of H1N1-2009.

RESULTSCases in Singapore affected mainly young adults, youths and children. By the end of September 2009, it was estimated that at least 270,000 persons had been infected by pandemic influenza A (H1N1) in Singapore. The peak number of cases occurred during E-week 30 (26 July-1 August) when an estimated 45,000 cases were seen in polyclinics and GP clinics. The hospitalisation, severe illness and mortality rates were estimated at 6 per 1000 cases, 0.3 per 1000 cases and 6.7 per 100,000 cases, respectively. The most common risk factors among hospitalised adult cases were asthma and diabetes. For hospitalised children, the most common risk factors were being under 5 years of age and asthma. The most common risk factors among persons with severe illness were diabetes in adults and epilepsy and being under 5 years of age in children. About half of cases with severe illness required mechanical ventilation. In addition, one-fifth of cases with severe illness had acute respiratory distress syndrome.

CONCLUSIONSThe fi rst wave of the influenza pandemic lasted about 10 weeks. Morbidity and mortality resulting from pandemic influenza were low.

Adolescent ; Adult ; Child ; Child, Preschool ; Comorbidity ; Disease Outbreaks ; Female ; Hospitalization ; Humans ; Infant ; Influenza A Virus, H1N1 Subtype ; isolation & purification ; Influenza, Human ; diagnosis ; epidemiology ; mortality ; Male ; Middle Aged ; Risk Factors ; Singapore ; epidemiology ; Young Adult

Objective: To understand the current status of national free antiretroviral therapy in interprovincial migrating people living with HIV/AIDS (PLWHA) and influencing factors in China. Methods: Descriptive and trend test analyses were performed to evaluate the historical characteristics and trends of main descriptive indicators on national free antiretroviral therapy for the interprovincial migrating PLWHA by using the data collected from National Comprehensive HIV/AIDS Information System from 2011 to 2015. Logistic regression model was used to explore the main factors that influencing the coverage of national free antiretroviral therapy among the interprovincial migrating PLWHA in China. Results: The proportion of interprovincial migrating PLWHA gradually increased in last 5 years from 7.1% (17 784/250 645) in 2011 to 10.3% (54 596/528 226) in 2015 (Z=51.38, P<0.000 1) in China. The coverage rate of free antiretroviral therapy in interprovincial migrating PLWHA increased from 37.3% (6 641/17 784) in 2011 to 71.0% (38 783/54 596) in 2015, showing a significant rising tendency (Z=96.23, P<0.000 1), but it was slightly lower than that in non-interprovincial migrating PLWHA in 2015 (71.5%, 338 654/473 630). Multivariate logistic regression analysis showed that the PLWHA who were females, aged ≥50 years, of Han ethnic group, married or had spouse, had the educational level of high school or above, infected through homosexual intercourse, with CD(4)(+)T cells counts ≤500 cells/μl at the first visit, identified to be infected with HIV in medical setting, living in urban areas et al, were more likely to receive free antiretroviral therapy. Conclusions: The coverage rate of free antiretroviral therapy varied among the interprovincial migrating PLWHA with different characteristics. It is still necessary to take effective measures to further increase the coverage of free antiretroviral therapy in interprovincial migrating PLWHA and to include the free antiretroviral therapy in interprovincial migrating PLWHA into standardized management system as soon as possible.
Anti-Retroviral Agents/therapeutic use* ; China/epidemiology* ; Female ; HIV ; HIV Infections/epidemiology* ; Healthcare Disparities ; Humans ; Logistic Models ; Middle Aged ; Transients and Migrants/statistics & numerical data*

Objective: To assess the implementation and impact of programs carried out by the National Demonstration Areas for Comprehensive Prevention and Control of Non-communicable Diseases. Methods: Both sociological and epidemiological methods were used to collect qualitative and quantitative data in November and December, 2016 in order to conduct on process and outcome evaluation of the above mentioned objective. In the meantime, case study was also conducted. Results: All the National Demonstration Areas for Comprehensive Prevention and Control of Non-communicable Diseases were found well implemented across the country, with health education and health promotion, surveillance and safeguard measures in particular. A government-led and inter-sector coordination and communication mechanism had been well established, with more than 16 non-health departments actively involved. 28.7% of the residents living in the National Demonstration Areas for Comprehensive Prevention and Control of Non-communicable Diseases were aware of the key messages related to chronic diseases. Among the residents, 72.1% of them consumed vegetables and 53.6% consumed fruits daily, with another 86.9% walked at least 10 minutes per day. Over 70% of the patients with hypertension or diabetes reported that they were taken care of by the Community Health Centers, and above 50% of them were under standardized management. Residents, living in the National Demonstration Areas under higher ranking of implementation scores, were more likely to be aware of relevant knowledge on chronic disease control and prevention (OR=6.591, 95%CI: 5.188-8.373), salt reduction (OR=1.352, 95%CI: 1.151-1.589), oil reduction (OR=1.477, 95%CI: 1.249-1.746) and recommendation on physical activities (OR=1.975, 95%CI: 1.623- 2.403). Conclusion: The implementation of programs carried out by the National Demonstration Areas for Comprehensive Prevention and Control of Non-communicable Diseases had served a local platform for the control and prevention of non-communicable diseases, and thus become an important 'carrier' for chronic disease prevention and control programs in China.
China/epidemiology* ; Chronic Disease/epidemiology* ; Delivery of Health Care ; Health Promotion/organization & administration* ; Humans ; National Health Programs ; Noncommunicable Diseases/prevention & control* ; Outcome Assessment, Health Care ; Population Surveillance ; Preventive Health Services/organization & administration* ; Program Evaluation ; Public Health

Objective: To investigate the infection pattern and etiological characteristics of a case of human infection with highly pathogenic avian influenza A (H7N9) virus and provide evidence for the prevention and control of human infection with highly pathogenic avian influenza virus. Methods: Epidemiological investigation was conducted to explore the case's exposure history, infection route and disease progression. Samples collected from the patient, environments and poultry were tested by using real time reverse transcriptase-polymerase chain reaction (RT-PCR). Virus isolation, genome sequencing and phylogenetic analysis were conducted for positive samples. Results: The case had no live poultry contact history, but had a history of pulled chicken processing without taking protection measure in an unventilated kitchen before the onset. Samples collected from the patient's lower respiratory tract, the remaining frozen chicken meat and the live poultry market were all influenza A (H7N9) virus positive. The isolated viruses from these positive samples were highly homogenous. An insertion which lead to the addition of multiple basic amino acid residues (PEVPKRKRTAR/GL) was found at the HA cleavage site, suggesting that this virus might be highly pathogenic. Conclusions: Live poultry processing without protection measure is an important infection mode of "poultry to human" transmission of avian influenza viruses. Due to the limitation of protection measures in live poultry markets in Guangzhou, it is necessary to promote the standardized large scale poultry farming, the complete restriction of live poultry sales and centralized poultry slaughtering as well as ice fresh sale.
Animals ; Chickens ; China ; Commerce ; Humans ; Influenza A Virus, H7N9 Subtype/pathogenicity* ; Influenza in Birds/virology* ; Influenza, Human/virology* ; Phylogeny ; Poultry/virology* ; Real-Time Polymerase Chain Reaction ; Zoonoses

Objective: To understand the current overall status of implementation on the National Demonstration Areas of Comprehensive Prevention and Control of Non-communicable Diseases. Methods: According to the scheme design of the questionnaires, all the National Demonstration Areas were involved in this study. For each National Demonstration Areas, eight departments were selected to complete a total of 12 questionnaires. Results: Scores related to the implementation of the National Demonstration Areas accounted for 71.8% of the total 170 points. Based on the scores gathered from this study, the 23-items-index-system that represented the status of project implementation was classified into seven categories. Categories with higher percentile scores would include: monitoring (88.0%), safeguard measures (75.0%), health education and health promotion (75.0%). Categories with lower percentile scores would include: the national health lifestyle actions (67.7%), community diagnosis (66.7%), discovery and intervention of high-risk groups (64.7%), and patient management (60.9%). There were significant differences noticed among the eastern, central and western areas on items as safeguard measures, health education/promotion, discovery and intervention of high-risk groups. In all, the implementation programs in the eastern Demonstration Areas seemed better than in the central or western regions. As for the 23 items, five of the highest scores appeared on policy support, mortality surveillance, tumor registration, reporting system on cardiovascular/cerebrovascular events, and on tobacco control, respectively. However, the lowest five scores fell on healthy diet, patient self-management program, oral hygiene, setting up the demonstration units and promotion on basic public health services, respectively. The overall scores in the eastern region was higher than that in the central or the western regions. The scores in the central and western regions showed basically the same. Conclusions: The overall status of implementation on the National Demonstration Areas was satisfactory. Future attention should be focusing on patient management as well as discovery and intervention of high-risk groups, which also presented the lowest scores, in this survey.
China/epidemiology* ; Chronic Disease/epidemiology* ; Delivery of Health Care ; Health Promotion/organization & administration* ; Humans ; National Health Programs ; Noncommunicable Diseases/prevention & control* ; Outcome Assessment, Health Care ; Population Surveillance ; Preventive Health Services/organization & administration* ; Program Evaluation ; Public Health ; United States

Objective: To investigate the consumption of vegetables and fruits and related influencing factors among residents from the National Demonstration Areas of Comprehensive Prevention and Control of Non-communicable Diseases. Methods: From November to December, 2016, a total of 4 000 residents, aged 18 or above, from ten Demonstration Areas, were selected as participants for this study by multi-stage cluster random sampling method. Information on vegetables, fruits consumption and related influencing factors was collected via questionnaire. Results: A total of 3 891 residents were involved in the final analysis. Daily consumption of vegetables and fruits accounted for 72.1% and 53.6% of the residents under study. The residents who were aware of the National Demonstration Areas activities were more willing to have adequate intake of vegetables (OR=3.017, 95%CI: 2.426-3.753) and fruits (OR=1.261, 95%CI: 1.007-1.580). Residents with higher degree of participation activities of the demonstration areas were more likely to have adequate fruits intake (high degree: OR=1.431, 95%CI: 1.210-1.694; medium degree: OR=1.573, 95%CI: 1.315- 1.882). Conclusions: The implementation of the National Demonstration Areas for Comprehensive Prevention and Control of Non-communicable Diseases has improved the adequate vegetables and fruits intake among residents. Relevant activities carried out in the Demonstration Areas appeared conducive to the healthy lifestyle of the residents.
Diet/statistics & numerical data* ; Fruit ; Humans ; Middle Aged ; Noncommunicable Diseases/prevention & control* ; Population Surveillance ; Surveys and Questionnaires ; Vegetables

Objective: To analyze the characteristics of super-antigen (SAg) of group A Streptococcus pyogenes (GAS), isolated from patients with scarlet fever or pharyngeal infections in Beijing between 2015-2017. Methods: Throat swab specimens from patients with scarlet fever or pharyngeal infections were collected and tested for GAS. Eleven currently known SAg genes including SpeA, speC, speG, speH, speI, speJ, speK, speL, speM, smeZ and ssa were tested by real-time PCR while M protein genes (emm genes) were amplified and sequenced by PCR. Results: A total of 377 GAS were isolated from 6 801 throat swab specimens, with the positive rate as 5.5%. There were obvious changes noticed among speC, speG, speH and speK in three years. A total of 45 SAg genes profiles were observed, according to the SAgs inclusion. There were significant differences appeared in the frequencies among two of the highest SAg genes profiles between emm1 and emm12 strains (χ(2)=38.196, P<0.001; χ(2)=72.310, P<0.001). There also appeared significant differences in the frequencies of speA, speH, speI and speJ between emm1 and emm12 strains (χ(2)=146.154, P<0.001; χ(2)=52.31, P<0.001; χ(2)=58.43, P<0.001; χ(2)=144.70, P<0.001). Conclusions: Obvious changes were noticed among SAg genes including speC, speG, speH and speK from patients with scarlet fever or pharyngeal infections in Beijing between 2015-2017. SAg genes including speA, speH, speI and speJ appeared to be associated with the emm 1 and emm 12 strains. More kinds of SAg genes profiles were isolated form GAS but with no significant differences seen in the main SAg genes profiles, during the epidemic period.
Antigens, Bacterial/genetics* ; Bacterial Outer Membrane Proteins ; Bacterial Proteins ; Beijing/epidemiology* ; China/epidemiology* ; Exotoxins ; Female ; Humans ; Membrane Proteins ; Pharyngitis/microbiology* ; Pharynx/microbiology* ; Pregnancy ; Pregnancy Complications, Infectious/microbiology* ; Real-Time Polymerase Chain Reaction ; Scarlet Fever/microbiology* ; Streptococcal Infections ; Streptococcus pyogenes/isolation & purification* ; Superantigens/genetics*