Objective: Mortality data is a critical input to public health decision-making and planning. Yet, about 36% of underlying causes of death reported by physicians in 2018 are considered garbage codes, not useful in analyzing public health and mortality (PSA, 2018). We used the PRECEDE-PROCEED approach to develop, implement, and report an advocacy and education Project to improve training on medical certification of cause of death (MCCOD) among senior medical students and interns. Methods: An MCCOD Instructional Design and eLearning course was introduced and validated in 33 medical education institutions. Lessons enhanced these education materials and are proposed for nationwide adoption. In the middle of the COVID-19 pandemic, the Project fast-tracked the training of physician-learners on the correct cause of death reporting and certification. Results: Awareness of correct MCCOD and its personal and public health value reached at least 4000 learners, over a hundred medical faculty, and all deans of medical colleges in the Philippines. Conclusion The PRECEDE-PROCEED Model provided a clear and practicable framework for the advocacy and education efforts to train senior medical students and interns on MCCOD. It can similarly guide other medical education innovations by defining predisposing, enabling, and reinforcing factors then considering these factors for intervention strategies, implementation, process evaluation, outcome evaluations, and impact evaluations.
advocacy ; medical education

Since 1990, descriptive studies about the concept of client advocacy have been published in the health journals. However, empirical studies of the concept are still lacking. There are not enough bases to apply the concept of client advocacy in nursing practice. The purpose of this paper is to encourage empirical research about client advocacy by clarification of the concept and to discusses application of the theory in child healthcare. The literature was reviewed that empirical studies on client advocacy conducted after the year 2000. The changing trends in the client advocacy concept was examined; it was changed from the philosophical concept to nursing action and changed from individual advocacy to collective advocacy, with the rise of the self advocacy concept. The research trends on client advocacy evolves from descriptive study to quasi-experimental study and instrument development study, with diversification and expansion of research methods, advocates, clients and settings. The advocacy role of the nurse in child healthcare is significant due to the child's lack of self determination ability. In ill child care, the application of individual advocacy is potent, while in healthy child care, collective advocacy, policy advocacy, and social advocacy is effective.
Child ; Child Care ; Delivery of Health Care ; Empirical Research ; Humans ; Patient Advocacy ; Personal Autonomy

PURPOSE: This descriptive study aimed to compare the perception of the acceptable foods for the neutropenic diet between nurses and patients by food type. METHODS: The participants were 225 nurses working at chemotherapy wards and 71 patients in chemotherapy treatment. Data were collected with a self-administered questionnaire from January 2 to February 24, 2012, and analyzed with SPSS 12.0 program using descriptive statistics and the chi2-test. RESULTS: Eighty-eight point eight percent of nurses and 76.1% of cancer patients thought the patients needed the neutropenic diets. The most important decisional criteria to determine dietary restriction was neutrophil count for nurses and food type for patients. The two groups showed significantly different allowance to raw fruits and raw vegetables, sterilized canned juice, fried vegetables, yogurt, uncooked tofu, salted fish, cooked fish, cooked shellfish, uncooked grain powder, jellified food, home-made bread/cookies, nuts including peanuts, instant coffee or tea and tea brewed. In general, patients were more permissive about the neutropenic diet than nurses. CONCLUSION: It is recommended to consider patients' preference as well as nurses' professional knowledge and publish standardized clinical diet guidelines for neutropenic patients with collaboration between nurses and patient representatives.
Arachis ; Edible Grain ; Coffee ; Cooperative Behavior ; Diet* ; Drug Therapy ; Fruit ; Humans ; Neutropenia ; Neutrophils ; Nuts ; Patient Advocacy ; Shellfish ; Soy Foods ; Tea ; Vegetables ; Yogurt

PURPOSE: To review and determine the complications in 76 child abuse cases recorded by a multidisciplinary hospital-based child protection team between 1987 and 2007. METHODS: We retrospectively reviewed the reports and medical records of child abuse cases maintained by a university hospital-based child protection team. We devised a questionnaire for standardized interviews with the victims' guardians to determine the current physical and mental status of the children; questionnaires were answered by social workers of the child protection team who interviewed the present fosterers of 24 (35.8%) children. RESULTS: Of the 76 children, 6 were infants, 10 were 1-3 years old, were 3-10 years old, and 19 were over 10 years old. Seven children (9.2%) were neglected and 27 (35.5%) and 44 (57.9%) were sexually and physically abused, respectively. In more than half of the cases, the perpetrators were the father or mother of the children. Most children (41 cases, 53.9%) were abused at their homes. The mean follow-up duration from the time of abuse infliction was 54.3+/-49.2 months, and the current mean age of the children was 8.3+/-6.4 years. Moderate and severe developmental delay and physical disability were observed in 6 (25.0%) and 3 (12.5%) cases, respectively. In 13 children (54.2%), the Global Assessment of Functioning Scale (GAF) score was less than 60, which indicates mild mental disability. CONCLUSION: A hospital-based child protection team may witness the different proportion of abuse types and patterns by conducting a nation-wide survey of child abuse cases.
Child ; Child Abuse ; Child Advocacy ; Fathers ; Follow-Up Studies ; Humans ; Infant ; Korea ; Medical Records ; Mothers ; Surveys and Questionnaires ; Retrospective Studies ; Social Workers ; Wit and Humor as Topic

PURPOSE: To review and determine the complications in 76 child abuse cases recorded by a multidisciplinary hospital-based child protection team between 1987 and 2007. METHODS: We retrospectively reviewed the reports and medical records of child abuse cases maintained by a university hospital-based child protection team. We devised a questionnaire for standardized interviews with the victims' guardians to determine the current physical and mental status of the children; questionnaires were answered by social workers of the child protection team who interviewed the present fosterers of 24 (35.8%) children. RESULTS: Of the 76 children, 6 were infants, 10 were 1-3 years old, were 3-10 years old, and 19 were over 10 years old. Seven children (9.2%) were neglected and 27 (35.5%) and 44 (57.9%) were sexually and physically abused, respectively. In more than half of the cases, the perpetrators were the father or mother of the children. Most children (41 cases, 53.9%) were abused at their homes. The mean follow-up duration from the time of abuse infliction was 54.3+/-49.2 months, and the current mean age of the children was 8.3+/-6.4 years. Moderate and severe developmental delay and physical disability were observed in 6 (25.0%) and 3 (12.5%) cases, respectively. In 13 children (54.2%), the Global Assessment of Functioning Scale (GAF) score was less than 60, which indicates mild mental disability. CONCLUSION: A hospital-based child protection team may witness the different proportion of abuse types and patterns by conducting a nation-wide survey of child abuse cases.
Child ; Child Abuse ; Child Advocacy ; Fathers ; Follow-Up Studies ; Humans ; Infant ; Korea ; Medical Records ; Mothers ; Surveys and Questionnaires ; Retrospective Studies ; Social Workers ; Wit and Humor as Topic

The aging process is linked to changes in the physiological function of organs and changes in body composition that alter the pharmacokinetics of drugs and pharmacodynamic responses. Comorbidity and polypharmacy in the elderly decreases tolerability of drugs, leading to greater vulnerability to adverse drug reactions than that observed in younger adults. In geriatric pharmacotherapy, the general recommendation is dose reduction and slow titration, which is based on pharmacokinetic considerations and concern for adverse drug reactions, rather than clinical trial data. Older patients are under-represented in clinical trials. In the absence of evidence, extrapolation of risk-benefit ratios from younger adults to geriatric populations is not necessarily valid. Sound evidence through prospective clinical trials is essential, and geriatric societies, governments, and patient advocacy groups should collaborate to promote the inclusion of older people in clinical trials. It is believed that all involved in clinical trials have both an obligation and an opportunity to eliminate age discrimination in clinical trial practice.
Adult ; Aged* ; Ageism ; Aging ; Body Composition ; Comorbidity ; Drug Therapy ; Drug-Related Side Effects and Adverse Reactions ; Geriatrics ; Humans ; Patient Advocacy ; Pharmacokinetics ; Pharmacology, Clinical* ; Polypharmacy

Medical reports are required to support court applications to appoint a deputy to make decisions on behalf of a person who has lost mental capacity. The doctor writing such a medical report needs to be able to systematically assess the mental capacity of the person in question, in order to gather the necessary evidence for the court to make a decision. If the medical report is not adequate, the application will be rejected and the appointment of the deputy delayed. This article sets out best practices for performing the assessment and writing the medical report, common errors, and issues of concern.
Documentation ; Humans ; Mental Competency ; legislation & jurisprudence ; Patient Advocacy ; legislation & jurisprudence ; Physicians ; legislation & jurisprudence ; Proxy ; legislation & jurisprudence ; Singapore ; Third-Party Consent ; legislation & jurisprudence ; Vulnerable Populations ; legislation & jurisprudence ; Writing

BACKGROUND: Patient-centered care (PCC) and integrative care approach are widely advocated. However, their implementation usually requires an extended consultation time. Despite significant advances in medical diagnosis and treatment, no studies have examined consultation time and patient centeredness in Korea. METHODS: We conducted a “15-Minute Consultation” for first-time patients in outpatient clinics of 13 departments. A control group was selected from the same physicians' first-time patients, adjusting for age and gender. A total of 275 patients were selected for receiving in-depth consultation and 141 control patients were selected for regular consultation. Data were collected from patients using a questionnaire comprising a patient-centeredness scale and items on potential predictors such as socio-demographic and clinical factors. We also investigated the participating physician's professionalism. RESULTS: As compared to the control group, the in-depth consultation group scored higher on 5 variables associated with PCC, including (patients' perception of) medical professionals, wait and consultation times, treatment, patient advocacy, and patient satisfaction. While 92.4% of patients in the in-depth consultation group reported that the consultation time was sufficient, only 69.0% of those in the control group reported the same (P < 0.01). In the in-depth consultation group, scores on satisfaction level were the highest for the department of internal medicine, followed by departments of surgery and pediatrics. Participating physicians' improved satisfaction following the intervention proved that in-depth consultation facilitated building a rapport with patients. CONCLUSION: This study illustrated that the provision of sufficiently long consultation for serious and rare diseases could improve PCC and physicians' professionalism. Health authorities should reshuffle the healthcare delivery system and provide sufficient consultation time to ensure PCC and medical professionalism.
Ambulatory Care Facilities ; Delivery of Health Care ; Diagnosis ; Humans ; Internal Medicine ; Korea ; Outpatients ; Patient Advocacy ; Patient Satisfaction ; Patient-Centered Care ; Pediatrics ; Professionalism ; Rare Diseases ; Tertiary Care Centers

PURPOSE: This research was conducted to reveal Japanese mothers' changing perceptions towards their technology-dependent children in the home care setting. METHODS: Fourteen Japanese mothers participated in semi-structured interviews, which were analyzed using a grounded theory approach. RESULTS: "Degree of preoccupation with the child" emerged as the category representing the mothers' perceptions towards their child. Three categories emerged that represented the progression of maternal perceptions over time: "accepting the child's conditions", "mastering the management of care in various conditions", and "considering social participation for the child". CONCLUSIONS: First, mothers gradually accepted the conditions of their child after his/her disease and disability were known. Second, others managed technology-required care and concurrently considered the social participation of their child through daily care at home. Third, the level of preoccupation with the child was affected by the mothers' management of care and their attitude towards the social participation of their child in home care. In this study, as is widely alleged in historical recognition of Japan, mothers provided daily care almost without help from other family members. Additionally, they thought it natural and good for their children. Above all, especially in Japan, professional support for mothers are necessary so that they can take breaks from care.
Adaptation, Psychological ; Adolescent ; Adult ; *Attitude to Health ; Biomedical Technology ; Caregivers ; Child ; Child Advocacy ; Disabled Children/*psychology ; Female ; Home Care Services ; Humans ; Japan ; Male ; Middle Aged ; Mother-Child Relations ; Mothers/*psychology ; Perception ; Personal Autonomy ; Self-Help Devices ; Young Adult

Air pollution, climate change, and reduced biodiversity are major threats to human health with detrimental effects on a variety of chronic noncommunicable diseases in particular respiratory and cardiovascular diseases. The extent of air pollution both outdoor and indoor air pollution and climate change including global warming is increasing-to alarming proportions particularly in the developing world especially rapidly industrializing countries worldwide. In recent years, Asia has experienced rapid economic growth and a deteriorating environment and increase in allergic diseases to epidemic proportions. Air pollutant levels in many Asian countries especially in China and India are substantially higher than are those in developed countries. Moreover, industrial, traffic-related, and household biomass combustion, indoor pollutants from chemicals and tobacco are major sources of air pollutants, with increasing burden on respiratory allergies. Here we highlight the major components of outdoor and indoor air pollutants and their impacts on respiratory allergies associated with asthma and allergic rhinitis in the Asia-Pacific region. With Asia-Pacific comprising more than half of the world's population there is an urgent need to increase public awareness, highlight targets for interventions, public advocacy and a call to action to policy makers to implement policy changes towards reducing air pollution with interventions at a population-based level.
Administrative Personnel ; Air Pollutants ; Air Pollution ; Air Pollution, Indoor ; Allergy and Immunology ; Asia ; Asian Continental Ancestry Group ; Asthma ; Biodiversity ; Biomass ; Cardiovascular Diseases ; China ; Climate Change ; Climate ; Consumer Advocacy ; Developed Countries ; Economic Development ; Family Characteristics ; Global Warming ; Humans ; Hypersensitivity ; India ; Rhinitis, Allergic ; Tobacco