Background Expert guidelines recommend low-risk women to consume a daily multivitamin supplement containing 400 µg of folic acid (FA) to prevent the occurrence of neural tube defects. This study assessed the knowledge, attitude and practice of physicians regarding FA recommendations, status and health outcomes during pregnancy since physicians play an essential role in promoting appropriate FA intake. Methods A cross-sectional survey of a sample of physicians practicing in the National Capital Region was self-administered in 2018-2019. Results Approximately 70% of physicians were not familiar with the most recent guidelines and 55% of them most often recommend a 1000 µg-FA supplement. A high level of willingness to recommend a supplement containing 400 µg-FA was reported by almost all physicians. Conclusion While most physicians would not feel comfortable recommending a supplement that is not in line with the most recent evidence-based guidelines, educational programs targeted to physicians are needed to improve their knowledge, attitude and practice.

The prevalence of obesity in the United States was stable at 17% from 2011-2014 among approximately 13 million children and adolescents 12-19 years of age, according to the Centers for Disease Control and Prevention. Nutritional counseling has been recommended, and while most physicians agree that it is necessary, it is not happening consistently. The purpose of this study was to examine the association between dietary intake, physical activity, and body mass index (BMI) characteristics of youth 12-17 years old in California and the receipt of nutritional counseling. Social cognitive theory guided this quantitative cross-sectional analysis of archived data from 814 youth in the California Health Interview Survey (CHIS) 2015-2016. Independent variables included demographics (age, gender, and race), BMI, unhealthy and healthy foods, physical activity and being sedentary; the dependent variable was receipt of nutritional counseling. Findings showed that 73.5% of children who were obese or overweight received counseling. BMI was the strongest predictor of dietary counseling. Independent of diet, physical activity, age, gender, and race, youth who were obese (BMI, kg/m2, -?¥95th percentile) were almost 100% more likely to talk to their doctor compared to children of normal weight (multivariable-adjusted OR=1.98, 95% CI: 1.23, 3.20). The number of cans of sweet fruit/sports drinks was significantly associated with the outcome (p=0.04). There was no significant association between fruit and vegetable consumption (adjusted OR=1.02, 95% CI: 0.95, 1.10) or physical activity (adjusted OR=0.99, 95% CI: 0.71, 1.39) and nutritional counseling. The implications of the study findings for social change include potential improvements in obesity screening and counseling to improve adolescent health outcomes. Addressing weight issues and diet /lifestyle education earlier in life, could reduce chronic disease in the youth.

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Medical sociologists and healthcare scholars have documented an upward trend in the use of complementary and alternative medicine (CAM) in the United States in recent decades. This study is focused on CAM use as it relates to the conventional U.S. healthcare system. The aim of this work is to differentiate CAM modalities functionally and to situate peoples’ CAM use in their structural location in the conventional healthcare system and their interactions with conventional medicine practitioners. Using the Household Component of the Medical Expenditures Panel Survey of 1998 two samples are considered. In a sample of combined CAM-users and non-users, comparisons are made between significant predictors of CAM use when CAM is treated as a uniform phenomenon to those when CAM is broken up into individual modalities for analysis. In a sample of respondents who used one of eleven CAM therapies in 1998, interactions with physicians and access to CAM modalities are compared between each of the modalities. The two indexes of variables, which are influence of MD interactions (measured by visits to an MD, discussing CAM use with MD and being referred to CAM by MD) and patients’ location within the structure of healthcare (measured by health insurance status, CAM insurance, and urban MSA code), are shown to have explanatory power on different CAM modalities’ use. These finding support the argument that CAM use should not be studied as a uniform phenomenon and that patients’ location in the larger healthcare system and interactions with medical doctors should be considered in research on complementary and alternative medicine’s use.

Background: To assess the validity and reliability of the set of scales (general professional activity, health services management, and working conditions) on the different areas of job satisfaction in Peruvian physicians based on the data from the National Survey of Satisfaction of Users in Health (ENSUSALUD). Method: We carried out a psychometric study based on the secondary data analysis of Questionnaire 2 of ENSUSALUD-2016. Participants were selected from a two-stage stratified national probability representative sampling by political region. Validity was assessed by exploratory and confirmatory factor analyses, and measurement invariance analysis. We assessed the reliability using internal consistency coefficients (alpha and omega). The set of scales were composed of items related to three different areas of job satisfaction: 1) satisfaction with general professional activity, 2) satisfaction with the health services management, and 3) satisfaction with the working conditions of the health center. Results: We included 2137 participants in the analysis. The general professional activity scale with six items (Comparative Fit Index, CFI = 0.946; Root Mean Square Error of Approximation, RMSEA = 0.071; Standardized Root Mean Square Residual, SRMR = 0.035), the health services management scale with eight items (CFI) = 0.972; RMSEA = 0.081; SRMR = 0.028), showed good measurement properties for the one-dimensional model. The working conditions scale with eight items for individual conditions and three items for infrastructural conditions (CFI = 0.914; RMSEA = 0.080; SRMR = 0.055) presented adequate measurement properties with a two-dimensional model. The invariance analysis showed that comparisons between sex, age, civil status, medical speciality, working in other institutions, work-related illness, chronic disease, and time working in the healthcare center. All scales had adequate internal consistency (ω and α between 0.70 and 0.90). Conclusions: The set of scales has a solid factorial structure and measurement invariance, making it possible for group comparison. The study achieved stability in the scores as they showed adequate internal consistency coefficients. Based on our findings, these instruments are suitable for measuring job satisfaction among outpatient physicians throughout Peru, as our data is representative of the country level. / Revisión por pares

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