Objectives:To assess the quality of dispensing and patient knowledge of drugs dispensed in primary care in Botswana. Setting: Thirty randomly assigned primary healthcare facilities in three districts of Botswana. Participants: Patients visiting clinics and health posts. Design: Analysis of data from prospective participative observations of the drug dispensing process and interview of patients about their knowledge of drugs received immediately after dispensing. The quality of drug labelling was assessed by calculating mean labelling scores composed of five dispensing attributes: name of patient, and name, strength, dosage, and volume of the drug (incorrect or no labelling=0, 1 point for each correct labelling attribute; maximum score=5). Mean knowledge scores were obtained immediately after dispensing from patient recall of name and dosage of drug, duration of treatment, and reason for prescription (incorrect recall=0, 1 point for each correct recall attribute; maximum score=4). Results: 2994 consecutive patient consultations were analysed. The mean labelling score was 2.75. Family welfare educators and pharmacy technicians scored highest (3.15 and 2.98, respectively) and untrained staff lowest (2.60). Factors independently associated with the labelling score were analgesics v other drugs, district, health posts v clinics, education of prescriber (nurse best), and years of experience of prescriber (4-11 years best). The mean patient knowledge score was 2.50. The reason for prescription of the drug(s), dosage, duration of treatment, and name of the drug(s) was recalled by 92%, 83%, 44%, and 31% of patients, respectively. The qualification level of the dispenser was the strongest factor independently associated with the knowledge score. Antibiotics had the second lowest score, both for labelling (2.39) and patient knowledge (2.39). Conclusion: Only trained dispensing staff provided satisfactory quality of labelling. Patients had a fair knowledge of the drugs dispensed. The knowledge of drugs dispensed by family welfare educators was less than satisfactory. The labelling score is a useful indicator of the quality of dispensing, and the knowledge score of both the quality of prescribing and of dispensing. These indicators should be added to the WHO list of patient care indicators. R ational prescription and use of drugs has been a concern in both developed and developing countries during the last two decades and has been promoted by WHO and others.

PURPOSE Knowledge about the ways patients perceive their vulnerability to disease is important for communication with patients about risk and preventive health measures. This interview study aimed to explore how patients with a diagnosis of heterozygous familial hypercholesterolemia understand and perceive their vulnerability to coronary heart disease. METHODSWe did a qualitative study of 40 patients with familial hypercholesterolemia who were recruited through a lipid clinic in Norway. We elicited participants' perceptions about their vulnerability to heart disease in semistructured interviews. Data were analyzed by systematic text condensation inspired by Giorgi's phenomenological method. RESULTSWe found that participants negotiated a personal and dynamic sense of vulnerability to coronary heart disease that was grounded in notions of their genetic and inherited risk. Participants developed a sense of their vulnerability in a 2-step process. First, they consulted their family history to assess their genetic and inherited risk, and for many a certain age determined when they could expect to develop symptoms of coronary heart disease. Second, they negotiated a personal sense of vulnerability by comparing themselves with their family members. In these comparisons, they accounted for individual factors, such as sex, cholesterol levels, use of lipid-lowering medications, and lifestyle. Participants' personal sense of vulnerability to heart disease could shift dynamically as a result of changes in situational factors, such as cardiac events in the family, illness experiences, or becoming a parent. CONCLUSIONSPatients with a diagnosis of familial hypercholesterolemia negotiate a personal and dynamic sense of vulnerability to coronary heart disease that is grounded in their understanding of their genetic and inherited risk. Doctors should elicit patients' understanding of their family history and their personal vulnerability to individualize clinical management. 2006;4:198-204. DOI: 10.1370/afm.529. Ann Fam Med INTRODUCTION Communicating with patients about their risk of future disease and preventive health measures is challenging for the doctor.1 A strong predictor of patients' readiness for medical treatment and preventive behavior is their perceived vulnerability to disease. [2][3][4][5][6] The family history forms a basis upon which a person assesses his or her own vulnerability to common chronic diseases, 7,8 and the family history is becoming increasingly important as a medical devise to predict risk of future disease.9 How do patients with a well-defi ned genetic disorder relate to their family history? How do patients with a diagnosed familial risk understand and perceive their vulnerability to future disease?Heterozygous familial hypercholesterolemia is an autosomal dominant genetic condition, characterized by elevated low-density lipoprotein Jan C. Frich, MD, MSc 1,2 Leiv Ose, MD, PhD 3 Kirsti Malterud, MD, PhD 4,5 Per Fugelli, MD 199 PAT IEN T S' PERC EIV ED V UL NER A BIL I T Y(LDL) chol...

Reversing or aborting the increase in allergic and other immunerelated noncommunicable diseases (NCDs) in the Western world, first observed for allergic rhinitis from the 1890s, 1 requires priat, or in collaboration with (in Sweden), the 3 participating hospitals were eligible, provided sufficient language skills. Women carrying more than 2 fetuses, fetuses with severe malformations or disease and infants born prior to 35.0 weeks of GA, were excluded.All infants were randomized at birth to 1 of 4 similar sized groups: (1) no intervention; (2) skin care (oil-bath at least 5 days per week from 0.5 to 9 months of age); (3) consecutive introduction, between 3 and 4 months of age, of peanut, milk, wheat, and egg at least 4 days per week complementary to breastfeeding; or (4) both interventions. Weekly electronic diaries (2-26 weeks of age) recorded skin care, infant feeding, and symptoms of allergic diseases.Adverse events (0-12 months of age) elicited relevant investigations and treatment by direct access for the participants to the local pediatric department.Data collection (Figure 1, Table S1) includes electronic questionnaires with information of health and disease in the mother, child, and family; lifestyle; environment; stress; quality of life; diet in the mother and offspring; clinical investigations; fetal and child anthropometrics; lung function; skin barrier; allergy; and blood pressure

Objectives: To evaluate general practitioners' knowledge of a range of psychosocial problems among their patients and to explore whether doctors' recognition of psychosocial problems depends on previous general knowledge about the patient or the type of problem or on certain characteristics of the doctor or the patient. Design: Multipractice survey of consecutive adult patients consulting general practitioners. Doctors and patients answered written questions. Setting: Buskerud county, Norway.

The objective of this study was to evaluate the effect of a simple smoking intervention programme, carried out by a large number of general practitioners (GPs) among pregnant and non-pregnant women. Four groups of women were defined by the dichotomies pregnant versus non-pregnant and intervention versus control. The intervention was semistructured, using a flip-over and a booklet, and it was implemented in an ordinary sequence of consultations. The study involved 187 GPs in western Norway. The subjects were 350 daily smoking pregnant women and 274 daily smoking non-pregnant women, 18-34 years of age. The point prevalence abstinence rate at 18 months was 15 and 20% for pregnant and non-pregnant women, respectively, in the intervention groups, and 7% in the control groups (Ppregnant = 0.06, Pnon-pregnant = 0.006). Twenty-five per cent of the pregnant women and 34% of the non-pregnant women reported that they had reduced their cigarette consumption, but had not stopped smoking entirely. If we include all drop-outs as smokers, the continuous abstinence rate during 15 months was 6%/0% among pregnant women (intervention/control) and 5%/1% among non-pregnant women. Stopping smoking was associated with having a non-smoking partner (P = 0.001), and being encouraged to do so by their partner (P = 0.004). The prevalence of both pregnant and non-pregnant women who stopped smoking was higher in the intervention than in the control groups. Pregnant women stopped smoking as frequently as non-pregnant individuals.(ABSTRACT TRUNCATED AT 250 WORDS)