From the Editor
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Chief Editor:
A. Abyad
MD, MPH, AGSF, AFCHSE
Email: aabyad@cyberia.net.lb

In this issue two papers dealt with the primary care implementation and the barriers involved. A cross-sectional multi-country study was conducted in six countries of EMR during May 2014 to October 2014. Expert Family Physicians from each country were identified and asked to participate in the study. The Family Physicians then recruited Patients from their own clinics (>18 years). Data analysis was performed on SPSS 19 and results are reported in the form of proportions, odds ratios and 95% confidence intervals. The aim of the study was to identify patients' perception regarding barriers and possible remedies for implementation of PCC in Eastern Mediterranean Region (EMR). A total of 234 patients were recruited, 60.6% were aged between 20 to 30 years and 36.3% of them were males. 56% of the patients preferred Person-Centered Care model for patient-physician consultation. The major barriers identified by patients in its implementing were; time constraints (73.9%, OR: 1.5; 95% CI: 0.86-2.78), doctors desire to control patient (OR: 2.6; 95% CI: 1.55-4.49), cultural and religious reasons (52.1%), increased cost (50.9%). Patients responded that increased cost related to Person-Centered Care practice would be acceptable (58.1%), if increase proved to be in the interest of better health and care outcomes (40.6%). The authors concluded that Person-Centered Care (PCC) is associated with significant barriers in its implementation in Eastern Mediterranean Region. These barriers can be overcome in the interest of better health and care related outcomes.

A paper from India analyzed the Medical and Non-medical aspects of Medical Consultation in the city of Visakhapatnam. The authors stressed that Indian healthcare industry is having a potential to reach $ 280 billion by 2020 (KPMG Report) reflecting a compounded growth of 17-18%. Indian health care is witnessing a huge change in the form of disease profile. Patient enters medical practitioners' chamber with a high hope at the appointed time, but this consultation session is a meaningful or superficial interaction. It is indeed a situation of dilemma. The authors stressed that basically, consultation session in the medical practitioners' chamber varies from one patient to another. This case study is an observational study conducted at Visakhapatnam (port city in Andhra Pradesh). Visakhapatnam has been a centre of pharmaceutical companies from the last one decade. Three specialties (Cardiologist, diabetologist and Oncologist) were selected. Different situations were recorded and analyzed in these consulting sessions through observational schedule. Result indicated there are many reasons for the uniqueness. It can be used as training materials to the medical representatives as they get to know what exactly is happening in the chamber and helps in preparing himself for their meeting with the doctor's.

A paper from Nigeria assessed the Public and Economic Rehabilitation Component of Leprosy Control Programmes in Anambra and Ebonyi States of Southeast Nigeria. The study adopted a cross-sectional survey design. Quantitative data was generated through structured questionnaire schedule administered on 1116 study participants. The participants were selected through a combination of cluster and simple random sampling methods. Qualitative data were generated through two instruments. These were Focus Group Discussion (FGD) administered on persons affected by leprosy and In-Depth Interview (IDI) of leprosy control staff and officials from both World Health Organization and the donor agency supporting leprosy control in the two states. The Statistical Package for the Social Sciences (SPSS) software was employed in analysis of data. Frequency tables, percentages, bar charts, chi-square and multiple regressions were used for presentation, analysis and in testing the stated hypotheses. It was found that only 25.5% of the respondents acknowledged availability of SER component which is institutional rather than community based. Furthermore, most respondents assessed SER activities in leprosy control in the two states as largely unsuccessful One hypothesis test showed that more respondents with low income perceived a link between adequate funding and effective leprosy control programme than those with higher levels of income (X2=190.427,df=70,p=0.000). It was recommended that aggressive public enlightenment through public, private and local media; incentive package for health workers and extensive socio-economic empowerment for effective rehabilitation of patients be adopted to enhance leprosy control in Anambra and Ebonyi states.

A retrospective study which was conducted in Jordan to evaluate the association between passive smoking and adverse reproductive effects or pregnancy outcomes among Jordanian pregnant women. A total samples of 4125 newborns were included in the study. The demographic characteristics of these newborns included: gestational age, gender, birth weight, congenital anomaly, mode of delivery and admission to NICU. Maternal characteristics of Jordanian women according to passive smoking included: age, parity, weight, and income. Pregnancy outcome for Jordanian women according to passive smoking status indicated that passive smoking are related with stillbirth with an incidence of 1.0%, low birth weight in 11.9%, pre-term delivery in 12.5%, congenital anomaly in 1.6%, caesarean delivery in 23.7% and need for admission in NICU in 35.4%. The result indicated that exposure to passive smoking during pregnancy had adverse effects on low birth weight, admission to NICU, and need antibiotic significantly p- value <.0005. The authors concluded that exposure to passive smoking during pregnancy had adverse effects on pregnancy outcome. Adverse reproductive effects are serious and costly health problems that have huge impact on morbidity and mortality rate in all societies.