ABSTRACT
Nous avons décrit le parcours de trois patients à partir de la date de la première consultation à l'Unité de Chirurgie oncologique. Il s'était agi de deux hommes et une femme, âgés respectivement de 60, 52 et 48 ans. La disponibilité financière, l'ignorance, la mauvaise orientation hospitalière et la non acceptation des méthodes de traitement, avaient constitué les barrières rencontrées au long du parcours de soins. La compréhension de la survenue de ces barrières afin d'en apporter les correctifs nous semble possible dans une étude menée avec un échantillon plus grand
Subject(s)
Africa , Neoplasms/drug therapy , Neoplasms/therapy , Socioeconomic Factors , Treatment RefusalABSTRACT
N.A.
Subject(s)
Antimalarials , Artemisinins/adverse effects , Drug Combinations , Treatment RefusalABSTRACT
Une enquete avec echantillonnage probabiliste a ete conduite entre juillet et septembre 2006; en utilisant les donnees relatives au suivi therapeutique de la tuberculose durant la periode de janvier 2002 a decembre 2004 dans 3 de 6 districts sanitaires et 7 de 35 zones de sante a Kinshasa. D'une part; 155 tuberculeux ayant abandonne le traitement et 155 temoins selectionnes parmi les patients ayant termine leur traitement ; et d'autre part 12 infirmiers issus des zones de sante ayant un taux d'abandon de traitement 5et 13 infirmiers issus des zones de sante presentant un taux d'abandon de traitement 5ont ete selectionnes et soumis a un questionnaire ad hoc pour rechercher les determinants associes a l'abandon du traitement. Cinq determinants associes a l'abandon du traitement anti-tuberculeux selon la strategie DOTS ont ete retenus dans le modele de regression logistique : le statut de celibataire OR 3.173 (1.232-11.037); l'age inferieur a 40 ans OR : 1.930(1.215-4.054); la meconnaissance de l'etiologie de la maladie 0R : 20.210 (2.358-29.060); une mauvaise accessibilite geographique 0R : 4.500 (1.289-15.573) et une mauvaise source d'information sur la maladie 0R : 4.451 (1.740-11.338). Ces resultats suggerent que la prise en compte et l'amelioration des conditions socio-economiques et demographiques et surtout le choix des canaux d'informa- tion pour la population ciblant les groupes a haut risque d'abandon de traitement reduiraient considerablement l'incidence de la tuberculose
Subject(s)
Antitubercular Agents , Directly Observed Therapy , Treatment RefusalABSTRACT
Background: The Upper East Region has one of the highest cataract surgical rates in Ghana. Notwithstanding this; cataract blindness is still a major problem. Aim: To determine patient-related barriers to cataract services in the region and their resolution. Methods: Focus Group Discussion (FGD) and Indepth interviews were used to explore the opinions of 66 cataract patients resident in the region between July and August 2003. Purposeful sampling was used in selecting 24 patients in the hospital while a Snowball sampling method was employed on 42 respondents resident in the village communities Results: Average age of the respondents was 67.6 years with equal proportions of males and females (0.9:1). Twelve and fifteen percent of respondents respectively cited fear and lack of escort as barriers to service up-take while 8and 9pointed to sociocultural beliefs and the fact that they were able to cope satisfactorily with their disability. Only 1.5of respondents gave lack of awareness as a barrier with none citing geographical barrier as a problem. Cost of surgery; however; stood out clearly as a very significant barrier with 91of respondents attesting to it. Conclusion: It is concluded that further expansion of outreach services; coupled with a more intensive health education is needed to overcome these barriers
Subject(s)
Cataract , Cataract Extraction , Health Care Costs , Socioeconomic Factors , Treatment RefusalABSTRACT
The research study aimed to identify the factors contributing to premature termination of treatment for substance addiction. The investigation took the form of a differential research design based on archival data obtained from patient files at an inpatient drug rehabilitation centre in Gauteng. One independent variable (treatment adherence) and five dependent variables (past and present patterns of scheduled medication use; legal history and DSM-IV-TR Axis I and II co-morbidity) were chosen. Eighty-five patient files were drawn; constituting 41 treatment adherent and 44 treatment non-adherent addicts. Extraneous variables of age; age of onset; duration of addiction; previous treatment history; drug of choice; current physical health status; gender; race; and level of education were equivalent in both samples. Univariate analysis indicated that treatment adherent and drop-out groups differed significantly in terms of legal history (Fisher's exact test = 12.369; p = 0.002) and past patterns of use of scheduled medication (Fisher's exact test = 29.131; p = 0.000). A logistic regression indicated that a history of abusing a combination of scheduled psychiatric and other medication prior to treatment is the single most accurate predictor of treatment non-adherence (Wald statistic = 11.1035; p = 0.0009). Although certain combinations of past medication patterns and legal history increase predicted probabilities of treatment non-adherence; legal history on its own failed to explain any further variance that past medication could not explain on its own
Subject(s)
Inpatients , Patient Dropouts , Substance-Related Disorders , Treatment RefusalABSTRACT
Two cases of pituitary macroadenomas are the basis for this study. The first; a 70 year old female who had a nonfunctioning pituitary macroadenoma presented with headache and visual impairment. Surgery was indicated but she declined until two years later when visual acuity got worse. The second was a 25 year old male who presented with a prolactinoma and diabetes. Visual abnormalities were related only to the left eye. When it was suggested that surgery might be indicated; he never kept the next appointment. Delay in effecting appropriate surgery timely is known to upset desired results. What is particular in this case is the attendant loss of vision; a very serious disability which could have been prevented. Those prone to fear of surgery should be assisted to understand their situations better and efforts made to encourage them to take the correct decision