Doença de Chagas: itinerário terapêutico de crianças e/ou adolescentes / Chagas disease: therapeutic itinerary of children and/or adolescents

No Brasil, a assistência em tempo oportuno aos indivíduos convivendo com Doença de Chagas ainda é um desafio à saúde pública. Objetivou-se analisar o itinerário terapêutico de crianças e adolescentes portadores de Doença de Chagas na busca de atenção e cuidado com a saúde. Adotada a abordagem qualitativa, descritiva, exploratória. Pesquisa de campo realizada com familiares de crianças/adolescentes convivendo com Doença de Chagas no Centro de Referência em Doenças Tropicais (CRDT) em Macapá, AP. Análise de conteúdo subsidiou a identificação de três categorias analíticas: o diagnóstico como desafio inicial do itinerário terapêutico; o Itinerário em busca do tratamento e controle da doença; fragilidades e potencialidades dos serviços de atenção à saúde. Os resultados apontaram que a oferta dos serviços voltados para o diagnóstico da doença ainda está centrada na atenção especializada. Portanto, o itinerário terapêutico de crianças e adolescentes portadores de Doença de Chagas em busca do tratamento e controle da doença é marcado por desafios que envolvem o diagnóstico em tempo oportuno, o que pode repercutir em tratamentos equivocados. A principal fragilidade identificada estava relacionada aos serviços de saúde, pois a atenção primária não está preparada para a identificação da doença, tão pouco a média e alta complexidade estão qualificadas para uma assistência resolutiva. Quanto às potencialidades, estão relacionadas ao sistema de cuidado e atenção à saúde.

In Brazil, time assistance for individuals living with Chagas disease is still a challenge to public health. It was aimed at analyzing the therapeutic itinerary of children and adolescents with Chagas disease in search of health care and care. Adopted the qualitative, descriptive, exploratory approach. Field research conducted with family members of children/adolescents living with Chagas disease at the Reference Center for Tropical Diseases in Macapá, AP. Content analysis subsidized the identification of three analytical categories: diagnosis as an initial challenge of the therapeutic itinerary; the itinerary in search of disease treatment and control; weaknesses and potentialities of health care services. The results pointed out that the offer of services focused on the diagnosis of the disease is still centered on specialized care. Therefore, the therapeutic itinerary of children and adolescents with Chagas disease in search of treatment and control of the disease is marked by challenges involving the diagnosis in a timely manner, which can reverberate in wrong treatments. The main fragility identified was related to health services, as primary care is not prepared for the identification of the disease, nor are the medium and high complexity qualified for resolution care. Potentialities are related to the health care system and care.

Saúde e discriminação no processo de envelhecimento LGBTQIA+ / Health and discrimination in the aging process LGBTQIA+ / Salud y discriminación em el processo de envejecimiento LGBTQIA+

Objetivo: Identificar as experiências e discriminações vividas pela população LGBTQIA+ em envelhecimento durante a prestação dos serviços de saúde. Método: Estudo exploratório de abordagem qualitativa, por meio da aplicação de um questionário com informações sociodemográficas e questões sobre experiências anteriores dentro de instituições de saúde e percepção do cuidado recebido. Resultados: Participaram nove pessoas, predominantemente, identificadas como homens cisgêneros; e, apenas um estava com idade entre 65 e 70 anos. Em sua maioria buscam o serviço de saúde duas vezes ao ano motivado principalmente por problemas particulares, do sistema respiratório, hipertensão arterial ou dores persistentes. Indicaram não haver desencorajamento para a procura de serviços e a maioria não relatou experiências de discriminação. Conclusão: A baixa frequência de discriminação pode indicar a dificuldade de caracterizar a exposição e/ou vivências por esta população. Sendo assim, devese buscar entender o que essa população considera discriminação por parte dos serviços de saúde a pessoas LGBTQIA + durante o processo de envelhecimento.

Objective: To identify the experiences and discrimination experienced by the aging LGBTQIA+ population during the provision of health services. Method: Exploratory study with a qualitative approach, through the application of a questionnaire with sociodemographic information and questions about previous experiences within health institutions and perception of care received. Results: Nine people participated, predominantly identified as cisgender men; and, only one was aged between 65 and 70 years. Most seek the health service twice a year motivated mainly by particular problems, the respiratory system, high blood pressure or persistent pain. They indicated that there was no discouragement to seek services and most did not report experiences of discrimination. Conclusion: The low frequency of discrimination may indicate the difficulty of characterizing the exposure and/or experiences of this population. Therefore, one should seek to understand what this population considers discrimination by health services to LGBTQIA+ people during the aging process.

Objetivo: Identificar las experiencias y la discriminación que vive la población LGBTQIA+ envejecida durante la prestación de los servicios de salud. Método: Estudio exploratorio con enfoque cualitativo, mediante la aplicación de un cuestionario con información sociodemográfica y preguntas sobre experiencias previas dentro de las instituciones de salud y percepción de la atención recibida. Resultados: Participaron nueve personas, predominantemente identificadas como hombres cisgénero; y, solo uno tenía entre 65 y 70 años. La mayoría acude al servicio de salud dos veces al año motivada principalmente por problemas particulares, del sistema respiratorio, hipertensión arterial o dolor persistente. Indicaron que no hubo desánimo para buscar servicios y la mayoría no reportó experiencias de discriminación. Conclusión: La baja frecuencia de discriminación puede indicar la dificultad de caracterizar las exposiciones y/o experiencias de esta población. Por lo tanto, se debe buscar comprender lo que esta población considera discriminación por parte de los servicios de salud a las personas LGBTQIA+ durante el proceso de envejecimiento.

Morbidity profile and dynamics of determinants of health-seeking behaviour in geriatric population of Chandigarh, India

Introduction: Aging is a natural process that usually results in physiological, biological, emotional, and financial decline. As a result, a robust health system is required to meet their escalating health needs. Through this study, we got an opportunity to study the morbidity profile of the elderly and to assess their health-seeking behavior and its determinants in urban areas of Chandigarh. Material and Methods: The sample consisted of 360 participants. Multistage and proportionate sampling techniques were used to recruit study subjects. A structured interview was carried out to get information on the different parameters of health-seeking behavior of the elderly population. Results: The most pervasive determinant of health-seeking behavior was perceiving health issues related to age, no family support, and health-care expenditure. Conclusion: The elderly had a positive behavior toward seeking help with regard to health care. Multiple morbidities were evident among the elderly, and modern medication was the greatest choice. Improved perspective toward health, easy accessibility, and awareness regarding the disease may contribute to the willingness of seeking help for the health-care needs.

Eye care seeking behavior among rural adults in South India: Tamil Nadu Rural Eye Examination (TREE) Study Report 1

Purpose: To present the eye care seeking behavior among rural adults in South India. Methods: This cross?sectional study was conducted between 2019 and 2020 covering three blocks of the Thiruvannamalai district, Tamil Nadu, India. Door?to?door survey was performed to collect demographic information, status of literacy, occupation, and details of previous eye examination. Distance visual acuity was tested for individuals available in the house using a log MAR (logarithm of minimum angle of resonance) chart. Association between demographic details, details of previous eye examination, and status of vision was analyzed using logistic regression. Results: A data of 12,913 individuals were included for the analysis, of which 6460 (50.03%) were females. Of the total individuals, 2007 (15.54%) had undergone an eye examination previously. There were 1639 (28.50%) people who had a vision less than 0.2 log MAR in at least one eye. The odds of reported ‘previous eye examination’ were more among females [odds ratio (OR) 1.48, 95% confidence interval (CI): 1.32–1.66, P < 0.001]; individuals aged above 60 years [OR: 11.46, 95% CI: 9.44–13.91, P < 0.001], between 40 and 60 years [OR: 10.43, 95% CI: 8.85–12.30, P < 0.001], and between 18 and 40 years [OR: 2.48, 95% CI: 2.16–2.84, P < 0.001]; illiterates (OR: 1.76, 95% CI: 1.45–2.15, P < 0.001); and farmers (OR: 1.32 95% CI: 1.12–1.55, P = 0.001). Conclusion: The study presents the utilization of eye care among rural South Indian adults. Almost 84.46% of individuals had not undergone any eye examination. Robust measures to promote eye care management would help in effective utilization of eye care services among rural adults.

Time Elapsed from Onset of Symptoms to Antituberculosis Treatment in Children with Central Nervous System Tuberculosis in a Tertiary Hospital in South India: A Mixed-Methods Pilot Study

A pilot study with a mixed-methods design was conducted to estimate the time for tuberculosis (TB) treatment initiation and associated factors among children with central nervous system-TB (CNS-TB). A total of 38 children were enrolled for the quantitative component, and 20 in-depth interviews were conducted. The median duration (interquartile range) from onset of symptoms to treatment initiation was 23 (11, 55) days. About 44% and 31% of the children presented with Stage II and Stage III of CNS-TB, respectively. The major reasons for delay were symptoms not taken seriously (50%) and too many referrals (21%). About 89% of the families went into catastrophic health expenditure due to the disease. The treatment delay may be due to both patient delay and health system delay. Tailoring approaches to target the pediatric population could further improve early detection and treatment initiation of CNS-TB.

Study of urinary incontinence affecting the quality of life and health seeking behavior in women of an urban slum in Mumbai

Background: Urinary incontinence (UI) defined by the International Continence Society as the complaint of any involuntary leakage of urine, is a social or hygiene problem. The purpose of this study was to determine how UI affected quality of life (QOL) of women in urban slum in Mumbai and also their health care seeking behavior for the same.Methods: A pre-formed, pre-tested, semi-structured questionnaire was designed for a centre based study, to collect information from 1200 eligible and willing women over a period of 6 months. Of these 361 had complaints of UI how had the UI affected their quality of life and whether they sought health care for treatment of same was studied. Data was entered in Microsoft Excel and analysis was done accordingly.Results: Of the 361 women who had UI, the QOL was affected as in avoiding social interactions 45.15%, avoiding religious functions 49.03%, feeling of emotional upset/distress 59.8% and hampering of domestic work 57.8%. The extra financial burden felt due to UI was only in 7.7% women and only 1.9% complained of sexual life getting affected. Health care services for treatment of UI were sought by only 24.1% of the affected women.Conclusions: That UI affected the QOL of women affected with it in terms of reduced social interactions and attendance at religious programs and the feeling of emotional upset and hampering of domestic works. Subjects felt their financial burden had increased due to UI.

Exploration of a pilot project for medicine and pharmacy separation reform and its impact on medical insur-ance fund and medical care seeking behavior of patients covered by such fund / 中华医院管理杂志

Objective To study the impacts of medicine and pharmacy separation reform on medical insurance fund and medical care seeking behavior of such patients.Methods The insurance data of patients was collected from year 201 1 to year 2014 at the hospital of the author.The differences of hospitals' revenue from insurance,the use of insurance fund and medical care seeking behavior of patients,before and after the reform were analyzed.Results The results showed that the effect of medicine and pharmacy separation reform in achieving translation;the proportions of drug and per-patient drug expenses were reduced.However,the demand of insurance fund was increased,and the fund used in outpatients began to exceed that used in inpatients after the reform.Totally,the choices of outpatients on doctor's technical titles were influenced by the pricing,as more outpatients tended to choose the intermediate title doctors,and the proportion was increasing.The differences of the choices on the outpatient in superior departments were very small,while those in non-dominant departments were very big,the same as the total patients.Conclusion There are both advantages and disadvantages in impacts of the reform on medical insurance fund conducted in some hospital in Beijing.The advantages included that the hospitals'revenue was not decreased from insurance patients,the use of insurance on paying drugs were reduced by management of proper medication, and out-of-pocket burden of the insurance patients was reduced.Yet the disadvantages contained that because of cheaper drugs and favorable insurance policy on the reform,the outpatients preferred higher level hospitals to buy drugs only,and the reform might lead to the increase of the requirement of insurance fund.

Health Care Seeking Behavior for Malaria among Laboratory Confirmed Outpatients in a Rural Community, Southern Nigeria.

Background: For effective malaria control at the community level, information on the treatment practices are essential. However, there is no information on malaria treatment practices in Ibusa community. Thus, this study seeks to assess the prevalence of malaria and health care seeking behaviors in Ibusa community. Study Design: A descriptive cross-sectional study. Place and Duration of Study: Ibusa, Oshimili North Local Government area in Nigeria. The study was untaken between June and November, 2006. Methods: Malaria treatment practices including sources of anti-malarial of the 600 individuals who visited the Fenlab Diagnostic and Research Laboratory Ibusa, Delta State were obtained using a previously validated structured questionnaire. Microscopy was used to establish malaria infection and species identification. Results: The prevalence rate was found to be 73.3% and all were infections of Plasmodium falciparium. The age prevalence showed an undulating pattern however, the prevalence was highest among subjects within age group 20-29 years (31.81%) and least in age group 40-49 years (8.64%). Chi-square analysis showed no significant difference (X2 =13.61, df=5, P=0.183). The prevalence by sex showed higher values in females (60.22%) than males (39.78%), but the difference was not statistically significant at (X2=0.027, df=1, P=0.870). The malaria management practices showed that 20.83% participants buy anti-malarials from shops, 17.33% visit hospitals, while 16.33% employ traditional medicine from local healers. However, some of the subjects employ a combination of approaches. 13.83% get anti-malarials from shops, hospitals and local healers, 10.50% get anti-malarials from shops and hospitals, 9.67% visit local healers and hospitals, while 0.33% do not employ any treatment practices. Conclusion: Given the high prevalence of malaria infection in Ibusa community, proper education of the people on the need to employ proper malaria treatment practice is essential.

Cross-sectional study on health care seeking behavior and financial burden of patients with rheumatic diseases in Fujian Province / 中华风湿病学杂志

Objective To investigate and analyze the health care seeking behavior,financial burden and relative factors of patients with rheumatic diseases in Fujian Province.Methods Patients diagnosed with rheumatic diseases were investigated in Fujian Provincial Hospital from December 2013 to February 2014,including demographic data,health care seeking behavior and financial burden.Relevant factors were analyzed by Logistic regression.Results ① In this study,474 patients were enrolled.The ratio of male to female was 1∶2.38.② At the onset of symptoms,51.9％(246 cases) of patients visited a doctor as soon as possible,and 36.1％(171 cases) of them went to hospital within a month after disease onset.③ 74.1％(351 cases) of patients could adhere to medication regimen prescribed by doctors,and the most common reason for stopping medication was symptoms relieved (33.3％,41 cases).④ 63.1％(299 cases) of patients learned about the knowledge of rheumatic diseases from hospitals and doctors.⑤ 34.2％(162 cases) of patients spent 1 000-5 000 yuan every month on treatment.⑥ Insurance type could affect the time of first visit to hospital (P=0.004),while income and cost of therapy might impact patients' compliance (P=0.013,P=0.004).Conclusion Most patients will go to hospital as soon as possible and adhere to treatment.Economic situation is the main factor influencing health care seeking behavior of patients with rheumatic diseases.

Practice on outpatient appointment service at Shanghai 6th Peoples Hospital / 中华医院管理杂志

The outpatient service system at Shanghai Sixth People's Hospital came into use since April 2009.Data from Jan.2010 to Oct.2010 and interviews with employees of department in question showed a rapid growth of outpatient appointments,a poor handling of outpatients absenteeism,and poor integration among the platforms of the appointments.The development of outpatient services depends on behavioral change of both medical workers and consumers.Some measures could be employed to improve outpatient appointment within the current mechanism.

How to Improve Influenza Vaccination Rates in the U.S / 예방의학회지

Annual epidemics of seasonal influenza occur during autumn and winter in temperate regions and have imposed substantial public health and economic burdens. At the global level, these epidemics cause about 3-5 million severe cases of illness and about 0.25-0.5 million deaths each year. Although annual vaccination is the most effective way to prevent the disease and its severe outcomes, influenza vaccination coverage rates have been at suboptimal levels in many countries. For instance, the coverage rates among the elderly in 20 developed nations in 2008 ranged from 21% to 78% (median 65%). In the U.S., influenza vaccination levels among elderly population appeared to reach a "plateau" of about 70% after the late 1990s, and levels among child populations have remained at less than 50%. In addition, disparities in the coverage rates across subpopulations within a country present another important public health issue. New approaches are needed for countries striving both to improve their overall coverage rates and to eliminate disparities. This review article aims to describe a broad conceptual framework of vaccination, and to illustrate four potential determinants of influenza vaccination based on empirical analyses of U.S. nationally representative populations. These determinants include the ongoing influenza epidemic level, mass media reporting on influenza-related topics, reimbursement rate for providers to administer influenza vaccination, and vaccine supply. It additionally proposes specific policy implications, derived from these empirical analyses, to improve the influenza vaccination coverage rate and associated disparities in the U.S., which could be generalizable to other countries.

Correlates of health-care seeking behavior in patients with irritable bowel syndrome / 中华全科医师杂志

Objective To explore correlates of health-care seeking behavior in patients with irritable bowel syndrome (IBS).Methods Four thousand permanent residents were recruited from eight urban communities and rural villages in Guangzhou and Huizhou, Guangdong province during 2009 by cluster stratified sampling for face-to-face questionnaire survey, including symptoms of bowel disease,behavior of seeking for health-care, demographic characteristics, coping style, life events and medical history.IBS was identified based on the Rome Ⅱ Criteria.Patient with IBS were divided into two groups,one seeking health-care at hospitals or clinics and the other non-seeking health-care.Univariate and multivariate logistic regression analysis was used to compare difference between the two groups and explore its related factors.Results A total of 237 IBS patients were identified based on the Rome Ⅱ Criteria, 53 of them (22.4% ) had sought health-care due to their symptoms.Results of multivariate logistic regression analysis showed that preference in seeking for health-care, abdominal pain lasting for more than one hour in each episode and extra-gastrointestinal symptoms were main factors related to their seeking for health-care,adjusted for age and gender, with odds ratios (ORs) of 1.81 (95% CI: 1.27 -2.58), 1.41 (95% CI:1.01 - 5.14 ) and 2.14 ( 95% CI: 1.06 - 4.33 ), respectively.Conclusions Extra-gastrointestinal symptoms and abdominal pain lasting for more than one hour in each episode correlate their health-care seeking behavior in patients with IBS, as well as their preferences in seeking for health-care.

Comparison of Clinical Manifestations and Treatment-Seeking Behavior in Younger and Older Patients with First-time Acute Coronary Syndrome

PURPOSE: This study was conducted to examine and compare clinical manifestations and predicting factors for treatment-seeking delay among patients or =65 yr with first-time acute coronary syndrome (ACS). METHODS: A total of 288 patients who were diagnosed with ACS were individually interviewed at C university hospital in G-city from November 2007 to December 2008. RESULTS: Median pre-hospital delays for younger and older patients were 5 and 12 hr, respectively. Younger patients were more likely to be current smokers, heavy drinkers, obese, stressed, and have an unhealthy diet and family history, and to complain of chest pain, left shoulder and arm pain, perspiration, and nausea. Older patients were more likely to have hypertension and diabetes, and to complain syncope and dyspnea. Logistic regression analyses showed that after adjustment for age, gender and education, progressive onset of symptom and no attribution to cardiac problem significantly predicted pre-hospital delay >3 hr in both younger and older patients. Low perceived health status was a significant independent predictor in older patients only. CONCLUSION: Health care providers should be concerned with different manifestations between younger and older adults, and educate people at risk for heart attack about symptoms and actions to get immediate help.

Decision-tree Model of Treatment-seeking Behaviors after Detecting Symptoms by Korean Stroke Patients / 간호학회지

PURPOSE: This study was performed to develop and test a decision-tree model of treatment-seeking behaviors about when Korean patients visit a doctor after experiencing stroke symptoms. METHODS: The study used methodological triangulation. The model was developed based on qualitative data collected from in-depth interviews with 18 stroke patients. The model was tested using quantitative data collected from interviews and a structured questionnaire involving 150 stroke patients. The predictability of the decision-tree model was quantified as the proportion of participants who followed the pathway predicted by the model. RESULTS: Decision outcomes of the model were categorized into immediate and delayed treatment-seeking behavior. The model was influenced by lowered consciousness, social-group influences, perceived seriousness of symptoms, past history of hypertension or stroke, and barriers to hospital visits. The predictability of the model was found to be 90.7%. CONCLUSIONS: The results from this study can help healthcare personnel understand the education needs of stroke patients regarding treatment-seeking behaviors, and hence aid in the development of educational strategies for stroke patients.

The Use of Professional Health Care Systems among the Elderly in Rural Communities / 간호학회지

PURPOSE: This ethnography is aimed at describing the health care seeking behavior of elderly details in their socio-cultural context. The research question is "under what conditions did elderly informants decide to use certain professional health care services and how do they make use of all the available resources?" METHOD: 10 sessions of fieldwork were conducted in the two agricultural villages between Sep. 1999 and Oct. 2002. The data for this paper came from participant observation with 14 informants. In the process of analysis I used proxemic and taxonomic techniques. RESULT: Informants decided to use a certain health care system according to their folk definition of illness. They prefer to use the health services where they felt more comfortable and free. They wished to be care from intuitive and holistic healers. Social network and having health resources was also important factor. CONCLUSION: We need more comprehensive research model to reach a plausible explanation. Combined qualitative-quantitative research is needed to get practical data to develop effective health care systems for the elderly.