ABSTRACT
ABSTRACT Objective: To identify social, clinical and behavioral factors of tuberculosis patients that are associated with delay in the search for primary health care. Method: This is a cross-sectional, quantitative study conducted with 56 people on treatment for pulmonary tuberculosis in the city of Natal, in the state of Rio Grande do Norte, Brazil. The data were collected through a structured instrument. The Chi-square and Fisher tests were applied to test the association between independent and dependent variables (search time). A value of p <0.05 was set as statistically significant. Results: No social or clinical variables were statistically associated with patient delays in the search for primary health care. Among the behavioral variables, self-medication and the first health service sought had a statistically significant association with the time for seeking care (p = 0.020, and p = 0.033, respectively). Conclusion: Self-medication contributes to the delay in the search for primary health care by tuberculosis patients.
RESUMEN Objetivo: Identificar factores sociales, clínicos y conductuales de enfermos de tuberculosis, asociados a la demora por buscar la primera atención de salud. Método: Estudio transversal, cuantitativo, realizado con 56 personas en tratamiento de tuberculosis pulmonar, en Natal/RN, Brasil. Datos recolectados mediante instrumento estructurado. Se aplicaron los tests de Chi-cuadrado y de Fisher para probar la asociación entre las variables dependientes e independientes (tiempo de búsqueda). Se estableció un valor de p < 0,05 como estadísticamente significativo. Resultados: Ninguna variable social o clínica mostró asociación estadística a la demora del enfermo en la búsqueda de la primera atención de salud. Entre las variables conductuales, la automedicación y el primer servicio de salud buscado presentaron asociación estadísticamente significativa con el tiempo de búsqueda (p = 0,020 y p = 0,033, respectivamente). Conclusión: La automedicación contribuye a la demora en la búsqueda de la primera atención de salud en el enfermo de tuberculosis.
RESUMO Objetivo: Identificar fatores sociais, clínicos e comportamentais dos doentes de tuberculose que estejam associados ao atraso na procura pelo primeiro atendimento à saúde. Método: Estudo transversal, quantitativo, conduzido com 56 pessoas em tratamento da tuberculose pulmonar em Natal/RN, Brasil. Os dados foram coletados por meio de instrumento estruturado. Aplicaram-se os testes de Qui-quadrado e Fisher para testar a associação entre as variáveis independentes e dependentes (tempo de procura). Fixou-se valor de p < 0,05 como estatisticamente significativo. Resultados: Nenhuma variável social ou clínica se mostrou estatisticamente associada ao atraso do doente na procura pelo primeiro serviço de saúde. Dentre as variáveis comportamentais, a automedicação e o primeiro serviço de saúde procurado apresentaram associação estatística significativa com o tempo de procura (p = 0,020 e p = 0,033, respectivamente). Conclusão: A automedicação contribui para o atraso na procura pelo primeiro atendimento à saúde pelo doente de tuberculose.
Subject(s)
Humans , Male , Female , Adult , Time Factors , Tuberculosis, Pulmonary/psychology , Mass Screening/psychology , Help-Seeking Behavior , Socioeconomic Factors , Tuberculosis, Pulmonary/diagnosis , Brazil , Patient Acceptance of Health Care/psychology , Sex Factors , Mass Screening/trends , Cross-Sectional Studies , Surveys and Questionnaires , Educational Status , Delayed Diagnosis/psychology , Income/statistics & numerical data , Middle AgedABSTRACT
Objective: Parents of children with autism spectrum disorders (ASD) seem to perceive that their child's development is not following the normal pattern as early as the first year of life. However, ASD children may not receive a diagnosis until they are of preschool age, especially in low- and middle-income countries. The objective of this study was to evaluate the pathway between initial parental concerns about atypical child development and ASD diagnosis in Brazil. Methods: Nineteen mothers whose children had been diagnosed with ASD participated and were interviewed. The ASD group consisted of two girls and 17 boys, with a mean age of 93.0 months (SD 48.4 months; range 39-197 months). Results: Mothers had their first concerns regarding ASD when children were 23.6±11.6 months old, but formal diagnosis occurred at a mean ± SD age of 59.6±40.5 months, corresponding to a 3-year delay. Most mothers felt discouraged to address their concerns due to negative experiences with health professionals. Conclusion: In Brazil, mothers perceived the first signs of ASD in their children at an age similar to that reported in other countries, but the diagnosis of ASD seemed to be delayed. Consistent with the literature, mothers reported negative experiences with health professionals during the pathway to achieving ASD diagnosis.
Subject(s)
Humans , Male , Female , Child, Preschool , Child , Adolescent , Adult , Professional-Family Relations , Delayed Diagnosis/statistics & numerical data , Autism Spectrum Disorder/diagnosis , Mothers/psychology , Brazil , Delayed Diagnosis/psychology , Autism Spectrum Disorder/psychology , Middle Aged , Mothers/statistics & numerical dataABSTRACT
Objective: Bipolar disorder (BD) is often left untreated for long periods, and this delay in treatment correlates with unfavorable prognosis. The present study sought to assess the magnitude of duration of untreated bipolar disorder (DUB) in Brazil. We hypothesized that DUB would be longer in Brazil than in developed countries, and would be associated with poor clinical outcomes. Methods: One hundred and fifty-two psychiatric outpatients were evaluated for BD diagnosis, demographics, DUB, and clinical outcomes. Results: The mean age and mean DUB were, respectively, 38.9±10.8 and 10.4±9.8 years. An extended DUB was associated with early onset of BD (p < 0.001), depression as first mood episode (p = 0.04), and presence of BD in a first-degree relative (p = 0.012). Additionally, a longer DUB was associated with poorer clinical outcomes, such as elevated rates of rapid cycling (p = 0.004) and anxiety disorders (p = 0.016), as well as lower levels of current full remission (p = 0.021). Conclusion: As DUB may be a modifiable variable, better medical education regarding mental health, more structured medical services, and population-wide psychoeducation might reduce the time between onset and proper management of BD, thus improving outcome.
Subject(s)
Humans , Male , Female , Adult , Bipolar Disorder/diagnosis , Delayed Diagnosis/psychology , Time-to-Treatment , Bipolar Disorder/psychology , Brazil , Demography , Cross-Sectional Studies , Age Factors , Age of Onset , Middle AgedABSTRACT
Con el propósito de conocer las vivencias de mujeres que atravesaron eventos de morbilidad materna severa, desde su propia perspectiva, entre febrero y mayo de 2011, se realizaron 16 entrevistas semiestructuradas a mujeres que padecieron morbilidad materna severa, atendidas en hospitales públicos del Área Metropolitana de Buenos Aires. Los testimonios dan cuenta de una serie de demoras, como la dificultad para identificar el problema a tiempo, los obstáculos en el acceso al sistema de salud, e importantes fallas en el manejo de la emergencia obstétrica. El evento es vivido como sorpresivo, angustiante y doloroso por las mujeres, lo cual se ve reforzado por una fuerte vulneración de sus derechos y por problemas significativos en la comunicación. Estos hallazgos constituyen un puntapié para avanzar en la comprensión integral y holística de la morbilidad materna severa, y confirman la necesidad de seguir investigando desde la perspectiva de género y de derechos.
With the objective of recording and analyzing women's experiences with severe maternal morbidity from their perspective, between February and May 2011, 16 semi-structured interviews with women treated in the public hospitals of the Buenos Aires Metropolitan Area who suffered from severe maternal morbidity were carried out. In their testimonies, women report a number of delays in care, such as difficulties in identifying the problem on time, obstacles in accessing health centers and important faults in the management of obstetric emergencies. They describe the event as surprising, distressing and painful, a perception reinforced by the violation of their rights and significant communication problems. These findings are meant as a step towards the holistic and comprehensive study of severe maternal morbidity, as well as to confirm the urgent need for further research from a gender and humans rights perspective.
Subject(s)
Humans , Female , Pregnancy , Adolescent , Adult , Young Adult , Pregnancy Complications/psychology , Patient Satisfaction , Health Services Accessibility , Argentina , Pregnancy Complications/diagnosis , Pregnancy Complications/therapy , Stress, Psychological , Women's Rights , Hospitals, Urban , Severity of Illness Index , Acute Disease , Interviews as Topic , Patient Rights , Qualitative Research , Delayed Diagnosis/psychology , Hospitals, PublicABSTRACT
A comunicação, mesmo ao fim da vida, é ferramenta importante. Ter informações sobre diagnóstico e prognóstico permite que pacientes e família vivenciem esse período de forma menos dolorosa. Quando se estabelece o pacto ou conspiração do silêncio, isso já não é possível. O pacto do silêncio é descrito como um acordo implícito ou explicito, por parte dos familiares, amigos e profissionais, de alterar a informação ao paciente com a finalidade de ocultar o diagnóstico ou a gravidade da situação. Esse tema é importante perante a incidência ainda elevada desse pacto na atualidade e pelas consequências dele. Este artigo teórico tem o objetivo de discorrer sobre este tema com base na pesquisa bibliográfica de estudos originais que apontam as causas, consequências e indicam possíveis estratégias de intervenções que estão sendo utilizadas para diminuir a incidência do pacto. Porém ainda são necessárias mais intervenções naquele sentido, pois, ainda hoje, se vivenciam mortes solitárias e despedidas silenciadas.
Communication, even at the end of life, is an important tool. Having information on diagnosis and prognosis lessens the pain for patients and their families. When we establish the pact or conspiracy of silence, this is no longer possible. The pact of silence is described as an implicit or explicit agreement on part of family members, friends and professionals. They agree to omit information from the patient in order to hide the diagnosis and/or the severity of the situation. This topic is important due to the high incidence of this pact today and the consequences of it. This theoretical paper aims to discuss this topic based on the bibliographical research of original studies that point to the causes and consequences and that indicate possible strategies of interventions that are being used to reduce the incidence of the pact. But there is still a need for more interventions because, even today, we experience lonely deaths and silent farewells.