Health care seeking behaviour of pulmonary tuberculosis patients in Jabalpur district, Madhya Pradesh

Background: Successful tuberculosis control requires specific behaviors from patients and health providers. Therefore, understanding behaviors is fundamental to design interventions to strengthen tuberculosis control programs, including communication interventions. The aim of this study was to assess the healthcare-seeking behavior of pulmonary tuberculosis (PTB) patients in Jabalpur district.Methods: Cross-sectional study was conducted among category I new sputum positive PTB patients identified from nine designated microscopy centres from November 2013 to October 2014. Calculated sample size of 135 with a multistage random sampling method was used. Student’s t-test and Chi-square test were used along with descriptive statistics.Results: Mean age of patients was 33.87 (14.3) years, males constituted 66.7%, 72.5% patients belonged to below class IV socioeconomic status. Cough was experienced by 91.1% subjects, followed by fever (69.6%). First action was consulting a health care provider (HCP) in 41.5% followed by self-medication (21.5%). It took two attempts for 76% of patients to reach a formal health care provider. Private health care providers were consulted as first choice among HCPs by 86.7% patients, initial diagnosis was made by them in 25.9% cases. Sixty-three percent of patients were not satisfied with care at government hospitals, 41.5% had not heard of tuberculosis before their diagnosis, 59.5% of patients got information about tuberculosis from their relatives suffering from it.Conclusions: Cough is the most common and earliest symptom responsible for seeking care in pulmonary tuberculosis. Government health facilities contribute maximum to diagnosis but private health facility is the first choice for initial consultation. Patients’ perception of suggestive symptoms needs to be changed.

Effect of physical activity on healthcare seeking behavior in the general Chinese population: an urban-rural perspective / 《全球健康杂志（英文）》

Background: The "two-week visiting rate in those needing to visit" has been examined extensively as an important indicator of healthcare seeking behavior in China. Nevertheless, its relationship with health behaviors, such as physical activity, remains unknown. In addition, a significant difference exists between urban and rural Chinese people in terms of physical activity and healthcare seeking behavior. This study sought to investigate the relationship between physical activity and the two-week visiting rate by conducting a stratified analysis.Methods: The analysis included 5,801 participants aged above 15 years old. Multivariable logistic regression was applied to analyze the association after adjusting for possible confounding variables. Urban and rural differences were investigated using stratified analysis. Results: Adjusted estimates showed that those who were physically active were more likely to visit a healthcare facility, but only among the whole sample (adjusted odds ratio (AOR) = 1.45, 95％ confidence interval (CI): 1.26–1.66) and the rural sample (AOR = 1.56, 95％ CI: 1.21–2.01), and not among the urban sample. Conclusions: Educating people on physical activity may help in improving healthcare seeking behavior and vice versa. Additionally, health interventions may be tailored based on different settings.

Itinerários terapêuticos de pessoas com câncer: produção científica no Brasil / Therapeutic itineraries of people with cancer: scientific production in Brazil

Embora recentes no Brasil, estudos na área de itinerários terapêuticos e oncologia permitem compreender dimensões cognitivas e interpretativas relativas aos processos de adoecimento, cura e tratamento dos indivíduos com câncer, assim como os desafios em relação às redes de cuidado, serviços e agentes de cuidado à saúde. Objetivou-se mapear a produção científica nacional, nos últimos 15 anos, acerca dos itinerários terapêuticos no cuidado à saúde de pessoas com câncer. A coleta de dados ocorreu em três meses, por meio de consulta à Biblioteca Virtual de Saúde. A amostra resultou em 8 artigos. Relativa à abrangência do conceito de itinerário terapêutico utilizado nos estudos, a maior parte considerou todas as práticas implicadas com os subsistemas de saúde, os demais restringiram-se às práticas relacionadas a cuidados de saúde ao sistema de saúde formal. O núcleo de interesse predominante referiu-se às percepções e comportamentos do paciente sobre a doença e tratamento, os demais voltados para acesso e organização dos serviços de saúde e para a satisfação na utilização destes. O estudo sobre itinerários terapêuticos e câncer pode potencializar a compreensão de comportamentos relacionados aos cuidados em saúde de pessoas com essa doença e configurar-se como instrumento para melhorar a assistência oncológica.

While recent in Brazil, studies in the field of itineraries of people seeking healthcare and oncology allow us to understand cognitive and interpretive dimensions related to the processes of disease, cure, and treatment of individuals with cancer, as well as the challenges in relation to the networks of care, services, and health care agents. This study aimed to map Brazilian scientific production in the last 15 years, on the healthcare-seeking behavior of people with cancer. Data collection occurred over three months, by consulting the Virtual Health Library. The sample resulted in eight articles. Regarding the coverage of the concept of therapeutic itinerary used in the studies, most considered all involved practices in the health subsystems, and the rest were restricted to the practices related to health care in the formal health system. The core of predominant interest referred to the perceptions and behaviors of the patient concerning the disease and treatment, with the remainder focused on access and organization of health services, and on satisfaction with their use. The results show that the healthcare-seeking behavior of people with cancer can be configured as a tool to improve cancer care.

Itinerários terapêuticos de sujeitos com sintomas anoréxicos e bulímicos / Therapeutic itineraries of individuals with symptoms of anorexia and bulimia

Resumo O objetivo deste estudo foi identificar e contextualizar as características dos itinerários terapêuticos de pacientes atendidos em um ambulatório universitário, especializado nas anorexias e bulimias nervosas. Para isso, buscou-se reconstituir, junto a 20 entrevistados, a sucessão de movimentos desencadeados neles e em seus próximos pela classificação das práticas anoréxicas e bulímicas como “problemas de saúde”. As narrativas foram analisadas de forma a vincular as experiências individuais e o contexto social de sua ocorrência (organização dos serviços de saúde, características da prática e do saber médico, características da subjetividade contemporânea), tendo como referencial teórico estudos da Saúde Coletiva e da Psicanálise. A análise dos dados revelou que esses itinerários são tecidos a partir de conexões e desconexões entre duas lógicas distintas: uma que organiza a conduta dos pacientes e outra que rege as condutas das instituições de saúde e das famílias. Se essas últimas pressupõem uma busca pela saúde, isso não é o que ocupa prioritariamente os sujeitos em questão. A recusa destes em moderar suas restrições alimentares marca os itinerários e indica a funcionalidade dessas práticas. Elas participam de um trabalho de recomposição da imagem do eu.

Abstract The scope of this study is to identify and contextualize aspects of the therapeutic itineraries of patients treated at a university medical clinic specialized in nervous anorexia and bulimia. For this purpose, an attempt was made to reconstitute the succession of events triggered in 20 respondents and their families with the classification of anorexia and bulimia as “health problems.” The narratives were analyzed in order to link the individual experiences and the social context of their occurrence (organization of health services, characteristics of treatment and medical knowledge and characteristics of contemporary subjectivity), in light of the theoretical studies of Public Health and Psychoanalysis. Data analysis revealed that these itineraries arise from connections and disconnections between two distinct approaches: one that organizes the management of patients and the other governing the conduct of health institutions and families. If the latter presuppose a quest for health, this is not what primarily concerns the individuals in question. Their refusal to moderate their own eating disorders is notable on their itineraries, and indicates the functionality of those practices. Such practices play a part in the reconstruction of their self-images.

Prevalence, Risk Factors, Quality of Life, and Health-Care Seeking Behaviors of Female Urinary Incontinence: Results From the 4th Korean National Health and Nutrition Examination Survey VI (2007-2009) / 대한배뇨장애요실금학회지

PURPOSE: There is a lack of information on female urinary incontinence (UI) in South Korea. We investigated the prevalence, risk factors, quality of life (QoL), and healthcare-seeking behaviors of women with UI. METHODS: We included 9,873 women over the age of 20 years who had participated in the Korea National Health and Nutrition Examination Survey IV. The condition of UI was defined as answering "yes" to the question "Do you have UI?" Additionally, health care seeking behavior for UI was defined as answering "yes" to "Have you ever been treated for UI?' The EuroQoL-5 Dimension (EQ-5D) descriptive system was used to evaluate QoL. RESULTS: The mean age of our sample was 49.7 years. The overall prevalence of UI was 7.9%. The prevalence of UI significantly increased with age. The rate of healthcare-seeking behavior for UI also significantly increased with age. However, the rate of healthcare seeking for UI was significantly lower when compared to the prevalence of UI. In our multivariate analysis, age, body mass index, and marriage were significantly and independently associated with UI. As the severity of all the subscales of EQ-5D increased, the unadjusted odds ratio for UI also increased. After adjusting for potential confounders, the subscales of mobility, usual activities, pain/discomfort, and anxiety/depression from the EQ-5D were significantly associated with UI. CONCLUSIONS: UI is a common disease and is significantly associated with QoL. Our results suggest the need for developing preventive measures and treatment policies for UI.

Impact of Eating Attitude and Impairment of Physical Quality of Life Between Tertiary Clinic and Primary Clinic Functional Dyspepsia Outpatients in Japan

BACKGROUND/AIMS: There is no available data on factors associated with healthcare-seeking behavior for functional dyspepsia (FD) symptoms at either tertiary or primary clinics in Japan. Therefore, we aimed to compare clinical symptoms and life styles such as sleep disorders and eating attitude in FD patients visiting general practitioners at primary clinics with those consulting gastroenterologists at tertiary clinics to clarify healthcare-seeking patterns in Japanese patients. METHODS: Fifty-one FD outpatients in a tertiary clinic (college hospital), 50 FD outpatients visiting primary clinics and 50 healthy volunteers were enrolled. Clinical symptoms, quality of life, sleep disorders, eating attitude and anxiety were estimated using the Gastrointestinal Symptom Rating Scale (GSRS), Social Functioning-8 (SF-8) test, Pittsburg Sleep Quality Index (PSQI) test and State-Trait Anxiety Inventory (STAI) for FD outpatients and healthy volunteers. RESULTS: FD outpatients exhibited higher mean scores of GSRS than healthy volunteers. The SF-8 physical component summary scores in the tertiary clinic group were significantly lower than those in the primary clinic group. GSRS scores were significantly (P < 0.001, P = 0.002) associated with global PSQI scores in FD outpatients as well as with STAI-trait scores (P = 0.006, P = 0.001) compared to healthy volunteers. The frequency of eating between meals in the primary clinic group was significantly (P < 0.05) higher than that in the tertiary clinic group. CONCLUSIONS: It may be important for clarification of healthcare-seeking behavior to determine the difference in both impairment of physical quality of life and eating attitudes between tertiary clinic and primary clinic FD outpatients in Japan.