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Background: Burn injuries continue to pose a significant and preventable global health challenge, with developing countries like India experiencing a troubling rise in cases. This study aimed to investigate the socio-demographic characteristics and patterns of burn injuries among patients admitted to a tertiary care hospital's. Methods: Over a six-month period, a hospital-based cross-sectional study was conducted using semi-structured questionnaires, with prior consent from patients or their caregivers. Clinical assessments were also conducted to determine the percentage of total body surface area (TBSA) affected and the most severely affected body part. Results: 145 patients included in the study, the females were (56.55%), primarily aged between 21 and 40 years. Hindus (58.62%), lived in rural areas (63.45%), and were married (66.90%). Accidental burns accounted for 81.38% of cases, mainly occurring at home (84.83%). Flame burns were more common among females, while electric burns were more prevalent among males. The majority of burn injuries covered up to 30% of TBSA (44.83%), with the upper limbs being the most severely affected (42.76%). Alarmingly, only 36.55% of patients were admitted on the same day as the injury. Infection (55.86%) and amputation (8.97%) were the most common complications observed, and 14 deaths (9.66%) occurred during the study period. Conclusions: This study highlights the vulnerability of females to flame burns, often stemming from unsafe cooking practices. Delayed hospital admissions were associated with a higher mortality rate. Efforts to promote safety and awareness, particularly in rural areas, are crucial to reducing the burden of burn injuries in India.
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Background & objectives: Assessing healthcare seeking behaviour (HSB), healthcare utilization and related out-of-pocket expenditures of Particularly Vulnerable Tribal Groups (PVTGs) of India through a prism of the health system may help to achieve equitable health outcomes. Therefore, this comprehensive study was envisaged to examine these issues among PVTGs of Odisha, India. However, there exists no validated questionnaire to measure these variables among PVTGs. Therefore, a study questionnaire was developed for this purpose and validated. Methods: Questionnaire was constructed in four phases: questionnaire development, validity assessment, pilot testing and reliability assessment. Nine domain experts face validated questionnaire in two rounds, followed by a single round of quantitative content validity. Next, the questionnaire was pretested in three rounds using cognitive interviews and pilot-tested among 335 and 100 eligible individuals for the two sections healthcare seeking behaviour (HSB-Q) and maternal and child healthcare service utilization (MCHSU-Q). Internal consistency reliability was assessed for de novo HSB-Q. Results: On two rounds of expert-driven face validity, 55 items were eliminated from 200 items. Questionnaire showed moderate to high content validity (item-level content validity index range: 0.78 to 1, scale-level content validity index/universal agreement: 0.73; scale-level content validity index/average: 0.96 and multirater kappa statistics range: 0.6 to 1). During the pre-test, items were altered until saturation was achieved. Pilot testing helped to refine interview modalities. The Cronbach alpha and McDonald’s omega assessing internal consistency of HSB-Q were 0.8 and 0.85, respectively. Interpretation & conclusions: The questionnaire was found to be valid and reliable to explore healthcare seeking behaviour, maternal and child healthcare utilization and related out-of-pocket expenditure incurred by PVTGs of Odisha, India.
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Objective@#To investigate the delay in identification, healthcare-seeking, and definitive diagnosis of tuberculosis among students in Urumqi City from 2010 to 2019, and to identify the influencing factors, so as to provide insights into tuberculosis control among students.@*Methods@#The demographic and diagnosis data of tuberculosis patients in Urumqi City from 2010 to 2019 were captured from the Tuberculosis Information Management System of Chinese Disease Control and Prevention Information System. The delay in identification, healthcare-seeking and definitive diagnosis of tuberculosis was analyzed among students, and the factors affecting the delay in identification, healthcare-seeking and definitive diagnosis of tuberculosis were identified using a multivariable logistic regression model. @*Results@#A total of 996 tuberculosis cases were identified among students in Urumqi City from 2010 to 2019. There were 702 students with delay in identification of tuberculosis (70.48%), 500 students with delay in healthcare-seeking (55.22%) and 534 students with delay in definitive diagnosis (53.61%). Multivariable logistic regression analysis identified active identification (OR=0.116, 95%CI: 0.032-0.420) as a factor affecting delay in identification of tuberculosis, women (OR=1.424, 95%CI: 1.104-1.836), non-local household registration (OR=1.311, 95%CI: 1.016-1.694) and active identification (OR=0.232, 95%CI: 0.064-0.848) as factors affecting delay in healthcare-seeking, and active identification (OR=0.143, 95%CI: 0.032-0.644) as a factor affecting delay in definitive diagnosis of tuberculosis among students.@*Conclusions@#There is a high proportion of delay in identification, healthcare-seeking and definitive diagnosis of tuberculosis among students in Urumqi City from 2010 to 2019, and female and non-locally household-registered students were at a high risk of delay in healthcare-seeking for tuberculosis. Active detection and screening of tuberculosis should be reinforced.
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Objective To create risk predictive models of healthcare-seeking delay among imported malaria patients in Jiangsu Province based on machine learning algorithms, so as to provide insights into early identification of imported malaria cases in Jiangsu Province. Methods Case investigation, first symptoms and time of initial diagnosis of imported malaria patients in Jiangsu Province in 2019 were captured from Infectious Disease Report Information Management System and Parasitic Disease Prevention and Control Information Management System of Chinese Center for Disease Control and Prevention. The risk predictive models of healthcare-seeking delay among imported malaria patients were created with the back propagation (BP) neural network model, logistic regression model, random forest model and Bayesian model using thirteen factors as independent variables, including occupation, species of malaria parasite, main clinical manifestations, presence of complications, severity of disease, age, duration of residing abroad, frequency of malaria parasite infections abroad, incubation period, level of institution at initial diagnosis, country of origin, number of individuals travelling with patients and way to go abroad, and time of healthcare-seeking delay as a dependent variable. Logistic regression model was visualized using a nomogram, and the nomogram was evaluated using calibration curves. In addition, the efficiency of the four models for prediction of risk of healthcare-seeking delay among imported malaria patients was evaluated using the area under curve (AUC) of receiver operating characteristic curve (ROC). The importance of each characteristic was quantified and attributed by using SHAP to examine the positive and negative effects of the value of each characteristic on the predictive efficiency. Results A total of 244 imported malaria patients were enrolled, including 100 cases (40.98%) with the duration from onset of first symptoms to time of initial diagnosis that exceeded 24 hours. Logistic regression analysis identified a history of malaria parasite infection [odds ratio (OR) = 3.075, 95% confidential interval (CI): (1.597, 5.923)], long incubation period [OR = 1.010, 95% CI: (1.001, 1.018)] and seeking healthcare in provincial or municipal medical facilities [OR = 12.550, 95% CI: (1.158, 135.963)] as risk factors for delay in seeking healthcare among imported malaria cases. BP neural network modeling showed that duration of residing abroad, incubation period and age posed great impacts on delay in healthcare-seek among imported malaria patients. Random forest modeling showed that the top five factors with the greatest impact on healthcare-seeking delay included main clinical manifestations, the way to go abroad, incubation period, duration of residing abroad and age among imported malaria patients, and Bayesian modeling revealed that the top five factors affecting healthcare-seeking delay among imported malaria patients included level of institutions at initial diagnosis, age, country of origin, history of malaria parasite infection and individuals travelling with imported malaria patients. ROC curve analysis showed higher overall performance of the BP neural network model and the logistic regression model for prediction of the risk of healthcare-seeking delay among imported malaria patients (Z = 2.700 to 4.641, all P values < 0.01), with no statistically significant difference in the AUC among four models (Z = 1.209, P > 0.05). The sensitivity (71.00%) and Youden index (43.92%) of the logistic regression model was higher than those of the BP neural network (63.00% and 36.61%, respectively), and the specificity of the BP neural network model (73.61%) was higher than that of the logistic regression model (72.92%). Conclusions Imported malaria cases with long duration of residing abroad, a history of malaria parasite infection, long incubation period, advanced age and seeking healthcare in provincial or municipal medical institutions have a high likelihood of delay in healthcare-seeking in Jiangsu Province. The models created based on the logistic regression and BP neural network show a high efficiency for prediction of the risk of healthcare-seeking among imported malaria patients in Jiangsu Province, which may provide insights into health management of imported malaria patients.
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Objective@#To investigate the epidemiological characteristics of pulmonary tuberculosis (PTB) among the elderly at ages of 65 years and older in Yangzhou City, Jiangsu Province from 2017 to 2021, so as to provide the evidence for the development of PTB prevention and control measures in the elderly. @*Methods@#Data of PTB cases at ages of 65 years and older in Yangzhou City from 2017 to 2021 were collected from the Tuberculosis Management Information System of the Chinese Disease Control and Prevention Information System, including age, gender, current address, population classification and diagnosis classification. Descriptive epidemiological methods were used to analyze the temporal distribution, regional distribution, population distribution and delay in healthcare-seeking of PTB cases.@*Results@#A total of 3 283 PTB patients at ages of 65 years and older were registered in Yangzhou City from 2017 to 2021, accounting for 41.12% of the total number of PTB cases. The incidence decreased from 112.10/105 to 66.03/105 (P<0.05), with an average annual incidence of 80.43/105. There were 1 236 cases of PTB cases from April to July, accounting for 37.65%. Guangling District had the highest annual incidence of 96.45/105, followed by Hanjiang District (89.29/105) and Jiangdu district (87.05/105). The average annual incidence of PTB in males was 134.07/105, which was higher than that in females (30.55/105, P<0.05). There were 1 070 cases of PTB cases at ages of 65-69 years, accounting for 32.59%. The highest incidence was seen in men at ages of 85 years and older (200.39/105) and in women at ages of 80-84 years (38.34/105). Farmers were the predominant occupation of PTB cases (2 488 cases, 75.78%). There were 2 365 cases of PTB with delay in healthcare-seeking, accounting for 72.04%.@* Conclusions @#The incidence of PTB in the elderly at ages of 65 years and older in Yangzhou City showed an overall downward trend from 2017 to 2021, peaked from April to July, and was higher in Guangling District, Hanjiang District and Jiangdu District. Males and farmers had higher risks of PTB.
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Objective:To clarify the influence and influence paths of stigma on the time of the healthcare-seeking decision in caregivers of elderly patients with dementia, and to provide a theoretical basis for the construction of corresponding humanistic care strategies.Methods:A total of 176 caregivers of elderly patients with dementia who visited the Affiliated Hospital of Xuzhou Medical University and Xuzhou Oriental People ′s Hospital from February 2021 to February 2022 were selected as the study subjects. The General Information Questionnaire, self-designed Scale of Stigma for Caregivers of Senile dementia patients, Multidimensional Scale of Perceived Social Support, self-designed Elderly Dementia Caregivers′ Perceived Barriers Scale for Healthcare-seeking Decision, and self-designed Scale of the Intention to Seek Healthcare for caregivers of senile dementia patients were used in the survey. AMOS 20.0 was used to establish a structural equation model for path analysis. Results:The higher the stigma of caregivers, the longer the time of the healthcare-seeking decision ( β=0.05, P<0.05). Social support, perceived barriers to the healthcare-seeking decision, and the intention to seek healthcare were the mediating variables of caregivers ′ stigma affecting the time of the healthcare-seeking decision, with a total effect of -0.04, 0.14, and 0.36, respectively, and all P<0.05. Conclusions:The stigma in caregivers of senile dementia patients is an important factor affecting the time of the healthcare-seeking decision. By improving mediating factors including social support, perceived barriers to the healthcare-seeking decision, and the intention to seek healthcare, the implementations of targeted humanistic care strategies are expected to help shorten the time of the healthcare-seeking decision.
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Introduction: The current COVID-19 pandemic has greatly affected the wellbeing of children,either directly or through the effects of the response. Measures are in place to curb the spread of the virus in Nigeria, but little is known of the effect these stringent measures have on the healthcare-seeking behaviour of parents for their sick children.Aim:This survey sought to describe parents’ healthcare-seeking behaviour for their sick children during the COVID-19 lockdown in Nigeria.Study Design: Descriptive cross-sectional.Methods:A cross-sectional survey was conducted among Nigerian parentswith children less than 18 years of age, via an online Google doc questionnaire administered through WhatsApp instant messaging. Using snowball sampling technique, 260 respondents from affected Nigerian states were recruited over one month. Chi-square tested differences between variables in assessing if healthcare-seeking behaviour was affected; statistical significance level was set at p-value <0.05.Results:The median age was 38 years (IQR:9); 155 (59.7%) were females, 167 (64.2%) had tertiary education, while 83 (31.9%) had low income. Half (50%) of the respondents cited that the lockdown had affected their healthcare-seeking behaviour for their sick children; this did not significantly differ by geopolitical zone of residence (χ2=3.90, p-value=0.42), and other variables. Thirty-seven 37 (14.3%) agreed their children couldn’t get routine immunizations as scheduled.Conclusion:The COVID-19 pandemic lockdown considerably affected parents’ healthcare-seeking behaviour for their sick children in Nigeria. Contextual strategies aimed at health system strengthening and improved accessibility are needed to mitigate the effect of COVID-19 on parental access and utilization of healthcare facilities
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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.
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@#AIM: To obtain the healthcare-seeking intention of eye patients during COVID-19 outbreak in China. <p>METHODS: Questionnaire survey was conducted from 2020-02-10 to 2020-02-20, with the combination form of convenience sampling and “Link-tracking related sampling”. We designed the questionnaires, forwarded them to individuals or WeChat group chats, and had the participants fill out the questionnaires on mobile phones, to evaluate their healthcare seeking time and intention, as well as their sense of trust towards online consultation when they had ocular discomforts or trauma.<p>RESULTS: Totally 458 males(51.3%)and 435 females(48.7%)responded and a total of 893 questionnaires were included. Our data shows that 26.5%, 33.3%, and 40.2% of the respondents respectively from low, medium and high risk area chose online consultation during the COVID-19 outbreak, and the hospital visiting rates were 45.1%, 30.3%, 24.6% in corresponding area. We also demonstrated that gender, age, education level, regional economic development, and the region-level risk classifications have impacts on the consultation methods of the population. Compared to females(39.3%), more males(60.7%)intended to accept online medicine, and the participants from highly developed area preferentially chose virtual medical advisory service(68.2%),while the hospital visiting rates of less developed area(65.2%)was much higher than that in developed area(34.8%). Interestingly, geographic risk level had dramatic influence on the participants' sense of trust towards online consultation.<p>CONCLUSION: Virtual online consultations were more favorable among Chinese population during COVID-19 outbreak, and were potential to facilitate clinician-patient communication. However, a balance should be achieved between online consultations and face-to-face communication, to avoid human-to-human coronavirus transmission, and to resolve patients' problems.
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@#AIM: To obtain the healthcare-seeking intention of eye patients during COVID-19 outbreak in China. <p>METHODS: Questionnaire survey was conducted from 2020-02-10 to 2020-02-20, with the combination form of convenience sampling and “Link-tracking related sampling”. We designed the questionnaires, forwarded them to individuals or WeChat group chats, and had the participants fill out the questionnaires on mobile phones, to evaluate their healthcare seeking time and intention, as well as their sense of trust towards online consultation when they had ocular discomforts or trauma.<p>RESULTS: Totally 458 males(51.3%)and 435 females(48.7%)responded and a total of 893 questionnaires were included. Our data shows that 26.5%, 33.3%, and 40.2% of the respondents respectively from low, medium and high risk area chose online consultation during the COVID-19 outbreak, and the hospital visiting rates were 45.1%, 30.3%, 24.6% in corresponding area. We also demonstrated that gender, age, education level, regional economic development, and the region-level risk classifications have impacts on the consultation methods of the population. Compared to females(39.3%), more males(60.7%)intended to accept online medicine, and the participants from highly developed area preferentially chose virtual medical advisory service(68.2%),while the hospital visiting rates of less developed area(65.2%)was much higher than that in developed area(34.8%). Interestingly, geographic risk level had dramatic influence on the participants' sense of trust towards online consultation.<p>CONCLUSION: Virtual online consultations were more favorable among Chinese population during COVID-19 outbreak, and were potential to facilitate clinician-patient communication. However, a balance should be achieved between online consultations and face-to-face communication, to avoid human-to-human coronavirus transmission, and to resolve patients' problems.
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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.
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Objective@#To study the main factors that influencing Pneumoconiosis patients' healthcare seeking behaviors.@*Methods@#Conducting a descriptive analysis to analyze the relationship between the annual hospitalization rate and social security status (medical insurance, location of medical insurance, proportion of insurance used for reimbursement of pneumoconiosis, whether there is employment injury insurance at work, whether to apply for compensation after diagnosing pneumoconiosis, whether they receive social assistance and a minimum allowance) , social relationship status of patients (whether there is pneumoconiosis in the family or relatives, whether there is a pneumoconiosis in a friend or a colleague, and whether or not he/she has received financial assistance) , life quality of patients (subjective feelings) and living standard of patients (dietary level) based on data acquired from 120 pneumoconiosis patients.@*Results@#The results of single factor analysis reveal that the location of medical insurance, the proportion of insurance for reimbursement of pneumoconiosis, whether there is employment injury insurance at work, whether to apply for compensation after diagnosing pneumoconiosis are statistically significant in pneumoconiosis patients' hospital utilization ratio (P<0.05) . The place where medical insurance is located is the current place of residence, the reimbursement ratio of medical insurance for pneumoconiosis is listed as 50%-70%, the work unit has medical insurance, those who have not applied for compensation for pneumoconiosis have a higher utilization rate of hospitalization services. The annual hospitalization rate was 73.3%, 80.0%, 60.6%, 63.0%, respectively.@*Conclusion@#The location of patient medical insurance, the proportion of insurance used for reimbursement of pneumoconiosis, whether there is employment injury insurance at work, and whether to apply for compensation after pneumoconiosis are the influencing factors of the patients' annual hospitalization rate.
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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.
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Aceitação pelo Paciente de Cuidados de Saúde , Neoplasias , Assistência Integral à Saúde , Atenção à Saúde , Usos TerapêuticosRESUMO
Objective:To analyze the factors and problems of health self-evaluation on their healthcare seeking decision for hypertension patients, and to provide the relevant suggestions and strategies for improving their health quality of life. Methods:Data from the 2016 Residents Dynamic Monitoring Survey of Health Service Utilization,u-sing the Anderson's Behavioral model as the theoretical basis, This study examined the predisposing, enabling, and need factors that determine the Single factor analysis,and construct the logistic regression model to analyze main fac-tors affecting medical treatment decisions in patients with hypertension. Results:During multi -factor analysis about the factors chiefly selected were age,urban and rural, commercial medical insurance,annual income,VAS,self-care ability. Conclusion:Enabling factor is the main factor affecting medical decision-making in patients with hyperten-sion;hypertension health self-evaluation on their medical decisions have important effect;hypertension patients with different demographic characteristics tendency to seek different medical treatments,and factors of need to promote the behavior of hypertension. It is suggested that policy makers should pay attention to the healthy self-evaluation of pa-tients with hypertension,the problems of depression and anxiety in hypertensive patients,and to improve the utiliza-tion of medical services of patients with hypertension in urban and rural areas.
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Objective:This study aims at exploring the impact of the health resources allocation on healthcare seeking behavior of inpatients with different income in China. Methods:Data at individual level were collected from China National Health Service Surveys conducted in 2008 and 2013 , interlinked with the data of health resources in county level. Multilevel zero-inflated negative binomial regression and multilevel multinomial logit model were respec-tively used to examine the impact of the health resources allocation on inpatient visits and the influence of the choice of healthcare providers by inpatients. Results: The results show that the increase of the number of beds in primary health centers ( PHCs) and physicians in county hospitals increased inpatient visits within counties. The investments in health resources in PHCs had greater impact on improving the likelihood of inpatient visits within counties for the low-income populations than that for the high-income populations. Conclusion: Investments in health resources in PHCs are vital to improve the healthcare seeking behaviors of the low-income populations in China.
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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.
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Humanos , Masculino , Feminino , Criança , Adolescente , Adulto , Pessoa de Meia-Idade , Adulto Jovem , Anorexia/terapia , Bulimia/terapia , Aceitação pelo Paciente de Cuidados de SaúdeRESUMO
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.
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Feminino , Humanos , Índice de Massa Corporal , Atenção à Saúde , Epidemiologia , Coreia (Geográfico) , Casamento , Análise Multivariada , Inquéritos Nutricionais , Razão de Chances , Aceitação pelo Paciente de Cuidados de Saúde , Prevalência , Qualidade de Vida , Fatores de Risco , Incontinência UrináriaRESUMO
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.
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Humanos , Ansiedade , Povo Asiático , Dispepsia , Ingestão de Alimentos , Clínicos Gerais , Voluntários Saudáveis , Japão , Estilo de Vida , Refeições , Pacientes Ambulatoriais , Qualidade de Vida , Transtornos do Sono-VigíliaRESUMO
Health financing strategies that incorporate financial incentives are being applied in many low- and middle-income countries, and improving maternal and neonatal health is often a central goal. As yet, there have been few reviews of such programmes and their impact on maternal health. The US Government Evidence Summit on Enhancing Provision and use of Maternal Health Services through Financial Incentives was convened on 24-25 April 2012 to address this gap. This article, the final in a series assessing the effects of financial incentives—performance-based incentives (PBIs), insurance, user fee exemption programmes, conditional cash transfers, and vouchers—summarizes the evidence and discusses issues of context, programme design and implementation, cost-effectiveness, and sustainability. We suggest key areas to consider when designing and implementing financial incentive programmes for enhancing maternal health and highlight gaps in evidence that could benefit from additional research. Although the methodological rigor of studies varies, the evidence, overall, suggests that financial incentives can enhance demand for and improve the supply of maternal health services. Definitive evidence demonstrating a link between incentives and improved health outcomes is lacking; however, the evidence suggests that financial incentives can increase the quantity and quality of maternal health services and address health systems and financial barriers that prevent women from accessing and providers from delivering quality, lifesaving maternal healthcare.
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Despite the wealth of studies on health and healthcare-seeking behaviour among the Bengali population in Bangladesh, relatively few studies have focused specifically on the tribal groups in the country. This study aimed at exploring the context, reasons, and choices in patterns of healthcare-seeking behaviour of the hill tribal population of Bangladesh to present the obstacles and challenges faced in accessing healthcare provision in the tribal areas. Participatory tools and techniques, including focus-group discussions, in-depth interviews, and participant-observations, were used involving 218 men, women, adolescent boys, and girls belonging to nine different tribal communities in six districts. Data were transcribed and analyzed using the narrative analysis approach. The following four main findings emerged from the study, suggesting that the tribal communities may differ from the predominant Bengali population in their health needs and priorities: (a) Traditional healers are still very popular among the tribal population in Bangladesh; (b) Perceptions of the quality and manner of treatment and communication can override costs when it comes to provider-preference; (c) Gender and age play a role in making decisions in households in relation to health matters and treatment-seeking; and (d) Distinct differences exist among the tribal people concerning their knowledge on health, awareness, and treatment-seeking behaviour. The findings challenge the present service-delivery system that has largely been based on the needs and priorities of the plainland population. The present system needs to be reviewed carefully to include a broader approach that takes the sociocultural factors into account, if meaningful improvements are to be made in the health of the tribal people of Bangladesh.