Challenges encountered in community-based physiotherapy interventions for urinary incontinence among women in rural areas of Anand District of Gujarat, India

Background: It is necessary to understand the way women think about their health. There is a 揷ulture of silence� among women regarding urinary incontinence (UI). Physiotherapy is proven effective mode of therapy in case of UI. Objectives: This study aimed to explore the attitude of the women toward UI, to understand the related sociocultural factors and health-seeking behavior, and to ascertain the challenges encountered in community-based physiotherapy interventions. Methods: A qualitative study was conducted among women who refused to participate in a physiotherapy intervention for UI in the rural community of Gujarat, India. Fourteen in-depth key informant interviews were conducted using an interview guide. The responses were noted and compiled into a composite interview script. Interviews were not recorded due to nonavailability of consent. Interviews were reviewed by investigators and content analysis was carried out. Key themes were identified after multiple iterations. Results: Most of the women were unaware of the UI and believed that it may be due to their gender or due to aging. Physiotherapy interventions were disregarded due to various reasons such as shy nature, lack of priority and privacy, dependency, self-neglect, and influence of social and cultural norms. Conclusion: Cultural and social systems were more important determinants of health seeking than health systems themselves particularly when sensitive issue such as UI in women of rural Western India was concerned.

Evaluation of community health service institutions responsiveness in Henan Province:Key in-formant survey / 中国卫生政策研究

Objective:To understand the responsiveness of community health service institutions in Henan Province. Methods:This research collected information through questionnaire investigations. The object of the investigations is key informants familiar with community health service institutions. Various dimensions of responsiveness within Henan province community health service institutions are determined through a multiple-input pecking order graph. The fuzzy comprehen-sive evaluation method is used to evaluate the level of responsiveness. Responsiveness inequality index is used to measure the distribution of reactions. Results:A total of 431 valid key informants were surveyed. The various dimensions of the questionnaire of Cronbach alpha coefficient was greater than 0. 623;the total scale of the Cronbach alpha coefficient was 0. 850;the correlation coefficient of each dimension of test-retest reliability were greater than 0. 907. The levels of responsive-ness and distribution index were 8. 33 and 0. 2744, respectively;each dimension by order of importance:timely attention>dignity>infrastructure>communication>confidentiality >social support >selective >autonomy. Approximately 50% of key informants considered that vulnerable groups in community health service institutions were sometimes or often treated unfairly. Conclusion:Key informants considered the responsiveness level of overall higher community health service institu-tions in Henan Province was high, and the distribution of responsiveness was relative equilibrium. However, there is a large shortage of infrastructure, privacy protection, doctor-patient communication, etc.

Best practice eye care models.

Since the launching of Global Initiative, VISION 2020 “the Right to Sight” many innovative, practical and unique comprehensive eye care services provision models have evolved targeting the underserved populations in different parts of the World. At places the rapid assessment of the burden of eye diseases in confined areas or utilizing the key informants for identification of eye diseases in the communities are promoted for better planning and evidence based advocacy for getting / allocation of resources for eye care. Similarly for detection and management of diabetes related blindness, retinopathy of prematurity and avoidable blindness at primary level, the major obstacles are confronted in reaching to them in a cost effective manner and then management of the identified patients accordingly. In this regard, the concept of tele-ophthalmology model sounds to be the best solution. Whereas other models on comprehensive eye care services provision have been emphasizing on surgical output through innovative scales of economy that generate income for the program and ensure its sustainability, while guaranteeing treatment of the poorest of the poor.

Afrontamiento familiar a la drogodependencia en adolescentes / The family facing up to drug dependency in adolescents

Objetivo Describir el afrontamiento familiar a la drogodependencia en adolescentes atendidos en el Centro de Deshabituación de Adolescentes en La Habana, 2009. Métodos Investigación descriptiva de corte transversal realizada en el 2009 en el contexto de la mencionada institución, sitio donde se ofrece un servicio multidisciplinario e integral dirigido a tratar la drogodependencia y sus complicaciones en adolescentes y jóvenes. La exploración del afrontamiento familiar a la enfermedad se realizó mediante entrevistas en profundidad. La unidad de análisis en la investigación fue el grupo familiar de convivencia de los pacientes drogodependientes. La fuente de información fue primaria a partir de la selección de un informante clave de la familia. El amplio volumen de datos recolectados fue procesado siguiendo el algoritmo propuesto por Taylor-Bogdan. Resultados Emergieron categorías de análisis, conceptos y proposiciones a través de los cuales se perfiló la descripción de un afrontamiento familiar a la drogodependencia desde antes de ser confirmada la enfermedad, hasta el momento del estudio. Sobresalió la figura materna, como moderadora de la relación de los familiares con el hijo enfermo en diferentes momentos de la vida de este, comportamientos familiares de justificación y encubrimiento de conductas relacionadas con el consumo de drogas de los adolescentes, percepción familiar de pérdida de control así como comportamientos de negación de responsabilidad familiar con la enfermedad del paciente y su tratamiento. Conclusiones Se identificó un estilo de Afrontamiento Familiar Evasivo a la drogodependencia, comportamiento grupal predominante, manifiesto ante las situaciones relacionadas con la historia del consumo de sustancias en los adolescentes, en el tránsito de la salud a la enfermedad

Objective To describe the various ways in which the family faces up to drug dependency in teenagers seen at the Havana's Center for Treatment of Drug Dependency in Adolescents. Methods Cross-sectional descriptive research study conducted in this institution in 2009, a place where a comprehensive multidisciplinary service is offered to treat drug dependency and its complications in adolescents and young people. The exploration of the various ways in which the family faced up to this problem was based on in-depth interviews. The analytical unit was the group of relatives living with the drug-dependent patients. The primary source of information was the chosen family key informant. The wide range of data was processed by the Taylor-Bogdanïs algorithm. Results Several analysis categories, concepts and proposals emerged, which helped to make a description of the ways the family faced up to drug dependency before the confirmation of the disease up to the moment of the study. It could be observed that the mother prevailed as the regulator of the family relationships with the sick son/daughter at different times of his/her life; there were some family behaviours in favour of justifying and covering up actions associated to drug consumption by adolescents, the family perception of loss of control over them as well as the denial of family responsibility over the patient's disease and treatment. Conclusions This research identified a sort of evasive way of family facing up to drug dependency as well as predominant group behaviour before the situations linked to the history of substance consumption by adolescents in the process of transition from health to disease

The Epidemiological Study of Mental Retardation in a Rural Area / 신경정신의학

OBJECTIVES: This study was designed to assess the present conditions of the mental retardation in a rural area by identifying the prevalence, socioeconomic characteristics and combined diseases of the subjects with mental retardation. METHODS: For this survey, four regions of a rural area with total population of 17,235 persons were chosen. The surveys were divided into 2 steps. After Key Informant Research(KIR) at first survey, one psychiatric specialist, two psychiatric residents and five clinical psychologists interviewed the high risk group who had been selected in KIR. By this two-step process, final diagnosis and degree of severity were confirmed. Diagnostic criteria of Mental Retardation by DSM-IV(Diagnostic and Statistical Manual of Mental Disorders-IV), K-WAIS, Social Maturation Scale were used as diagnositc tools. RESULTS: Prevalence of Mental Retardation in survey areas was 0.42%. The prevalences in male and female were 0.37% and 0.47%, respectively, which were of no significant statistical difference. The relative ratio of each degree of mental retardation-mild, moderate, severe and profound mental retardation-was 33:47:18:3 respectively. The prevalence of moderate mental retardation was higher than that of any other degrees. By age groups, the prevalence in twenties and thirties was 0.69%, which was the highest of all age groups. The prevalence in forties and over was 0.35%, which was the lower than that of twenties and thirties(x2-18.64, p=0.00002). CONCLUSIONS: Prevalence of mental retardation in survey areas was 0.42%, which was higher than any other previous studies in Korea. The prevalence of mild mental retardation was relatively lower than that of other previous studies, which means that the key informants may not have detected the subjects with mild mental retardations who were relatively socially adaptive in rural areas, because they might have focused on the ability of social adaptation as an important feature in detecting the mental retardations. The prevalence of moderate mental retardation was 0.20%, higher than any other groups, which resulted from low rate of failure in the detection of the moderate mental retardations because of their severe deficits in social adaptation and from the higher prevalence than severe and profound mental retardation in reality. The prevalence of severe and profound mental retardation was low rate because they used to be short-lived due to combined medical illnesses and congenital anomalies. The persons with mental reatardation were in low socioeconomic status and had poor supporting systems.

An Epidemiological Study of Attention-deficits Hyperactivity Disorder and Learning Disabilities in a Rural Area / 신경정신의학

OBJECTIVES: We atlempted to determine the prevalence rate of attention deficit-hyperactivity disorder, learning disorder, and mental retardation of elementary school children in a rural area, and to evaluate a cost, and time-efficient method for identifying of children with such disabilities. METHODS: We studied 1,256 children from 6 elementary schools in a rural aiea using used two-stage design. At the first step, we used the key informant and the total population survey methods for identifying children with disability. Teacher checklists were used as screening instruments in total population survey. And at the second step, child interview and KEDI-WISC were employed to make diagnoses. RESULTS: 1)The prevalence rate of attention-deficit/hyperactivity disorder(ADHD)was 1.99%. The prevalence rates of learning disorder(LD)and mental retardation(MR)were 0.40% and 2.23%, respectively. 2)The prevalence rate of MR was significantly higher in total population method compared with key informant method(3.29% vs. 1.23%) Other comparison of prevalence rates in two methods was not significantly different. Positive predictabilities of ADHD and learning disabilities by key informants were higher than by DBDRS and APRS, the checklists used in total population methods. 3)The probability of illness was much higher when the teacher and parents reported the problems of child concurrently. CONCLUSIONS: The prevalence rate of ADHD in elementary school children in the rural area was 1. 99%. And the prevalence rates of LD and MR were 0.40% and 2.23%, respectively. Key informant method was more effective compared with total population survey in positive predictability and diagnostic concordance. In identifying children with disabilities, the combined data from teacher and a parent was most reliable.