Reasons for non-vaccination against influenza among older adults with hypertension in Brazil: a cross-sectional study

ABSTRACT The aim of this study was to estimate the prevalence of non-vaccination against influenza among Brazilian older adults with systemic arterial hypertension and determine the main reasons for non-adherence. A cross-sectional study was conducted using data from older adults (≥ 60 years of age) with hypertension who participated in the 2013 National Health Survey and reported not having been vaccinated against flu over the previous 12 months (n = 1,295). The analyses were performed using the Stata 14.0 software. The data were weighted because of the sampling design. An estimated 3,026,080 older adults with hypertension had not received a flu vaccine over the 12 months prior to the survey (22.6%). No significant associations were found with sex, age group or schooling. The prevalence of unvaccinated older adults was lower in the southern and southeastern regions of Brazil than in the northern and northeastern regions, even after adjusting for age. The prevalence was higher among individuals without private health insurance. The main reasons for non-vaccination were fear of a reaction, rarely having the flu and not believing in the protection of the vaccine. The present findings underscore the need for healthcare professionals to explain to the population the benefits of the vaccine for preventing severe influenza (protective effect and possible reactions) and for secondary prevention of cardiovascular events. Increasing the prevalence of vaccination in older adults with hypertension and other cardiovascular diseases is of fundamental importance within the realm of public health as a strategy for reducing occurrences of complications and deaths associated with influenza.

Condiciones de salud y uso de servicios en pueblos indígenas de México / Health conditions and use of services among indigenous peoples of Mexico

Resumen: Objetivo: Identificar diferencias en indicadores socioeconómicos, de condiciones de salud y uso de servicios entre la población indígena (PI) y no indígena (PNI) del país. Material y métodos: Estudio trasversal descriptivo con información de la Encuesta Nacional de Salud y Nutrición 2018-19. Resultados: La mayoría de la PI se encuentra en el quintil socioeconómico más bajo y usa menos los servicios de salud. Las mujeres indígenas reportaron un mayor número de hijos, así como atención del parto con parteras. La PI acude por atención médica a las instituciones para población sin seguridad social como primera opción, pero manifiesta menor deseo de regresar a atenderse al mismo lugar. Conclusiones: La PI utiliza menos los servicios de salud. Se configura un panorama epidemiológico de doble carga e inequidad en indicadores de acceso que afecta a la PI. La salud reproductiva es el ámbito donde se observan las mayores desigualdades.

Abstract: Objective: To identify differences in socioeconomic indicators, health conditions and use of services between the indigenous (IP) and non-indigenous population (NIP) of the country. Materials and methods: Descriptive cross-sectional study carried out with information obtained by the 2018-19 National Health and Nutrition Survey. Results: Most IP are in the lowest socioeconomic quintile and they use less health services. Indigenous women reported a higher number of children, as well as childbirth care with midwives. IP go for medical care to institutions for the population without social security as the first option but expressed less desire to return to the same place. Conclusions: IPs use less health services. An epidemiological panorama of double burden and inequity in access indicators that affect IP is configured. Reproductive health is the area where the greatest inequalities are observed.

Knowledge and Acceptability about Adult Pertussis Immunization in Korean Women of Childbearing Age

PURPOSE: The adult tetanus, reduced diphtheria, and acellular pertussis (Tdap) vaccine has been introduced in order to provide individual protection and reduce the risk of transmitting pertussis to infants. We assessed the knowledge and acceptability of the Tdap vaccine around pregnancy. MATERIALS AND METHODS: This study was a cross-sectional survey of women of childbearing age (20-45 years) who visited obstetrics and gynecologic units of primary, secondary, or tertiary hospitals. They were asked to fill in a questionnaire assessing their knowledge, attitudes, and acceptability of Tdap. RESULTS: The questionnaire was completed by 308 women; 293 (95.1%) had not received information from doctors about Tdap, and 250 (81.2%) did not know about the need for vaccination. A significantly important factor related to subjects' intention to be vaccinated, identified by stepwise multiple logistic regression, was the knowledge (OR 13.5, CI 3.92-46.33) that adult Tdap is effective in preventing pertussis for infants aged 0-6 months. Additionally, 276 (89.6%) considered the recommendation of obstetric doctors as the most influencing factor about Tdap vaccination. CONCLUSION: In Korea, most women of childbearing age seem to be neither recommended nor adequately informed about the vaccination, although our population was not a nationwide representative sample. Information given by healthcare workers may be critical for improving awareness and preventing pertussis.

Binational utilization and barriers to care among Mexican American border residents with diabetes / Utilización binacional y barreras a la atención en las personas con diabetes que residen en la frontera mexicano-estadounidense

OBJECTIVE: To assess whether U.S.-Mexico border residents with diabetes 1) experience greater barriers to medical care in the United States of America versus Mexico and 2) are more likely to seek care and medication in Mexico compared to border residents without diabetes. METHODS: A stratified two-stage randomized cross-sectional health survey was conducted in 2009 - 2010 among 1 002 Mexican American households. RESULTS: Diabetes rates were high (15.4%). Of those that had diabetes, most (86%) reported comorbidities. Compared to participants without diabetes, participants with diabetes had slightly greater difficulty paying US$ 25 (P = 0.002) or US$ 100 (P = 0.016) for medical care, and experienced greater transportation and language barriers (P = 0.011 and 0.014 respectively) to care in the United States, but were more likely to have a person/place to go for medical care and receive screenings. About one quarter of participants sought care or medications in Mexico. Younger age and having lived in Mexico were associated with seeking care in Mexico, but having diabetes was not. Multiple financial barriers were independently associated with approximately threefold-increased odds of going to Mexico for medical care or medication. Language barriers were associated with seeking care in Mexico. Being confused about arrangements for medical care and the perception of not always being treated with respect by medical care providers in the United States were both associated with seeking care and medication in Mexico (odds ratios ranging from 1.70 - 2.76). CONCLUSIONS: Reporting modifiable barriers to medical care was common among all participants and slightly more common among 1) those with diabetes and 2) those who sought care in Mexico. However, these are statistically independent phenomena; persons with diabetes were not more likely to use services in Mexico. Each set of issues (barriers facing those with diabetes, barriers related to use of services in Mexico) may occur side by side, and both present opportunities for improving access to care and disease management.

OBJETIVO: Evaluar si las personas con diabetes que residen en la frontera mexicano-estadounidense 1) encuentran mayores barreras para obtener atención médica en los Estados Unidos de América que en México; y 2) acuden a México en busca de atención y medicación con mayor probabilidad que las personas no diabéticas que residen en la frontera. MÉTODOS: Durante el 2009 y el 2010, en una muestra de 1 002 hogares mexicano-estadounidenses, se llevó a cabo una encuesta transversal de salud en dos etapas, estratificada y aleatorizada. RESULTADOS: Las tasas de diabetes eran elevadas (15,4%). La mayor parte de las personas con diabetes (86%) notificaron comorbilidades. En comparación con los participantes no diabéticos, los afectados de diabetes experimentaban dificultades algo mayores para pagar US$ 25 (P = 0,002) o US$ 100 (P = 0,016) por recibir atención médica, y encontraban mayores barreras en materia de transporte e idioma (P = 0,011 y 0,014, respectivamente) para ser atendidos en los Estados Unidos, aunque era más probable que contaran con una persona o lugar adonde acudir en busca de atención médica y para ser sometidos a tamizaje. Una cuarta parte de los participantes acudían a México en busca de atención o medicamentos. Una edad menor y el haber vivido en México se asociaban con la búsqueda de atención en México, pero no el padecer diabetes. La presencia de múltiples barreras financieras se asociaba independientemente con una probabilidad aproximadamente tres veces mayor de acudir a México en busca de atención médica o medicación. Las barreras idiomáticas se asociaban con la búsqueda de atención en México. La confusión acerca de los trámites para recibir atención médica y la percepción de no recibir siempre un trato respetuoso por parte de los proveedores de atención médica en los Estados Unidos se asociaban con la búsqueda de atención y medicación en México (odds ratio, 1,70 - 2,76). CONCLUSIONES: La notificación de barreras modificables a la atención médica fue frecuente entre los participantes y algo más frecuente entre 1) las personas con diabetes; y 2) los que buscaban se atendidos en México. Sin embargo, estos fenómenos son estadísticamente independientes; no era más probable que las personas con diabetes utilizaran servicios en México. Ambos conjuntos de problemas (las barreras que deben afrontar las personas con diabetes, las barreras relacionadas con el uso de servicios en México) pueden coexistir, y proporcionan oportunidades para mejorar el acceso a la atención y el tratamiento de las enfermedades.

Goffman: contribuições para a Sociologia da Saúde / Goffman: contributions to health sociology

Com uma obra que trouxe inegáveis contribuições, Goffman inovou a pesquisa etnográfica nos estudos socioantropológicos. Esta marca pode ser observada desde os seus primeiros trabalhos nos quais aborda a apresentação do self na vida diária, os manicômios, o estigma e são, por sinal, aqueles que mais referências receberam nos estudos sociais sobre a doença, instituições e práticas de saúde. Neste artigo são analisadas essas contribuições e a importância que tiveram para a construção da sociologia da saúde. O texto destaca alguns conceitos que se tornaram fundamentais para os estudos sociológicos da doença e do paciente, como carreira do paciente, instituição total, interação estratégica e organizações formais instrumentais.

Author of a work with undeniable contributions, Goffman brought innovation to ethnographic research in socio-anthropological studies. This characteristic may be already observed in his first works - where he approaches the presentation of 'self' in daily life, asylums, and stigma -, which are those more cited in social studies about the disease, institutions and health practices. This study analyzes these contributions and their importance for the development of the field of health sociology. The text highlights some concepts considered fundamental for sociological studies on the disease and the patient, such as the patient's career, the whole institution, the strategic interaction, and instrumental formal organizations.

(Re)construindo a experiência de mulheres com HIV/AIDS no grupo de apoio do CRASE, em Governador Valadares, MG / (Re)building the life history for adhesion to the treatment: the experience of women with HIV/AIDS

Trata-se de estudo etnográfico cujo objetivo foi compreender a experiência da adesão ao tratamento por mulheres com HIV/AIDS...

Use of complementary and alternative medicine by patients with diabetes mellitus.

BACKGROUND: A wide variety of alternative medicines have been traditionally used for the treatment of diabetes in India. We did a cross-sectional study to assess the use of complementary and alternative medicine by patients with diabetes attending our outpatient department. METHODS: Four hundred and ninety-three patients attending the outpatient endocrine clinic for allopathic treatment were included. They were interviewed to assess their knowledge, awareness and methods of practice of non-allopathic forms of therapy. Information on the patients' background characteristics, family history of disease, existing knowledge of their disease and therapy was obtained. RESULTS: The user rate of complementary and alternative medicine was 67.8% and this was not significantly associated with the educational or socioeconomic status of the patients. Desire for early and maximum benefit was the most common reason (86.8%) for using these remedies. The patients felt that acupressure followed by naturopathy were the most beneficial alternative therapies, while homeopathy was felt to have the least benefit in the control of diabetes. CONCLUSION: There was widespread use of complementary and alternative systems of medicine by our patients. It is therefore necessary to obtain objective data to assess the improvement in blood sugar level with, and side-effects of, these methods of treatment.

Assessment of relevant cultural considerations is essential for the success of a vaccine.

This paper explores applications of social science research to international vaccine development and implementation. The paper discusses examples of vaccine-implementation controversies, suggesting that many of these issues could have been avoided with a greater focus on cultural issues regarding perceptions of disease, vaccination, and health services. The paper also discusses the relationship of theory-based behavioural interventions with the development of an overall vaccine strategy and examines experience of growing vaccine research with regard to perceptions of medical decision-making, acceptable practices, and authority and how these perceptions impact vaccine usage. The importance of social science in the ethical conduct of research is also discussed.

Cervical Cancer Screening in Korean American Women : Findings from Focus Group Interviews / 간호학회지

PURPOSE: Korean American women have twice the rate of cervical cancer than white women and demonstrate low rates in participation in cervical cancer screening. This study was to describe the perceptions about cervical cancer and factors related to cervical cancer screening among Korean American women. METHOD: Focus group methods. RESULT: Five themes emerged. First, knowledge about cervical cancer; misconceptions about cervical cancer, its causes, reproductive anatomy and the treatment Second, perceived meanings of having cervical cancer; most of the women felt that cervical cancer represented a loss of femininity and existential value of womanhood. Third, knowledge about cervical cancer screening ; regular medical check-ups were necessary for early detection and prevention of cervical cancer. Forth, experiences and perceived meanings of cervical cancer screening; the participants expressed their feelings; embarrassment, fear, shame and shyness. Fifth, practices of cervical cancer screening; various intervals in participating in cervical cancer screening. But they mentioned several deterrents, language, insurance, time constraint, embarrassment, fear of the screening results, misbelief about susceptibility, lack of health prevention behavior, and lack of information written in Korean. CONCLUSION: Results emphasize the critical need for culturally appropriate health education to encourage participation of Korean American women in cervical cancer screening.

A study of knowledge about malaria and treatment seeking behaviour in two tribal communities of Manipur.

The study was conducted on a sample of 250 tribal people of Manipur state, comprised of 125 from the urban valley population and 125 persons from rural tribals settled on hilly area at a higher altitude. The finding shows that knowledge regarding transmission of malaria, self protection and treatment seeking behaviour is still poor among the tribal communities of Manipur. However the urban tribals had better knowledge regarding diagnosis of malaria and prevention of mosquito breeding than their rural counterparts.

Gender differences in healthcare-seeking during common illnesses in a rural community of West Bengal, India.

This follow-up observational study examined gender disparities in seeking healthcare and in home management of diarrhoea, acute respiratory infections, and fever among 530 children (263 boys and 267 girls) aged less than five years in a rural community of West Bengal, India, from June 1998 to May 1999. Of 790 episodes detected by a weekly surveillance, 380 occurred among boys and 410 among girls. At the household level, girls were less likely to get home fluids and oral rehydration solutions (ORS) during diarrhoea. Qualified health professionals were consulted more often (p = 0.0094) and sooner for boys than for girls (8.3 +/- 4.5 hours vs 21.2 +/- 9.5 hours), for which parents also travelled longer distances (3.3 km for boys vs 1.6 km for girls). Expenditure per treated episode (Rs 76.76 +/- 69.23 in boys and Rs 44.73 +/- 67.60 in girls) differed significantly (p = 0.023). Results of logistic regression analysis showed that chance of spending more money was 4.2 [confidence interval (CI) 1.6-10.9] times higher for boys. The boys were 4.9 (CI 1.8-11.9) times more likely to be taken early for medical care and 2.6 (CI 1.2-6.5) times more likely to be seen by qualified allopathic doctors compared to girls. Persistence of gender disparities calls for effective interventions for correction.

Rural people and fine needle aspiration cytology (FNAC)--some findings in North Bengal Medical College, Darjeeling, West Bengal.

A hospital based interdepartmental collaborative study was carried out from 1st July to 30th September, 2000 on 269 rural people residing in six districts of the northern part of West Bengal and attending the Pathology Department in North Bengal Medical College for Fine Needle Aspiration Cytology (FNAC) after being referred from different clinical departments. The objectives of the study were to study some aspects of the outcomes of FNAC among rural people and to suggest for its wider application in rural community through Community Health Centre/Rural Hospital/Block Primary Health Centre. The results shows that Hindus (80.3%) are attending more in number than Muslims (14.13%), Christians (4.83%) and Buddhist (0.74%); 53.54% of the population are in 11-40 years age group. In benign conditions 76.95% are coming from up to 100 kms. of N.B.M.C; people in lower per capita income group of up to Rs.400/- per month are attending twice in number than those in the income groups of Rs.401/- and more per month. In malignancy however people do not think of distance or expenses due to seriousness of the diseases. In 14.5% cases FNAC remains inconclusive whereas in 85.5% cases it provides definite diagnoses.