Adult patients with alopecia areata report a significantly better medication adherence compared to those with atopic dermatitis: Results from a large cross-sectional cohort study.

Background: Alopecia areata (AA) and atopic dermatitis (AD) are chronic skin diseases where the suboptimal medication adherence (MA) may result in poor clinical outcomes. Objective: To assess the impact of AA on MA among adults compared to AD. Methods: Patient reported MA of adults with AA were compared with AD. Patients were identified from the Danish Skin Cohort, a nationwide prospective cohort of dermatological patients in Denmark. We used the Medication Adherence Report Scale- 5, a self-reporting questionnaire, to assess MA. Demographic and disease characteristics were collected. Logistic regression was conducted. Results: Patients with AA reported higher MA than AD (mean 21.81 vs 18.29). Logistic regression analyses showed AA diagnosis had a statistically significant positive effect on MA (odds ratio = 3.94, 95% CI 2.01-8.89). Men reported significantly higher MA (odds ratio = 1.49, 95% CI 1.14-1.94). Current disease severity did not impact MA. Limitations: Data were self-reported by patients. Data regarding the specific treatment undergone by patients were not available. Conclusion: Patients with AA have significantly higher MA compared to patients with AD. The stability of AA patients' symptoms may lead to higher MA due to a desire for disease control. Conversely, the sporadicity of AD symptoms could negatively affect adherence, causing fluctuations in medication use.

Prevalence and consultation behavior of childhood respiratory diseases in a hospital in Zhejiang Province in 2019-2021 / 公共卫生与预防医学

Objective To analyze the causes of changes in the prevalence of respiratory diseases and the reason for changes in medical visit behavior of children in Zhejiang Province during the winter and spring seasons of 2019-2021, and to provide important reference for the allocation of hospital resources, implementation of hierarchical diagnosis and treatment, and epidemic prevention and control. Methods A retrospective study was conducted on 256 937 outpatient medical records from January 23rd to April 23rd of each year from 2019 to 2021 at the Children's Hospital Affiliated to Zhejiang University School of Medicine. Statistical methods were used for data analysis. Results A total of 256 937 cases were selected in the present study, including 157 000 cases in 2019, 22 192 cases in 2020, and 77 745 cases in 2021. The number of patients to the Children's Hospital of Zhejiang University School of Medicine from outside Hangzhou accounted for 41.74%, 14.36% , and 18.53% in 2019-2021, respectively. For 0~2 years old , 3~6 years old , and 7~14 years old groups , the percentages of patients with upper respiratory tract infections were 49.54%, 45.95%, and 46.74%, respectively ; with lower respiratory tract infections were 42.90% , 31.76% , and 22.95% ; with influenza were 2.23% , 3.15% and 4.09%; and with asthma were 1.37%, 5.08%, and 8.15%, respectively. Conclusion From 2019 to 2021, there have been significant changes in the total number of respiratory diseases in children, the proportion of disease types, and the proportion of children's geographical composition. It is necessary to continue to monitor children's respiratory diseases, grasp the dynamic changes in their medical visits in real time, adjust the hospital admission model , implement the graded treatment policy, and promote the prevention and control of respiratory diseases in children.

The impact of centralized coronary stent procurement program on acute myocardial infarction treatments: evidence from China.

Background: The advent of coronary stents has resulted in many more many lives being saved from acute myocardial infarction (AMI). However, the high price associated with this method of treatment also imposes a heavy economic burden on healthcare systems. As a country making significant use of coronary stents, in 2021, China introduced a program around this method of treatment grounded in centralized procurement and it is the focus of this paper to assess the impact of this policy on AMI treatments. Methods: The patients with AMI are selected as the study group, and the patients with pre-cerebral vascular stenosis are selected as the control group, and individual-level medical insurance settlement data are collected from the years 2018, 2019, and 2021. Differences-in-differences methodology is used to analyze the impacts of this program on the probability changes in respect of AMI patients receiving stent therapy, as well as changes relating to cost, length of stay and 30-day readmission. Results: The results show that the reform has led to a reduction in the probability of AMI patients using stents to 51% of the original rate. Additionally, the average cost is shown to have decreased by 41%, and no significant changes can be found in respect of the length of stay and 30-day readmission. Conclusion: In sum, the centralized procurement program is shown to reduce not only the medical expenses incurred by treating patients with AMI, but also the use of coronary stents, resulting in changes to the treatment patterns of patients with AMI.

Optimization of Printing Process Variables and the Effect of Post-Heat Treatments on the Mechanical Properties of Extruded Polylactic Acid-Aluminum Composites.

Polymer extrusions are employed in the fabrication of crucial parts for automotive, aerospace, and other mechanical applications. The use of fillers and microfibers is contributing to the advancement of material extrusion polymers. In order to enhance their mechanical characteristics, printed materials undergo a post-heating process utilizing microwaves. Specimens were fabricated using polylactic acid filaments containing 2 wt% aluminum. Two sets of specimens were fabricated and subjected to testing in order to evaluate the features of extruded specimens and specimens that underwent post-heating. In terms of mechanical performance, specimens subjected to post-heating exhibited superior results compared to specimens merely subjected to extrusion. The tensile, flexural, and Shore D hardness properties of the specimens exhibited improvements of 5.07, 6.16, and 1.32%, respectively, after being subjected to heating. Furthermore, the wear rate decreased by 13.58 percent. The results of the regression analysis indicate that the print angle and the air gap exhibit the greatest influence on the observed responses. The validation test outcomes exhibit a high level of concordance with the predicted findings. The mechanical and surface properties of components extruded with filler-added material are enhanced by subsequent heating.

Analysis of doctor′s diagnosis and treatment behavior before and after the implementation of diagnosis-intervention packet based on propensity score matching: taking chronic diseases as an example / 中华医院管理杂志

Objective:To analyze the effect of the implementation of diagnosis-intervention packet (DIP) on the doctors′ diagnosis and treatment behavior of chronic diseases, so as to provide reference for further improving medical insurance payment related policies.Methods:The first page information of chronic disease patients admitted to hospitals with diabetes, hypertension and coronary atherosclerotic heart disease as the main conditions in 103 hospitals at all levels and township health centers in a city from 2016 to 2020 was collected, and the patients were divided into non-DIP group and DIP group according to the implementation time of DIP. After 1∶1 propensity score matching to balance the general conditions of the 2 groups, the diagnosis and treatment behaviors were analyzed from two dimensions: diagnostic behavior and treatment behavior. The grade A rate of medical record writing, admission and discharge diagnosis coincidence rate, and the average length of stay were used to evaluate the diagnostic behavior; the proportion of drugs and the degree of change in the cost structure were used as the evaluation indicators of treatment behavior.Results:After matching, 41 050 patients were included in both the non-DIP group and the DIP group.From the perspective of diagnostic behavior, the grade A rate of medical record writing in the non-DIP group and the DIP group was 99.40% and 99.83%, the coincidence rate of admission and discharge diagnosis was 58.42% and 61.79%, the average hospital stay was 8.03 days and 7.04 days respectively, and the difference between the groups was significant ( P<0.05). From the view of treatment behavior, the proportion of drugs decreased from 33.00% in the non-DIP group to 27.59% in the DIP group, with a significant difference ( P<0.05); the drug cost represented by Western medicine changed negatively, while the diagnostic cost showed a positive change. Conclusions:DIP has played a certain role in regulating doctors′ diagnosis and treatment behavior for chronic diseases. Among them, doctors have significantly improved their diagnostic behavior for chronic diseases, and the proportion of drugs in treatment behavior has been well controlled.

Preliminary exploration of medical service price reform based on choice behavior motivation / 中华医院管理杂志

Medical service pricing system is the basic system of health economics, which has a profound impact on physicians′ medical behavior and the running mode of hospital. Rui′an City, Wenzhou City, Zhejiang Province, freed up the cost space of drug and consumables based on the reasonable diagnosis and treatment behavior of doctors and selection of drug and consumables in the hospital procurement link. 68% of the free space was used to improve the price of medical services. 248 medical service items with obvious cost inversion were selected, such as nursing, traditional Chinese medicine, diagnosis, etc., and the price adjustment range was determined according to the agreed free space limit. Meanwhile, the credit mechanism of Alipay was applied to synchronously implement " vacating space and adjusting structure" , so as to solve the game problem between medical treatment and medical insurance, broaden the path of the " translation compensation method" of medical service price reform, and produce policy superposition and linkage effect with the reform of medical insurance payment mode.

A Self-Report Measure of Diabetes Self-Management for Type 1 and Type 2 Diabetes: The Diabetes Self-Management Questionnaire-Revised (DSMQ-R) - Clinimetric Evidence From Five Studies.

Aims: Measurement tools to evaluate self-management behavior are useful for diabetes research and clinical practice. The Diabetes Self-Management Questionnaire (DSMQ) was introduced in 2013 and has become a widely used tool. This article presents a revised and updated version, DSMQ-R, and evaluates its properties in assessing self-management practices in type 1 diabetes (T1D) and type 2 diabetes (T2D). Methods: The DSMQ-R is a multidimensional questionnaire with 27 items regarding essential self-management practices for T1D and T2D (including diabetes-adjusted eating, glucose testing/monitoring, medication taking, physical activity and cooperation with the diabetes team). For the revised form, the original items were partially amended and the wording was updated; eleven items were newly added. The tool was applied as part of health-related surveys in five clinical studies (two cross-sectional, three prospective) including a total of 1,447 people with T1D and T2D. Using this data base, clinimetric properties were rigorously tested. Results: The analyses showed high internal and retest reliability coefficients for the total scale and moderate to high coefficients for the subscales. Reliability coefficients for scales including the new items were consistently higher. Correlations with convergent criteria and related variables supported validity. Responsiveness was supported by significant short to medium term changes in prospective studies. Significant associations with glycemic outcomes were observed for DSMQ-R-assessed medication taking, glucose monitoring and eating behaviors. Conclusions: The results support good clinimetric properties of the DSMQ-R. The tool can be useful for research and clinical practice and may facilitate the identification of improvable self-management practices in individuals.

Big data analysis of patients with periodontitis and factors influencing treatment behavior / 口腔疾病防治

Objective @#To study patient-related information and factors altering their decision making in periodontal treatment and treatment behavior via big data analysis of the electronic medical records and to guide better dental care service and improve periodontal treatment. @*Methods@# A retrospective study was performed in patients with periodontitis who visited the Affiliated Stomatological Hospital of Tongji University from 2014 to 2016. Based on the periodontal sequence treatment procedure, the treatment types were divided into six groups and were analyzed using multivariable regression analysis. Chi-square test was performed according to gender and age.@*Results@#Age, payment method, disease severity, exhibited statistically significant differences regarding their effects on patients’ treatment behavior (P ＜ 0.05). Men were more likely to have severe periodontitis than women (male 41.04%; female 31.85%), and use medical insurance more often as payment method (male 86.14%; female 83.74%) (P ＜ 0.05). Compared with the population under 35 years old, moderate and severe periodontitis accounted for a larger proportion (84.58%) in the population over 35 years old. The compliance of the population over 35 years old was poor. Less follow-up reviews were conducted (17.10%) and medical insurance was less often used (49.65%) in this population. The differences were statistically significant (P ＜ 0.05).@*Conclusion@#Moderate and severe periodontitis accounted for a larger proportion in the population over 35 years old. Patients over 35 years old tend to choose simpler treatments with lower compliance and frequency of revisits. This situation may be related to the lower proportion of medicare use in this population. The awareness and compliance of periodontal treatment protocols in people over 35 years old needs to be improved.

Status of sexually transmitted infections and seeking medical treatment among Vietnamese cross-border female sex workers in Hekou County, Yunnan / 公共卫生与预防医学

Objective To understand the status of sexually transmitted infection and seeking medical treatment behavior, and influencing factors of Vietnamese cross-border female sex workers (FSWs) in Hekou County, Yunnan, and to provide a basis for promoting reproductive health and preventing and controlling the spread of sexually transmitted diseases (STD) in Vietnamese cross-border FSWs. Methods The snowball sampling method was used to recruit research subjects in entertainment venues in Hekou County, Yunnan, to conduct a questionnaire survey and collect blood, vaginal secretions and cervical swab specimens for HIV/STD testing. Results A total of 262 Vietnamese cross-border FSWs were investigated. The total infection rate of sexually transmitted diseases and HIV was 35.8% (94/262). The positive rate of genital herpes simplex, fungal vaginitis, trichomoniasis, wet warts and chlamydia were 23.5%, 8.0%, 2.7%, 1.5% and 1.5%, respectively. The positive rate of HIV was 1.5%. In the past year, 116 Vietnamese cross-border FSWs had symptoms related to sexually transmitted diseases. Among them, 34.5% chose to go to the hospital or private outpatient clinic, 44.8% bought medicines by themselves, and 20.7% did not receive any treatment. The FSWs who reported having sexually transmitted diseases testing in the past year (OR=3.54, P<0.05), came from medium and high-end places (OR=3.94, P<0.05), had more than two symptoms (OR=3.88, P<0.05), and self-perceived high risk of sexually transmitted infection were more likely to seek medical treatment. Conclusion The Vietnamese cross-border FSW population in Hekou County of Yunnan Province had a high rate of sexually transmitted infections. The proportion of seeking medical treatment among FSWs having symptoms related to sexually transmitted diseases was low. It is necessary to guide the Vietnamese cross-border FSWs to seek formal medical treatment.

Malaria prevalence, knowledge, perception, preventive and treatment behavior among military in Champasak and Attapeu provinces, Lao PDR: a mixed methods study.

BACKGROUND: Malaria is a major health problem in Lao People's Democratic Republic (Lao PDR) with high transmission in remote and forest areas, particularly in the South. The military is at risk of malaria infection especially those deployed in forest areas. This study determined the prevalence of malaria infection and assessed knowledge, perception, and preventive and treatment behavior regarding malaria among military personnel in two southern provinces in Lao PDR. METHODS: Quantitative and qualitative approaches were undertaken in Champasak and Attapeu provinces in 2017. From 313 military personnel, quantitative data were collected through questionnaire-based interviews and blood samples used for parasite detection by polymerase chain reaction (PCR). Qualitative data were collected through 7 focus group discussions and 17 in-depth interviews among 49 military personnel. Fisher's exact test and Mann-Whitney U test were used to assess the association between malaria infection and participant characteristics. Content analysis for qualitative data was performed to explore perception and treatment behaviors regarding malaria. RESULTS: The prevalence of malaria infection was 11.2% (Plasmodium falciparum: 1.3%, Plasmodium vivax: 9.3% and mixed infections: 0.6%). Many participants understood that malaria is transmitted through mosquito bites, although they did not necessarily know the name of vector mosquitoes (Anopheles). Surprisingly, more than a half also believed that malaria is transmitted through drinking stream water. One-third of the participants used long-lasting insecticidal nets. Due to limited supply, participants were often unable to use mosquito repellent and coils when necessary. Because participants were unable to receive timely diagnosis and appropriate treatment for malaria in their camps, they commonly practiced self-treatment using antibiotics, painkillers, and/or traditional medicines. They only go to a healthcare facility through their supervisor if their conditions worsen. CONCLUSIONS: The prevalence of symptomatic and asymptomatic malaria was conspicuous among military in forest areas. Many participants believed that malaria is transmitted not only by mosquito bites but also from drinking stream water. Preventive equipment was often insufficient. Self-treatment was practiced before referring to healthcare facility. To further prevent military from contracting malaria, the National Malaria Control Program and military body should provide adequate and suitable health education, protective equipment, and on-site malaria case management.

The influence of emotional state on sleep disorder and treatment behavior among men who have sex with men with newly diagnosed HIV infection / 中华疾病控制杂志

Based on the international large-scale epidemiological research results, the Joint United Nations Programme on HIV and AIDS (UNAIDS) has proposed three 90%-90%-90% strategies for AIDS prevention and control, and the major countries in the world are actively promoting it. However there is a big gap in the strategy to promote the treatment of newly diagnosed HIV-positive people because of insufficient research on the acceptance and continuum care and treatment behavior of newly diagnosed person. Domestic and foreign studies have reported that diagnose outcome may cause psychological problems under pressure. Men who have sex with men with HIV infection are more stressed than the general population for their sexual orientation and HIV infections. Depression and anxiety are common mental problems which were present in 70.7% of the population, especially among newly diagnosed MSM. Unstable emotional state and unhealthy psychological condition may effect on their sleep, seeking treatment behavior and other aspects. The bi-directional affect between sleep and emotion has been proved, while the function of emotional state impact on HIV infection MSM ignition and retention ART is still unclear yet. This paper reviews treatment behavior status of men who have sex with men with HIV diagnosis, and both the effects of emotional state and sleep disorder on their treatment behavior, also analyzes and interprets the relationship between sleep disorder and emotion. This paper may contribute to provide new ideas and basis for HIV prevention and treatment among risky population and also for the care of HIV positive people.

Survey of disease awareness, treatment behavior and treatment satisfaction in patients with atopic dermatitis in Korea: A multicenter study.

In Korea, there is a high dependency on oriental medicine and folk remedies (Korean J Asthma Allergy Clin Immunol, 25, 2005, 110). In addition, inaccurate information available through the Internet is increasing (Korean J Dermatol, 44, 2006, 137). So, there is always a possibility that patients may have difficulty obtaining accurate information about atopic dermatitis (AD). The aim was to determine the awareness, treatment behavior and treatment satisfaction of patients with AD and their caregivers. In October 2017, patients diagnosed with AD at nine hospitals were enrolled in this study. A questionnaire was completed by each patient. A total of 371 subjects were surveyed. In response to the question asking about knowledge of AD, the correct answer rate was 55.4%. Bathing using soap, body scrub and moisturizer showed favorable outcomes. A total of 54.9% patients responded that they were reluctant to use steroid ointment. When asked about their previous treatment, 39.6% reported using oriental medicine and 26.5% had tried folk remedies. The hospital treatment satisfaction score was 6.6. Patients usually applied their knowledge in their daily lives. However, there was a lot of inaccurate knowledge. Therefore, it is important for patients to understand the characteristics of this disease and obtain correct information.

Research on Theoretical Framework on Excessive Medical Treatment and Hierarchical Medical System Based on the Perspective of Supply Side / 中国卫生经济

Objective:It discussed the decision-making mechanism of medical market on supply side and how the hierarchical medical system help inhibiting the excessive medical behavior.Methods:Establishing medical behavior choice model based on the perspective of supply side and hierachy diagnosis Results and Conclusion:In the case of incomplete information and rigid demand hypothesis,the patient would accept all the supplies doctor offered and there was structural unbalance in both general medical market and advanced medical market which meant the excessive medical treatment existed.Under the hierarchical medical system,distinguishing by primary medical institution,both generalmedical market and advanced medical market reached equilibrium which improved the social resource allocation efficiency and the patients' welfare at the same time.

Study on influence of clinical pathway management on physician diagnosis and treatment behaviors / 重庆医学

Objective To observe the influence of the clinical pathway management intervention on medical service behaviors.Methods The clinical cases data in a grade A class 3 hospital of Zhangjiakou City,Hebei Province during 2011-2013 were retrospectively analyzed.The influence of implementing the clinical pathway management on the diagnosis results,medical records writing quality,clinical medication,operation,hospitalization time,medical costs,assisted examination items selection were observed and analyzed.Results The admission and discharge diagnosis coincidence rate and preoperative and postoperative diagnostic coincidence rate of 3 diseases entities in the two groups were 100%,the difference had no statistical significance (P>0.05);the medical record grade-A rate in the implementing clinical pathway group was significantly higher than that in the non-implementing clinical pathway group,the medical record grade-B rate was significantly lower than that in the non-implementing clinical pathway group,the difference was statistically significant (P0.05);the average hospitalization time,total costs,drug costs,laboratory fee and examination fee in the implementing clinical pathway group were lower than those in the non-implementing clinical pathway group,the difference was statistically significant (P<0.05);the operation fee,healthy material fee and nursing fee had no statistically significant difference was statistically significant(P<0.05).Conclusion Implementing the clinical pathway can standardize the doctor′s diagnosis and treatment behaviors and makes the medical work to develop to be more favorable for patients.

Outpatient clinic behavior analysis based on HIS database / 中国医学装备

Objective:To investigate the behaviors of the patients in clinic and analyze the behavior of the patients.Methods: To extract the basic information, diagnostic information, prescription information and so on from the 2013-2014 HIS database of Tai’an traditional Chinese medicine hospital to establish data model. The structure and flow of patients in the hospital had been analyzed by the data model.Results:Data analysis is the effective support of the hospital's continuous improvement service.Conclusion:Based on the HIS database to analyze the behaviors of the patients can let the manager from the perspective see a hospital running status, and this is the hospital management “precision decision-making” reference.

Medical Care Utilization Behavior for Treatment of Skin Diseases: A Questionnaire-based Study of Dermatologic Outpatients at a University Hospital / 대한피부과학회지

BACKGROUND: Analyzing the medical care utilization behavior and conception of disease treatment of dermatologic patients is important. However, the Korean literature has few studies reporting this information. OBJECTIVE: The aim of this study is to evaluate medical care utilization behavior and conception of disease treatment of dermatologic patients. METHODS: A written questionnaire concerning personal information, treatment behavior, treatment conception, patient satisfaction, and patient compliance was completed by 442 outpatients who visited the department of dermatology at a university hospital. RESULTS: According to the patients, satisfactory outpatient consultation time for dermatology was 14.2 minutes for the first-visit consultation, and 9.92 minutes for the second-visit consultation. Most (76.0%) patients initially sought the dermatologic clinics for dermatoses, but only 39.8% of patients knew how to distinguish dermatologists from other doctors. Among the participants, 26.7% of patients directly visited a tertiary medical center without visiting primary clinics. Before visiting the hospital, 52.3% of patients sought disease information, and 28.3% of patients obtained information about doctors. Some respondents (39.7%) had a negative attitude about dermatologic medicine because of lay referral. Men were highly satisfied with explanations of drugs and had more positivity towards drugs, but showed low compliance to applying topical medication. Patients of older age, lower education level, and lower economic status had lower satisfaction with explanations given during the examination. CONCLUSION: We advise dermatologists to play a major role in enlightening patients and constructing proper information delivery systems via diversified routes to prevent unreasonable medical care utilization behavior and groundless negative conceptions about dermatologic treatment.

Rural Christians' view of sickness treatment behavior: a case study from a Shandong village, China.

There are few studies of Christian views of disease and treatment behavior in rural China. Based on Village G in Shandong Province, this paper describes how, under conditions of rural social and medical deprivation, Christians regard physical (routi) and mental (jingshen) sickness as resulting from disturbances to communal peace. Sickness occurs when everyday sinful words and actions allow the devil to enter or when God uses the devil to test worshippers' beliefs. In either case, it is the devil who directly causes sickness. Christian treatment is through scripture, communal and individual prayer, and expurgation. Diagnosis and treatment thus reflect both theodicy and the emergence of a kind of devil culture in the context of rural social crises.

Factors associated with treatment-seeking behavior for postpartum urinary incontinence.

PURPOSE: To identify the factors associated with treatment-seeking behavior for urinary incontinence (UI) among postpartum women. DESIGN: This is a cross-sectional study. A total of 142 women with postpartum UI responded a telephone interview between August of 2010 and March of 2011. The association between the treatment-seeking and the predicting variables were measured through odds ratio and 95% confidence interval. RESULTS: The treatment-seeking percentage was 37.3% and the treatment percentage was 27.5%. The result of multiple logistic regressions indicated that: counseling about UI in pregnancy, postpartum physical exercise, and Spanish nationality predicted 47.8% of the variance in treatment-seeking behavior CONCLUSIONS: The lack of counseling largely determines the low rates of treatment-seeking among Spanish mothers. CLINICAL RELEVANCE: Nursing counseling during pregnancy can contribute substantially to increasing the number of women treated for postpartum UI.

A study on help-seeking behavior and treatment with mental illness / 中华行为医学与脑科学杂志

ObjectiveTo explore help-seeking behavior and treatment towards people with mental illness,so as to provide evidence for intervention measures.Methods 1988 mental disorders in outpatient were selected with a self-developed questionnaire randomly,and regression analysis was carried out.ResultsUnstable marriages and the lack of mental health knowledge were risk factors for actively professional help-seeking contact after first onset of a mental disorder.Median delays of seeking help and treatment in depression,schizophrenia,anxiety disorders and somatoform disorders were 113.5 days,34.0 days,86.5 days,309.0 days and 6.0 months,3.0 months,3.0 months,5.5 months orderly.There were notable difference for primary treatment contact between the four mental disorders ( x2 =46.317,P =0.029 ).No-professional recognition ratio was 17.8％.The ratio of correctly diagnosed and rationally cured with drugs ratio was 10.5％.89.5％ of outpatients had not been given rational drugs then they sought to psychiatry.ConclusionThe delay of help-seeking and treatment in mental illnesses are serious,so it should be taken effective measures to promote the popularization of mental health knowledge and train no-professional doctors in order to improve the behavior of seeking help and provide the ratio of recognition and treatment.