Healthcare-seeking behaviour of primary caregivers for acute otitis media in children aged 6 months to <30 months in Panama: results of a cross-sectional survey.

BACKGROUND: Acute otitis media (AOM) is the most common bacterial childhood infection. However, caregivers with children having mild episodes often do not seek healthcare services, which may lead to an under-appreciation of the disease experienced by the community. The objectives of this survey were to estimate the proportion of primary caregivers who went to a healthcare facility when they suspected that their child aged 6 to <30 months was having an AOM episode during the past 6 months and to assess what factors influenced their decision. METHODS: This observational, cross-sectional survey of primary caregivers (≥18 years), with at least one child aged 6 to <30 months was performed in 19 healthcare facilities in Panama (March to May 2013). A 28-item paper questionnaire was administered to assess demographic data, AOM symptoms, as well as potential healthcare-seeking behaviour and factors influencing this behaviour. Potential confounding effects were individually assessed using Chi-squared or Cochran-Mantel-Haenszel tests, and all together in logistic regression models. RESULTS: The total number of eligible participants was 1330 (mean age 28.5 ± 8.0 years). Of these, 245 participants had at least one child whom they suspected had an AOM episode during the past 6 months. Of the 245 participants, 213 (86.9%) sought healthcare at a facility. Several factors were associated with healthcare usage: perceived severity of illness (p = 0.001), occupational status of the caregiver (p = 0.002), household income (p = 0.016) and length of time since the last suspected AOM episode (p = 0.032). CONCLUSIONS: When confronted with a child with obvious symptoms of AOM, the majority of caregivers reported seeking healthcare. This behaviour appeared to be associated with factors related to the severity of the illness, the length of time since the last episode, as well as with the income and occupational status of the caregivers themselves. As many episodes of AOM present with non-specific respiratory symptoms, our results apply only to caregivers who were confronted with children with an obvious symptom.

Intergenerational Mobility of the Mexican-Origin Population in California and Texas Relative to a Changing Regional Mainstream.

We combine two approaches to gauge the achievements of the Mexican-origin second generation: one the intergenerational progress between immigrant parents and children, the other the gap between the second generation and non-Latino whites. We measure advancement of the Mexican-origin second generation using a suite of census-derived outcomes applied to immigrant parents in 1980 and grown children in 2005, as observed in California and Texas. Patterns of second-generation upward mobility are similar in the two states, with important differences across outcome indicators. Assessments are less favorable for men than women, especially in Texas. We compare Mexican-Americans to a non-Latino white reference group, as do most assimilation studies. However, we separate the reference group into those born in the same state as the second generation and those who have migrated in. We find that selective in-migration of more highly-educated whites has raised the bar on some, not all, measures of attainment. This poses a challenge to studies of assimilation that do not compare grown-children to their fellow natives of a state. Our model of greater temporal and regional specificity has broad applicability to studies guided by all theories of immigrant assimilation, integration and advancement.