Determinants of consultation, diagnosis and treatment delays among new smear-positive pulmonary tuberculosis patients in Morocco: a cross-sectional study.

We conducted a cross-sectional survey in 2012 in 12 selected provinces and prefectures in Morocco to determine consultation delay (patient delay), diagnosis delay and treatment delay (health system delays), and factors relating to these delays. The sample included 250 eligible and consenting newly diagnosed smearpositive pulmonary tuberculosis patients who were interviewed at the time of their registration within Diagnosis of Tuberculosis and Respiratory Diseases Reference Centers (CDTMR) or Integrated Health Centers (CSI) using a pretested and structured questionnaire. The median total delay was 46 days [inter-quartile interval (IQI) = 29-84 days]. Patient delay (median = 20; IQI = 8-47 days) was higher than health system delay (median=15; IIQ = 7-35 days). Being illiterate, thinking symptoms will disappear by themselves; having financial constraints and feeling fear of diagnosis or social isolation were associated with patient delay. Consulting first in the private sector or having 3 or more consultations before diagnosis was associated with health system delay.

Determinants of consultation, diagnosis and treatment delays among new smear-positive pulmonary tuberculosis patients in Morocco: a cross-sectional study

We conducted a cross-sectional survey in 2012 in 12 selected provinces and prefectures in Morocco to determine consultation delay [patient delay], diagnosis delay and treatment delay [health system delays], and factors relating to these delays. The sample included 250 eligible and consenting newly diagnosed smear-positive pulmonary tuberculosis patients who were interviewed at the time of their registration within Diagnosis of Tuberculosis and Respiratory Diseases Reference Centers [CDTMR] or Integrated Health Centers [CSI] using a pretested and structured questionnaire. The median total delay was 46 days [inter-quartile interval [IQI]= 29-84 days]. Patient delay [median = 20; IQI = 8-47 days] was higher than health system delay [median-15; IIQ = 7-35 days]. Being illiterate, thinking symptoms will disappear by themselves; having financial constraints and feeling fear of diagnosis or social isolation were associated with patient delay. Consulting first in the private sector or having 3 or more consultations before diagnosis was associated with health system delay

Nous avons conduit en 2012 une étude transversale dans une sélection de 12 provinces/préfectures au Maroc pour déterminer les délais de consultation [délai patient], de diagnostic et de mise sous traitement [délai système de santé]chez les nouveaux cas de tuberculose pulmonaire à microscopie positive et les facteurs en relation avec ces délais. L’échantillon comprenait 250 patients, éligibles et consentants, qui ont été interviewés lors de leur enregistrement aux Centres de Diagnostic de la Tuberculose et des Maladies Respiratoires [CDTMR] ou aux Centres de Santé Intégrés [CSI], en utilisant un questionnaire structuré et prétesté. Le délai total médian est de 46 jours [intervalle interquartile [IIQ]: 29-84 jours]. Le délai patient [médiane : 20 jours ; IIQ : 8-47] est supérieur au délai système de santé [médiane : 15 jours ; IIQ : 7-35]. Etre analphabète, croire à la disparition spontanée des symptômes, avoir des contraintes économiques ou peur du diagnostic et de l’isolement social sont associés au délai patient. Consulter en premier dans le secteur privé ou faire trois consultations au moins avant le diagnostic sont associés au délai système de santé

Developmental effects of early immune stress on aggressive, socially reactive, and inhibited behaviors.

The origins of individual differences in social development are examined in relation to early stress (immune challenge) and social milieu (maternal behavior) in a genetic-developmental analysis using an animal model. Neonatal male mice (5 or 6 days of age) from two lines of mice selectively bred for high versus low levels of inter-male aggressive behavior received a standard immune challenge (i.p. injections of 0.05 mg/kg endotoxin or saline). Animals were reared by their line-specific biological dam or by a foster dam from a line bred without selection. Adult levels of social behaviors were assessed in a dyadic test (age 45-50 days). Mice from the high-aggressive line show more developmental sensitivity to immune challenge than mice from the low-aggressive line, and line differences persist regardless of the early maternal environment. As adults, endotoxin-treated mice from the high-aggressive line have lower levels of aggressive behavior, longer latency to attack, and higher rates of socially reactive and inhibited behaviors compared to saline controls. Developmental effects of endotoxin in the low-aggressive line are minimal: endotoxin increases socially reactive behaviors, compared to saline controls, but only for mice reared by their biological dams. Rearing by foster dams increases social exploration in the low-aggressive line. The findings raise novel questions regarding the openness of behavioral systems to effects of nonobvious but omnipresent features of the environment, such as antigenic load, how these effects are integrated to affect social development and psychopathology, and the nature of intrinsic factors that contribute to individual differences in sensitivity to early stressors.