农村妇女就医选择行为的影响因素——基于2018年CFPS数据分析

目的 为引导农村妇女合理有序就医,本文基于计划行为理论框架探索其就医选择行为的影响因素。方法 运用2018年中国家庭追踪调查数据,采用二元Probit回归、Bootstrap抽样方法对农村妇女就医选择行为的影响因素进行研究。结果 农村妇女的就医选择行为受到其主观态度、结构性因素和知觉行为控制因素的正向影响（β = 0.403,0.388,0.096,P＜0.05）,医疗自付费用支出在农村妇女主观态度及其就医选择行为间起部分中介作用（β = 0.135,95%CI: 0.026～0.054）。 结论 农村妇女就医选择行为受到主观态度、结构性因素和知觉行为控制因素的影响,应加大健康教育宣传力度;合理统筹医联体医保政策;夯实农村基层首诊制度,推进基层医院家庭医生签约服务,提升农村基层医疗卫生服务利用效率,对农村妇女就医选择行为进行有针对性的干预。     

Estimating pertussis incidence in general practice using a large Australian primary care database

BackgroundWhile pertussis is notifiable in most countries, notifications typically underestimate the true pertussis burden. We explored the incidence of pertussis in general practice in Australia.MethodsUsing MedicineInsight, a large longitudinal electronic medical record database of general practice (primary care) encounters which includes >1.5 million patients, we first defined a cohort of active patients and then used free-text search algorithms to identify patients with pertussis-related encounters. We defined and identified pertussis-related encounters in four patient categories: pertussis-associated (category 1), potential pertussis (category 2), epidemiologically-linked pertussis (category 3), and symptoms consistent with pertussis (category 4). Incident pertussis-related encounter rates per 100,000 active patients were calculated from Jan 2008 to Aug 2015.ResultsEstimated mean annual pertussis incidence increased as definitions were expanded, from 94.3 (category 1 patients only) to 148.8 (categories 1+2+3 patients combined) per 100,000 active patients per year. Monthly time-series corresponding to the first three categories were highly correlated (Pearson’s r > 90% for each pair), but each was poorly correlated with category 4. For categories 1+2+3, the highest incidence was among 0–4 and 5–9 year olds. Incidence was 30% higher in females than males (i.e. 184.5 vs 139.8 per 100,00 active patients for categories 1–3 patients combined). Pertussis-associated incidence (category 1) was similar to national pertussis notification rates. Categories 2 and 3 added 25% and 33%, respectively, on average relative to category 1 incidence. The estimated incidence from categories 1+2+3 together were on average 64% higher than national pertussis notification rates.ConclusionWe provide comprehensive estimates of pertussis-related incidence in general practice (primary care), well in excess of notified pertussis incidence in Australia. This highlights the utility of MedicineInsight data in providing a greater understanding of the burden of medically-attended pertussis infections.     

Irritable Bowel Syndrome in a Bangladeshi Urban Community: Prevalence and Health Care Seeking Pattern

Background/Aims:

Although irritable bowel syndrome (IBS) is a common gastrointestinal disorder, its prevalence is unknown, especially in the urban population of Bangladesh. This community-based study aimed to find out the prevalence of IBS and healthcare-seeking patterns using the Rome-II definition.

Materials and Methods:

A population-based cross-sectional survey of 1503 persons aged 15 years and above was carried out in an urban community of Bangladesh. The subjects were interviewed using a valid questionnaire based on Rome-II criteria in a home setting. Statistical analysis was performed with Statistical Package for Social Science (SPSS) Programmers and the level of significance was set at P ≤ 0.05.

Results:

A response rate of 97.2% yielded 1503 questionnaires for analysis. The prevalence of IBS was found to be 7.7% (n = 116) with a male to female ratio of 1:1.36 (49 vs. 67). “Diarrhoea-predominant IBS” (50%, n = 58) was the predominant IBS subgroup. Symptoms of abdominal pain associated with a change in stool frequency (100%) and consistency (88.8%) were quite common. All IBS symptoms were more prevalent among women (P < 0.000). In the past one year, 65.5% (n = 76) IBS subjects had consulted a physician with a slightly higher rate of women consulters (68.6 vs. 61.2%). The main predictor for healthcare-seeking was the presence of multiple dyspeptic symptoms.

Conclusions:

The prevalence of IBS in the urban community was found to be similar to that in rural communities. A higher rate of consultation was found among urban IBS subjects than in the rural subjects, with sex not seen to be a discriminator to seek consultation.     

南京市社区≥60岁女性生殖道感染及就医行为影响因素分析

目的 探讨城市社区老年妇女生殖道感染情况并分析影响其就医行为的相关因素。方法 采用分层整群抽样法抽取南京市老年妇女进行生殖道感染及相关因素问卷调查并进行常规妇科检查,采用描述流行病学分析方法对该人群生殖道感染情况及就医行为进行分析,并采用单、多因素分析方法对就医行为影响因素进行分析。结果 本研究共对3 270名南京市各社区≥60岁女性进行调查,年龄60~88岁,平均（68.78 ± 5.24）岁。文化程度以初中、高中/中专为主（2 092人,占64.0%）。1 897例在过去3个月内至少出现过1项生殖道感染相关症状,发生率为58.01%。916例诊断为生殖道感染,生殖道感染患病率为28.01%,就医率为59.93%（549/916）。多因素分析结果显示已婚（OR=1.253）、生育子女数≥2个（OR=2.765）、大专及以上文化程度（OR=3.056）、家庭年收入≥5万元（OR=2.428）、有生殖道感染史（OR=2.522）、有医保（OR=4.609）、生殖道感染知识得分越高（OR=4.477）的生殖道感染老年妇女就医可能性越高。结论 生殖道感染在城市社区老年妇女中有较高的发病率,就医率较低,其就医行为主要受到文化程度、经济状况、生殖道感染知识了解程度等因素的影响。     

基于计划行为理论的社区卫生服务中心老年患者频繁就诊行为影响因素的质性研究

背景　在社区卫生服务中心,老年人的频繁就诊行为较为普遍,占用了较多的医疗资源。目的　了解社区卫生服务中心老年患者频繁就诊行为及其影响因素。方法　2018年5月通过目的性抽样和信息饱和原则抽取20例在上海某社区卫生服务中心具有3年持续频繁就诊行为（3年内就诊次数均在前10%）的老年患者进行半结构化访谈,访谈提纲的制定以计划行为理论模型为依据,主要包括认知测量、态度测量、主观规范测量、知觉行为控制测量及对本社区卫生服务中心的意见或建议。根据访谈结果,探析老年人群频繁就诊行为的影响因素。结果　18例患者对自己的频繁就诊行为不自知。9例对频繁就诊有具体定义,55.6%（5/9）患者定义每月就诊≥3次为频繁就诊患者。90.0%（18/20）患者认为频繁就诊行为对自己的生活或健康无不良影响,60.0%（12/20）患者认为频繁就诊能够获得一定的心理安慰,50.0%（10/20）患者提及频繁就诊对于控制及改善病情有一定的帮助。签约政策（70.0%,14/20）、家人支持（45.0%,9/20）、他人行为（15.0%,3/20）均可影响到患者的频繁就诊行为。慢性疾病（100.0%,20/20）、社区医院的便捷性（90.0%,18/20）、医患关系较好（90.0%,18/20）、对自身健康的关心（60.0%,12/20）、急性病症（45.0%,9/20）、自觉健康状况不佳（30.0%,6/20）等均会促使患者的就诊行为,而行动不便（20.0%,4/20）、经济原因（10.0%,2/20）、家中琐事（10.0%,2/20）等原因会限制患者的就诊频次。结论　老年患者的频繁就诊行为受较多因素影响,需要全科医师对患者的疾病、心理、社会等多方面进行关注并解决其真实需求。     

The wet patient: understanding patients with overactive bladder and incontinence

SUMMARY

Overactive bladder (OAB) is a constellation of lower urinary tract symptoms, including urinary frequency and urgency, which can occur with or without urinary incontinence. Incontinence is present in over half of female patients with OAB. This condition affects more than 33 million Americans and imposes considerable economic, social, and psychological burdens. Although continued improvements in the pharmacologic management of lower urinary tract disorders have led to the availability of well-tolerated, effective treatment options, the symptoms of OAB are generally underreported by patients and under- treated by healthcare professionals. Heightened awareness of the multifaceted disease burden imposed by OAB and increased understanding of the characteristics of patients who are likely to be most severely affected, in particular those who suffer from incontinence, may improve the timely identification, diagnosis, and clinical management of the syndrome, enhancing both the health and quality of life of these patients. This review will summarize the characteristic features, prevalence and epidemiology, clinical consequences, and management of OAB, with particular focus on the incontinent patient.     

智慧医疗背景下慢性病患者就医行为优化及展望

智慧医疗正日益应用于慢性病管理实践中,成为优化慢性病患者健康管理行为的重要推手。本文结合Anderson卫生服务利用行为模型,通过总结我国慢性病患者就医行为影响因素相关研究文献发现,影响慢性病患者就医行为的因素主要包括倾向特征、能力资源、健康需求3个方面,能力资源因素是决定慢性病患者就医行为的关键因素,表现为经济能力与知识能力。基于此,提出有必要利用智慧医疗服务模式的信息化优势,通过整合健康知识宣教全媒体资源、强化弱势群体的社会支持、优化医疗服务的群体性联动,进而弥补慢性病患者群体的能力“短板”,优化其就医行为,实现医疗服务资源的有效利用。     

Factors associated with the healthcare-seeking behaviour of older people in Nigeria

This study aimed to examine the factors associated with healthcare-seeking behaviour of Nigeria's older adult population.Data were retrieved from the Nigeria General Household Survey (GHS - year 2013) database, representative at the national level. Bivariate analysis and Poisson regression were performed.Among 3587 adults aged 50 years and over, 850 reported having been sick in the previous four weeks, and 53% of those had consulted a health practitioner in that period. Those consulting were more likely to be women (PR = 1.30, 95% CI [1.1–1.15]), older than 65 (PR = 1.25, 95% CI [1.1–1.5]), and unemployed (PR = 1.24, 95% CI [1.0–1.4]), whereas lack of education (PR = 0.73, 95% CI [0.6 0–0.8]), low household income (PR = 0.72, 95% CI [0.5–0.9]) and living in the South East (PR = 0.59 95% CI [0.4–0.7]) and in the South South zones (PR = 0.60 95% CI [0.4–0.7]) were associated with lower consultation rates.Our results suggest that improving older adults’ healthcare-seeking behaviour in Nigeria will require the lifting of financial barriers and improvements to education. More studies are needed to better understand geographic differences and the low consultation rate by men.     

Underrecognition and un-dertreatment of stress-related psychiatric disorders in physicians: Determinants,challenges, and the impact of the COVID-19 pandemic

Medical practitioners’ duties are highly stressful and performed in a particularly challenging and competitive work environment. Stress and burnout among physicians have emerged as a worldwide public health problem in recent years. A high level of distress and burnout can lead to clinically significant behavioral health problems, such as stress-related psychiatric disorders. Mounting evidence shows that physicians have higher risks of insomnia, anxiety, and depression than the general population, especially during the coronavirus disease 2019 pandemic. However, the behavioral health problems of these vulnerable healthcare professionals are noteworthy for being underrecognized and undertreated. In this mini-review, we summarize the current progress of studies on the prevalence and determinants of distress and stress-related psychiatric disorders among phy-sicians and their healthcare-seeking behaviors. We discuss future research directions and the clinical approach that may maximize self-awareness and promote prompt and adequate treatment for clinically significant behavioral health problems of physicians.     

罕见病患者社会支持、社会保障与就医选择行为的关联研究

本文基于安德森卫生服务利用行为模型,构建罕见病患者就医行为影响因素的理论分析框架,利用2016年中国罕见病患者生存状况调查数据,重点考察社会支持、社会保障因素与罕见病患者就医选择行为的关联.实证分析结果表明,非正式社会支持与患者的卫生服务利用、就医选择行为呈显著正相关,社会支持水平越高,患者的就诊率、选择县级及以上医院...