云南西盟佤族居民患疟求医的现状、费用支付能力和障碍

目的　评价佤族患疟求医的现状、费用支付能力和障碍。　方法　对社区居民进行问卷调查和参与式行动评估 ,对关键人员进行半结构深度访谈。　结果　自己治疗是村民治疗疟疾的第一行动 ,只有自己治疗无效后才到卫生机构求医 ;5 1% (95 %CI :2 6～ 8 9% )问卷调查回答者从不求医 ,8 8% (95 %CI :5 4～ 13 3 % )仅靠自己治疗 ;3 7 4% (95 % :3 0 9～ 44 3 % )付不起疟疾治疗费 ;村民提出的疟疾治疗费为平均RHB 64 15± 7 0 6(范围 :0～ 5 0 0 )元 ,88 5 % (95 %CI :82 4～ 93 0 % )的人认为不能超过RHBl0 0元。　结论　佤族中的患疟求医行为不当 ,障碍为经济 ,地理 ,知识和技术上的不可及性 ;疟疾病例的家庭管理是改善疟疾治疗现状的方法之一。     

"I thought it was only ordinary fever!" cultural knowledge and the micropolitics of therapy seeking for childhood febrile illness in Tanzania

Economic considerations are often cited as important determinants of health-seeking behavior. This paper describes a situation in peri-urban Tanzania where user fees do not constitute the primary reason why mothers delay seeking prompt treatment at a public health facility for their young, febrile children. Mothers commonly believe that they are dealing with an ordinary fever and not malaria or any other serious illness complicated by fever. Hence, they engage in extended home-based treatment. Drawing upon an ethnographic study, this paper illustrates how cultural knowledge about disease symptomatology, cultural meanings associated with febrile illness, gender relations, and patterns of communication between health care providers and mothers significantly influence outcomes for childhood febrile illnesses. It is argued that an overemphasis on the correlation between user fees and treatment delays with regard to childhood illnesses tends to divert attention from other significant cultural factors and existing structural constraints that influence the dynamics of health care seeking and health outcomes. At a time when calls to implement artemisinine-based combination therapy as one of the front-line strategies in Tanzania are increasingly frequent, there is a need to pay closer attention to the contextual factors and socio-cultural dynamics that influence patterns of treatment-seeking for childhood malaria.     

Women's experiences and behaviour at onset of symptoms of ST segment elevation acute myocardial infarction

Background

Minimizing time from onset of symptoms to treatment (treatment delay) is crucial for patients with ST segment elevation acute myocardial infarction (STEMI), and one of the great challenges is to reduce the delay relating to the prehospital behaviour of the patient (patient delay). Studies indicate that women delay longer than men and insights into this area could lead to improved health education programmes aimed at reducing patient delay in women with STEMI.

Method

Open interviews with 14 women with STEMI were held during their hospital stay from June to September 2009. The interviews were aimed at exploring determinants of treatment delay, and were carried out and analysed within a phenomenological framework.

Findings

Three themes emerged important for the delay in seeking medical assistance: (1) Knowledge and ideas of AMI symptoms and risks. (2) Ambivalence whether to call for medical assistance or to cope with the situation. (3) Actions and strategies taken after onset of symptoms.

Conclusions

Three factors determined whether women showed appropriate behaviour for reduced patient delay after onset of symptoms: (1) identifying the symptoms as being of cardiac origin, (2) having a prepared action plan in case of an emergency situation, and (3) living with someone or contacting other persons.     

云南省疟区农村居民发热病人求诊行为及影响因素分析

目的了解云南省疟疾流行区农村居民发热病人的求诊行为及相关的影响因素,为制定改善疟疾病人早期诊断和及时治疗的策略和措施提供依据。方法在云南省疟区47个县,采用多阶段抽样方法进行横断面调查。结果在被调查家庭中,发热病人就诊率为76.8%(2311/3007),发热后24h内就诊的比例为43.2%,发热病人到村卫生室、乡镇卫生院、个体诊所、县医院和自购药品的就诊比例分别为53.9%、24.9%、8.7%、6.4%和5.2%。Logistic回归分析显示,家庭经济状况、性别、民族、受教育程度、疟疾知识综合得分等因素影响疟区发热病人的就诊。结论在开展疟疾防治活动中,应通过对贫困家庭、男性、少数民族、低教育程度者等重点人群开展针对性强的干预措施促进发热病人的求医,以便及时发现和规范治疗疟疾病例。     

青岛市婚检青年生殖健康相关求医行为的研究

目的:了解未婚青年生殖健康相关自觉不适症状和求医行为的情况。方法:2011年8月～12月采用自填式问卷对青岛市黄岛区和即墨市3 360名婚前体检青年进行调查。结果:共回收合格问卷3 164份。生殖健康相关自觉不适症状报告率为28.2%,到医院就诊者占53.4%。多因素Logistic回归分析显示,女性(OR=1.768)、年龄较大(OR=1.728)、平均月收入较高(OR=2.111)、职业为公司职员(OR=1.915)、出现的生殖健康相关症状越多(OR=2.633),越愿意去医院就诊;而有多个性伴侣(OR=0.427),父母的婚姻状态属于离异、再婚、丧偶的情况(OR=0.461)则会阻碍未婚青年采取正确的求医行为。结论:未婚青年人群生殖健康相关求医行为的意识较淡漠,并受到多种社会因素的影响。     

Disseminating treatment for anxiety disorders: Step 1: Recognizing the problem as a precursor to seeking help

Untreated mental illness is a substantial public health issue in the United States, with only approximately 1/3 of the estimated 46 million adults in the US with mental illness receiving treatment. Many of the individuals with mental illness suffer from excessive anxiety, as over 25% of Americans experience an anxiety disorder during their lifetime and most of these individuals remain untreated. Building from the premise that recognizing one's symptoms precedes requests for help, the current paper presents data from 577 adults (50% Caucasian, 50% African American) in the US regarding their ability to recognize anxiety disorders. Findings from a national survey showed that when presented with detailed vignettes portraying symptoms and their impact, 50% of respondents correctly recognized depression, whereas less than 20% correctly recognized the anxiety disorders. Recognition that the symptoms were a cause for concern was much more common, with 75% or more of the sample noting concern. Responses were surprisingly similar across the two races, and few consistent moderators were found. In conclusion, increasing recognition of anxiety disorders may be a useful first step toward increasing service utilization.     

The multinational Men's Attitudes to Life Events and Sexuality (MALES) study: I. Prevalence oSf erectile dysfunction and related health concerns in the general population

Objective: The aims of the Men's Attitudes to Life Events and Sexuality (MALES) study were to identify prevalence of erectile dysfunction (ED) and related health issues in the general male population in Europe, North and South America, and to examine the attitudes and behavior of men in relation to these health issues.

Research design and methods: Phase I of the MALES study involved 27839 men aged 20-75years who were interviewed in eight countries (United States, United Kingdom, Germany, France, Italy, Spain, Mexico, and Brazil) using a standardized questionnaire. Phase II of the MALES study involved 2912 men who were recruited from the sub-sample of Phase I MALES participants who reported ED together with additional men with ED recruited from other sources.

Main outcome measure: Prevalence of ED and associated attitudes.

Results:The overall prevalence of ED in the MALES sample was 16%. ED prevalence varied markedly by country, however, from a high of 22%

of men in the US reporting ED to a low of 10% in Spain. The prevalence of self-reported ED increased with increasing age. Men with co-morbid medical conditions and risk factors, including cardiovascular disease, hypertension, dyslipidemia, and depression all reported higher prevalence of ED. Men with ED also reported increased prevalence rates of these co-morbid conditions. MALES Phase II data indicated that among men who reported ED, 58% had actively sought medical attention for their condition; however, only 16% of men with ED were currently being treated with oral PDE-5 therapy.

Conclusions: The MALES study confirms the high prevalence rates of ED and its association with co-morbid medical conditions, such as diabetes and depression, reported in other large-scale, epidemiological studies. Despite the advent of oral phosphodiesterase inhibitors, only 58% of ED sufferers consult a physician about their problem, and only 16% of men with self-reported ED maintain their use of oral therapy.     

College students rarely seek help despite serious substance use problems

The prevalence of substance use disorders (SUD) and aspects of the help-seeking process among a high-risk sample of 946 students at one large public university were assessed in personal interviews during the first 3 years of college. After statistically adjusting for purposive sampling, an estimated 46.8%_wt of all third-year students met Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria for SUD involving alcohol and/or marijuana at least once. Of 548 SUD cases, 3.6% perceived a need for help with substance use problems; 16.4% were encouraged by someone else to seek help. Help-seeking was rare among SUD cases (8.8%) but significantly elevated among individuals who perceived a need (90.0%) or experienced social pressures from parents (32.5%), friends (34.2%), or another person (58.3%). Resources accessed for help included educational programs (37.8%), health professionals (27.0%), and 12-step programs (18.9%). College students have high rates of substance use problems but rarely recognize a need for treatment or seek help. Results highlight the opportunity for early intervention with college students with SUD.     

Looking within the household: gender roles and responses to malaria in Ghana

Studies of factors affecting treatment-seeking behaviour for malaria have rarely considered the influence of gender roles and relations within the household. This study supported district-level government workers in the Volta Region of Ghana in conducting a situational analysis of gender inequities in relation to the malaria burden and access to healthcare services for malaria in one community in their district. Qualitative and participatory methods, such as focus group discussions, in-depth individual interviews and ranking exercises, were used. The study found that women who lacked either short- or long-term economic support from male relatives, or disagreed with their husbands or family elders about appropriate treatment-seeking, faced difficulties in accessing health care for children with malaria. This illustrates the significant influence of women's access to resources and decision-making power on treatment-seeking behaviour for children with febrile illnesses, and the importance of approaching malaria management in the community or household from a gender perspective.