Gender-based violence among healthcare students: Prevalence, description and associated factors.

OBJECTIVES: The aims of the current study were 1) to provide the prevalence of five types of gender-based violence (GBV) among male and female healthcare students; 2) to describe perpetrators' status, where the GBV occurred, and psychological and behavioural impacts of the GBV; and 3) to identify factors associated with GBV. DESIGN: A cross-sectional study was conducted among voluntary healthcare students in France. SETTING: Health Campus at Rouen and nursing schools in Normandy, France. PARTICIPANTS: Volunteer healthcare students of 18 years and over. DATA COLLECTED: Five types of GBV were recorded: GBV1: damage to a person's image due to a sexual connotation on social networks, GBV2: sexist remarks and behaviour, GBV3: comments with sexual connotations, GBV4: sexual assaults and GBV5: rape or attempted rape. Perpetrators' status, where the GBV occurred, psychological and behavioural impacts of GBV were also recorded. RESULTS: One thousand one hundred and fifty-two students were included. The mean age was 20.8 years (SD = 2.26), 82.6% of students were women (0.4% non-binary). Since the beginning of their healthcare study, 41.2% of students CI 95% [39.7-42.6] were victim of at least one type of GBV: 15.8% among men CI 95% [13.2-18.4] and 46.0% CI 95% [44.4-47.6] among women (p < 0.001). The perpetrators were student peers, regardless of the type of GBV, healthcare workers for the GB2 and GBV3, and patients except for GBV5. The main consequences of GBV on health was psychological and eating related. After multivariate analysis, being a woman, LGBTQ+ (Lesbian, Gay, Bi, Trans, Queer and other), a nurse, a physiotherapist student, having a job, living with roommates and year of study were risk factors for GBV. CONCLUSION: GBV is so common at healthcare universities and could have such severe consequences for students that more work is needed to generate a culture change and ensure safe learning environments.

Phone contacts and treatment discontinuation predict survival cancer patients in a subsidized drug access program.

Aim: Survival of patients with Hodgkin's lymphoma is lower in in low- and middle-income countries, but factors leading to these outcomes are poorly understood. The objective of this study was to identify predictive factors associated with overall survival among cancer patients undergoing therapy in seven low- and middle-income countries. Materials & methods: A multicenter cohort was conducted in Egypt, Malaysia, Mexico, Peru, Philippines, Thailand and Ukraine. Results. A total of 460 patients were included. Phone-based support during patient follow-up and number of patients seen by the physician provided a positive impact, while the number of adverse events remains a predictor of death and physician decision to stop treatment. Conclusion: Furthers research on the potential benefit of phone-based programs to support patients with chronic diseases treatments should be explored in less developed countries.

Video abstracts are associated with an increase in research reports citations, views and social attention: a cross-sectional study.

Video abstracts have been proposed as a tool to disseminate research through to social networks. However, its association with metrics of research dissemination has not been adequately investigated, particularly in the field of medical research. The aim of this study was to assess the association between video abstracts and citations, views and Altmetric Attention Score (AAS) of research papers. A cross-sectional study of research reports published in the New England Journal of Medicine (NEJM) over a 3-year period was conducted. An inverse binomial regression was used to assess factors associated with citations, views and AAS. The model included the presence of video abstracts as well as other independent covariables as potential confounding factors. 500 research reports were included in the analysis and 152 benefited from a video abstract. The median time from publication was 3.0 (2.2 to 3.6) years and 72% were RCTs. Research reports published with a video abstract were associated with an increase in citations (IRR 1.15), although this estimate came with uncertainty ranging from virtually no effect to a worthwhile effect (95% CI 0.98 to 1.35). There were also associated with a worthwhile increase in views (IRR 1.35, 95% CI 1.18 to 1.54) as well as with an increase in AAS (IRR 1.25, 95% CI 1.08 to 1.44). To conclude, video abstracts are associated with a worthwhile increase in the number of views of research reports. They are also associated with an increase in citations and social attention, although the association may be small. Supplementary Information: The online version contains supplementary material available at 10.1007/s11192-023-04675-9.

Effect of the COVID-19 Pandemic on Healthy Components of Diet and Factors Associated with Unfavorable Changes among University Students in France.

INTRODUCTION: The COVID-19 pandemic and the lockdowns have affected many aspects of university students' daily lives, including their dietary habits. This study aimed to evaluate the change of diet quality of university students before and during the COVID-19 period, and the factors associated with unfavorable changes in diet quality. METHODS: An online cross-sectional study was performed in May 2021 among Rouen (France) university students. Socio-demographic characteristics, body mass index, depression, academic stress, risk of eating disorders and food security were collected. The French "Programme National Nutrition Santé-Guidelines Score 2" (PNNS-GS2) was used to access diet quality. RESULTS: A total of 3508 students were included, 74.4% were female, the mean age was 20.7 (SD = 2.3), and 7.0% were in a situation of food insecurity. The PNNS-GS2 score decreased between the pre- and the COVID-19 pandemic period for 33.1% of university students. The associated factors with the decrease in the PNNS-GS2 score were food insecurity, financial insecurity, not living with parents, depression, academic stress, eating disorders, being in the two first years of study and having been infected by COVID-19. CONCLUSIONS: Diets with healthy components decreased for one-third of university students since the COVID-19 pandemic, and this was shown to be associated with food insecurity, poor mental health and eating disorder. This study provides important information to help public health authorities and universities give better support to student health feeding programs during pandemics and lockdowns.

Perception and Coverage of Conventional Vaccination among University Students from Rouen (Normandy), France in 2021.

The aim of this study was to assess vaccination perception and the prevalence of the overall vaccination coverage (VC) and associated factors among university students. An online study was conducted among students of a university in Rouen (Normandy), France, in January 2021, with questions about the VC and perception of the vaccines. The convenience sample included 3089 students (response rate of 10.3%), with a mean age of 20.3 (SD = 1.9). The overall VC was 27.8% (39.2% for the healthcare students (HCS) and 21.3% for the non-HCS; p < 0.0001). Confidence (efficacy and security) was lower than the conviction of usefulness. The characteristics associated with VC were having the intention to be vaccinated against COVID-19, high perceptions of usefulness for their own health, having confidence in the vaccines' efficacy and security, and a high estimated level of knowledge about vaccination. Education about the general interest and mechanism of action of vaccines could improve the perception of vaccines. Then, it is relevant to improve vaccination literacy and confidence in university students, who, as future adults and parents, will vaccinate themselves and their children; as well as healthcare students who are future healthcare workers and, therefore, will vaccinate and counsel their patients.

Depressive symptoms in higher education students during the COVID-19 pandemic: the role of containment measures.

BACKGROUND: Students are a vulnerable group for the indirect impact of the COVID-19 pandemic, particularly their mental health. This paper examined the cross-national variation in students' depressive symptoms and whether this can be related to the various protective measures implemented in response to the initial stage of the COVID-19 outbreak. METHODS: Student data stem from the COVID-19 International Student Well-being Study, covering 26 countries during the first wave of the COVID-19 pandemic. Country-level data on government responses to the COVID-19 pandemic were retrieved from the Oxford COVID-19 Tracker. Multilevel analyses were performed to estimate the impact of the containment and economic support measures on students' depressive symptoms (n = 78 312). RESULTS: School and workplace closures, and stay-at-home restrictions were positively related to students' depressive symptoms during the COVID-19 pandemic, while none of the economic support measures significantly related to depressive symptoms. Countries' scores on the index of these containment measures explained 1.5% of the cross-national variation in students' depressive symptoms (5.3%). This containment index's effect was stable, even when controlling for the economic support index, students' characteristics, and countries' epidemiological context and economic conditions. CONCLUSIONS: Our findings raise concerns about the potential adverse effects of existing containment measures (especially the closure of schools and workplaces and stay-at-home restrictions) on students' mental health.

Change in University Student Health Behaviours after the Onset of the COVID-19 Pandemic.

INTRODUCTION: The COVID-19 pandemic has caused many disruptions in the lives of the population. In particular, the health behaviours of university students were impacted. Thus, the aim of this study was to evaluate the evolution of these behaviours from before the COVID-19 period to May 2021, during which lockdowns or curfews were in effect. METHODS: Two retrospective online cross-sectional studies were conducted among university students in Normandy in May 2020 and May 2021. Socio-demographics and academic characteristics were collected. Tobacco smoking, binge drinking, cannabis use, and moderate and vigorous physical activity were collected for the 4 weeks before the COVID-19 lockdown in May 2020 and in May 2021. RESULTS: Overall, 6991 university students were included in the study (3483 in 2020 and 3508 in 2021) with a mean age of 20.8 (standard deviation = 2.5) and 73.4% of women. After logistic regression, binge drinking (occasional and regular), cannabis use (occasional), moderate physical activity (regular), and vigorous physical activity (occasional) decreased in 2020 and 2021 compared to the pre-COVID-19 period. Tobacco smoking (occasional) and vigorous physical activity (regular) decreased only in 2020. Regular tobacco and cannabis use did not change significantly in 2020 and 2021 compared to the pre-COVID-19 period. DISCUSSION: Student health behaviours changed in May 2020 and May 2021 due to the implementation of measures restricting mobility and social interaction. Even if some risky consumption decreased in 2020 after the first lockdown, there was no rebound phenomenon in 2021: consumption either remained lower or similar to the pre-COVID-19 period. These behaviours need to be monitored in the future to assess the long-term effects of these restrictions on student health behaviours.

Factors impacting self-management ability in patients with chronic diseases in the United Arab Emirates, 2019.

Aim: Poor adherence to chronic disease therapy is a critical global problem that negatively effects the long-term therapy for chronic diseases, resulting in negative population health and economic effects. The WHO multidimensional model proposed a systems-based approach for improving adherence to chronic disease therapy. Patients & methods: In the current study, the WHO five-dimension framework was used to evaluate factors among, chronic-disease patients in the United Arab Emirates. Results: We show that patient's understanding of disease, involvement in treatment decision, age more than 40 years, time spent with physician and fear of how patients were perceived by others were the most predictive factors associated with a high ability to self-manage a chronic disease. Conclusion: Sociocultural factors have an indirect impact on disease self-management.

COVID-19 Pandemic and Eating Disorders among University Students.

An online cross-sectional study was conducted in May 2021 to identify factors, such as changes in food choices, lifestyle, risk and protective behavior, mental health, and social demographics, on eating disorders (ED) among students of a French university. Students were invited to fill out an online questionnaire. ED were identified using the French version of the five-item "Sick, Control, One stone, Fat, Food" (SCOFF) questionnaire. The Expali™-validated algorithmic tool, combining SCOFF and body mass index, was used to screen EDs into four diagnostic categories: bulimic ED, hyperphagic ED, restrictive ED and other ED. A total of 3508 students filled the online questionnaire, 67.3% female, mean age 20.7 years (SD = 2.3). The prevalence of ED was 51.6% in women and 31.9% in men (p < 0.0001). Lower food security scores were associated with a higher risk for all ED categories. Depression and academic stress due to COVID-19 were associated with ED regardless of category. Regarding health behaviors, a high adherence to the National nutrition recommendation was a protective factor for the risk of bulimic ED, hyperphagic ED and restrictive ED. A lower frequency of moderate and vigorous physical activity was associated with a higher risk of hyperphagic ED. Our study has shown a high screening of ED among the students of a French university fourteen months after the beginning of the COVID-19 pandemic. By disrupting academic learning, jobs and social life, the COVID-19 pandemic could have exacerbated existing ED or contributed to the onset of new ED.

Sharp Increase in Eating Disorders among University Students since the COVID-19 Pandemic.

The COVID-19 pandemic has caused stress as well as modified physical activity and eating habits among university students. The objectives were to identify the changes in body mass index (BMI) and eating disorders among university students between 2009 and 2021. Between 2009 and 2021, five repeated cross-sectional studies were conducted among university students who filled in an anonymous online self-questionnaire. Age, gender, and BMI were recorded, and the SCOFF questionnaire was used for ED screening which, in combination with BMI, allows to identify the four broad categories of ED with the Expali algorithm. With the five studies, 8981 university students were included in total. Obesity steadily increased between 2009 and 2021, for both men and women. The prevalence of ED was stable between 2009 and 2018 and significantly increased from 31.8% in 2018 to 51.8% in 2021 for women (p trend < 0.0001), and from 13.0% in 2009 to 31.3% in 2021 for men (p trend < 0.0001). All types of ED increased significantly between 2009 and 2021, except for restrictive ED among men. These results indicate for the first time a significant increase in ED prevalence among students since the COVID-19 pandemic. Initiatives to reinforce early screening of ED to implement targeted interventions in the student population are urgently needed.

Ethical Issues Linked to the Development of Telerehabilitation: a Qualitative Study.

While telerehabilitation (TR) makes it possible to respond to many significant health system problems, TR still gives rise to debates, particularly concerning ethical issues. This qualitative study collected the opinions of stakeholders with varied profiles. A guided interview focused on discerning strategies that might foster the ethical deployment of TR. Such strategies were found to be linked to the decision-making of the public authorities, the role of scientific and professional bodies, the training of health professionals, and the management of patient information. Ethical issues relating to the development of TR included universal accessibility, patients' free choice, respect of privacy, and professional confidentiality. The ethical development of TR can be fostered by the provision of information to stakeholders as well as reminding practitioners of the ethical framework that regulates medical practice.

COVID-19 Vaccine Acceptance, Hesitancy, and Resistancy among University Students in France.

The objectives were to explore, among university students, the level of COVID-19 vaccine acceptance, hesitancy, and resistancy and to determine the motivations and barriers, and the reasons that may change student vaccination decision making. An online observational cross-sectional study was conducted among students of a French university in January 2021 with questions about the intention to be vaccinated against COVID-19, the motivations and the barriers. The convenience sample included 3089 students, with a mean of age of 20.3 (SD = 1.9). To the question on the intention to vaccinate against the COVID-19, 58.0% of students reported that they would choose to have a vaccination, 17.0% reported that they would not and 25.0% were not sure. The main motivations for vaccine acceptance were "I don't want to transmit COVID-19 to others", the main barriers for vaccine resistance or hesitancy were "I prefer to wait until I have more experience with these new vaccines". Age, female gender, being in first three years of study, studied sciences courses and neither sciences nor healthcare courses of study were significantly associated with a higher risk of vaccine hesitancy or resistancy. Self-estimated knowledge of conventional vaccines and COVID-19 vaccines, and confidence in efficiency and safety of conventional vaccination were associated with a lower risk of vaccine hesitancy or resistancy. It is relevant to disseminate evidence-based interventions to promote COVID-19 vaccine acceptability for college students, especially for the students in neither sciences nor healthcare courses of study, as college students will soon be eligible to receive a COVID-19 vaccine.

Maghreb doctors need capacity building in epidemic investigation and control.

OBJECTIVE: Describe the training needs of young Maghreb doctors in epidemic management. METHODS: This is a study to quantify the need for medical training on "epidemic management". The study population was formed by residents and assistant professors of the French-speaking faculties of medicine in the Greater Maghreb, hospital-university professors, who were invited to respond to an online questionnaire. The "need" for learning a skill was defined by the perception of its importance, of its low coverage by the curricula and its poor mastery. A grid with 20 items, coded according to the Likert scale of 1 to 5 points, was specially developed for the measurement of need, retained beyond the thresholds of 45/90 points for the two dimensions "confirmation" and "investigation", 60/120 points for the "control" dimension, and 150/300 for the total sum. RESULTS: A total of 121 young Maghreb doctors answered the questionnaire to assess the needs for learning epidemic management skills. The median overall scores for the chapters "importance", "coverage" and "performance" were 76, 40 and 48 respectively out of 100 points. The median scores for training "needs" were 54/90, 48/90 and 67/120 points, respectively, for the dimensions "confirmation", "investment" and "control", giving a global median score of 168 / 300. CONCLUSION: Capacity building in epidemic management is a need felt by young Maghreb doctors, partially covered by current medical school programs, and consequently altering their professional performance.

The Impact of COVID-19 Lockdown on Health Behaviors among Students of a French University.

This study aimed to determine the changes in health behaviors among students of a French university during the COVID-19 lockdown. An online retrospective survey was distributed to Rouen-Normandy University students at the end of the COVID-19 lockdown (13th March-11th May 2020). Voluntary university students were included. Data collected were on socio-demographics, academic environment, COVID19 concerns, tobacco smoking, binge drinking, cannabis use, and physical activity in the periods before and during COVID-19 lockdown. The survey was completed by 3671 university students (mean age 20.9 ± 2.47 years, 72.9% female). Significantly favorable changes between the periods before and during COVID-19 were reported for tobacco smoking (18.5% vs. 14.8%), binge drinking (35.9% vs. 9.3%) and cannabis use (5.6% vs. 3.2%) and unfavorable changes for moderate (79.4% vs. 67.9%) and vigorous physical activity (62.5% vs. 59.1%). After logistic regression, factors associated with unfavorable changes in tobacco smoking and with favorable changes in vigorous physical activity were the worry of not validating the academic year and stress related to changes in the mode of teaching, respectively. For each health behavior, unfavorable changes were associated with higher depression levels, and male gender. Then as a decrease, mainly in binge drinking was observed during the COVID-19 lockdown, care must be taken to prevent university students from resuming binge drinking after the end of the lockdown. Health-promotion strategies directed at adopting or maintaining positive mental health and promoting physical activity should be developed for university students to better manage future lockdown periods.

Neuroenhancement in French and Romanian University Students, Motivations and Associated Factors.

This cross-sectional study aimed to determine the use of neuroenhancers, the motivations and factors associated with their use in French and Romanian university students. Students from two universities in France (Rouen and Opal Coast University) and one in Romania (Cluj-Napoca) were asked to complete a self-administered anonymous questionnaire, either online or on paper, about the use of three different categories of substance: Prescription drugs (methylphenidate, modafinil, and beta-blockers), drugs of abuse (alcohol, cannabis, cocaine, and amphetamines), and soft enhancers (coffee, vitamins, caffeine tablets, and energy drinks). In total, 1110 students were included: The users were 2.2% for prescription drugs, 4.3% for drugs of abuse, and 55.0% for soft enhancers. Students used neuroenhancement to stay awake for study (69.3%), to improve concentration (55.5%), to decrease stress (40.9%), and to improve memory (39.6%). Neuroenhancement was considered to meet expectations by 74.4% of users. The factors associated with the use of drugs of abuse were frequent binge drinking (Adjusted Odds Ratio-AOR: 6.49 [95% CI: 2.53-16.6]), smoking (AOR: 5.50 [95% CI: 2.98-10.14]), having a student job (AOR: 2.42 [95% CI 1.13-5.17]), and being male (AOR: 2.23 [95% CI:1.21-4.11]). No significant associations with eating disorders were detected for any of the three categories of substances. University students reported neuroenhancement with prescription drugs, drugs of abuse, and mainly soft enhancers. These substances were used mainly to increase the waking hours. Educational programs in universities seem to be required in order to increase student awareness of the problems caused by neuroenhancements, and to decrease the associated risks by changing students' attitudes and beliefs.

Eating Disorders among College Students in France: Characteristics, Help-and Care-Seeking.

The aim of this paper was to identify the characteristics of broader categories of eating disorders (ED) and help- and care-seeking among college students. An online cross-sectional study was conducted among students of the University of Rouen-Normandy, France. The Expali-validated algorithmic tool, combining SCOFF test (Sick, Control, One stone, Fat, Food) and body mass index, was used to screen eating disorders into three diagnostic categories: restrictive eating disorders, bulimic eating disorders, and hyperphagic eating disorders. A total of 1493 college students were included; mean age was 20.1 years (SD = 1.9). The prevalence of likely cases of eating disorder was 24.8% (95% CI, 22.6-27.0). Percentage distributions of bulimic eating disorders, hyperphagic eating disorders, and restrictive eating disorders were 13.3%, 8.6%, and 2.9%, respectively. The two main resources for help-seeking in emotional stress situations were friends and family, whatever the ED. Students with eating disorders consulted their general practitioner more often for stress or anxiety than students without eating disorders: hyperphagic eating disorders (44.9%), restrictive eating disorders (35.1%), bulimic eating disorders (30.2%), and no eating disorder (20.4%) (p < 0.0001). The prevalence of healthcare renunciation was 21.9%, with a higher risk among students with bulimic eating disorders (AOR CI 95% 1.91 (1.34-2.72). The findings show one quarter of students screened positive for an eating disorder. Stress management was not necessarily different between students with eating disorders and students without eating disorders, but the former had a greater risk of renouncing treatment, especially related to a fear of seeing a general practitioner.

Risk of eating disorders in university students: an international study in Hungary, Poland and Ukraine.

OBJECTIVE: In this international study, the prevalence of Eating disorders (EDs) was determined among university students and identified associated demographic and behavioral factors predicting disorders using data from three European countries. METHODS: The survey was conducted in Hungary, Poland, and Ukraine in 2018. Registered full-time students completed an online anonymous questionnaire. Students provided data about socioeconomic characteristics, body mass index (BMI), EDs, physical fitness and sport practice, psychological distress (stress, anxiety, depression), life orientation, alcohol, tobacco, and cannabis use. Data were analyzed using SPSS 24.0 software. RESULTS: From the 1965 returned questionnaires 1950 were analyzed, because of the missing data (67.3% female, mean age of the total participant's 21.40 ± 3.83 years old). EDs were observed in 26.3% of students. In logistic regression, EDs were predicted by female sex, higher BMI, single marital status, elevated psychological distress and limited access to health care. CONCLUSION: EDs are relatively common in university students especially in females. Students with higher distress and BMI, limited access to health care and living without partner are at risk for EDs. This result highlights the need for a public health approach. Universities are the last chance where students can be screened in an organized setting and offer interventions early when treatment is likely to be most effective.

Ability to pay for medication: a clustering analysis of 1404 patients with the Patient Financial Eligibility Tool.

Aim: The study was conducted to understand how key determinants of the Patient Financial Eligibility Tool (PFET), a previously validated tool for assessing patients' ability to contribute to their medication costs, vary across countries. Materials & methods: A clustering analysis was conducted on economic data from 1404 patients from Thailand (n = 947), the UAE (n = 347) and Mexico (n = 110). Results: The analysis identified seven patient clusters, including globally wealthy or poor patients (14%/48%) and those with only selectively increased PFET economic indicators (38%), and revealed country-specific differences in the correlation between PFET metrics and patients' overall economic status. Conclusion: The PFET is a versatile tool that can be adapted to each country's economic context to assess patients' ability to contribute to their medication costs.

Does binge drinking between the age of 18 and 25 years predict alcohol dependence in adulthood? A retrospective case-control study in France.

OBJECTIVE: A retrospective case-control study was conducted to evaluate whether frequent binge drinking between the age of 18 and 25 years was a risk factor for alcohol dependence in adulthood. SETTING: The Department of Addictive Medicine and the Clinical Investigation Center of a university hospital in France. PARTICIPANTS: Cases were alcohol-dependent patients between 25 and 45 years and diagnosed by a psychiatrist. Consecutive patients referred to the Department of Addictive Medicine of a university hospital between 1 January 2017 and 31 December 2017 for alcohol dependence were included in the study. Controls were non-alcohol-dependent adults, defined according to an Alcohol Use Disorders Identification Test score of less than 8, and were matched on age and sex with cases. Data on sociodemographics, behaviour and alcohol consumption were retrospectively collected for three life periods: before the age of 18 years; between the age of 18 and 25 years; and between the age of 25 and 45 years. Frequency of binge drinking between 18 and 25 years was categorised as frequent if more than twice a month, occasional if once a month and never if no binge drinking. RESULTS: 166 adults between 25 and 45 years were included: 83 were alcohol-dependent and 83 were non-alcohol-dependent. The mean age was 34.6 years (SD: 5.1). Frequent binge drinking between 18 and 25 years occurred in 75.9% of cases and 41.0% of controls (p<0.0001). After multivariate analysis, frequent binge drinking between 18 and 25 years was a risk factor for alcohol dependence between 25 and 45 years: adjusted OR=2.83, 95% CI 1.10 to 7.25. CONCLUSIONS: Frequent binge drinking between 18 and 25 years appears to be a risk factor for alcohol dependence in adulthood. Prevention measures for binge drinking during preadulthood, especially frequent binge drinking, should be implemented to prevent acute consequences as injury and death and long-term consequences as alcohol dependence. TRIAL REGISTRATION NUMBER: NCT03204214; Results.

Willingness to pay for medical treatments in chronic diseases: a multicountry survey of patients and physicians.

AIM: The objective was to investigate factors influencing patients' willingness to pay (WTP) and physician's views on the cost of therapy for two contrasted chronic diseases, chronic heart failure and psoriasis. METHODS: A cross-sectional survey was conducted in ten developing countries, using a stated WTP contingent valuation method. Multivariate analyses were performed by linear regression. RESULTS: Independent factors influencing patient WTP were income (+0.04 $PPP [purchasing power parity] in WTP per $PPP in monthly income; p < 0.001) and purchase of branded treatment for chronic heart failure therapy, and income, out-of-pocket treatment costs but also education level higher than secondary school (+115 $PPP in WTP comparatively to patients with none/primary school level; p = 0.008) for psoriasis therapy, suggesting the influence of sociopsychological factors in this disease. CONCLUSION: Disease-specific factors may affect WTP for treatment that should be accounted for to support effective public health programs in developing countries.