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1.
Artigo em Inglês | MEDLINE | ID: mdl-32867315

RESUMO

Background: Cervical cancer is one of the most common cancers in women and about 90% of cervical cancer can be reduced by regular screening. The Pap smear has been well in place as a primary cervical screening method since 1950s; however, coverage is still not optimal. This study explored the feasibility of HPV self-sampling in two under-screened population groups in Hong Kong (HK): never screened and not regularly screened females, to estimate the uptake rate and preference rate in the future. Materials and Methods: This was a cross-sectional study to explore the acceptability and feasibility of HPV self-sampling in two age groups: aged 25-35 and aged ≥45, which were reported as the highest proportion of the under-screened population in HK between 2017 and 2018. The study invited eligible women from an HPV study cohort to perform HPV self-sampling at home by themselves. The number of specimens returned from participants was recorded and used to determine the feasibility of HPV self-sampling in the community. The participants were asked to fill in the questionnaires before and after HPV self-sampling to indicate their attitudes, acceptability, and future preference for HPV self-sampling as an acceptable alternative primary cervical cancer screening method. Results: A total of 177 subjects participated in the present study and have achieved a good overall uptake rate of 73% (129/177) who returned the self-collected cervicovaginal sample for HPV testing. Among the under-screened population, there was a higher response rate in aged ≥45 than those aged 25-35. The findings also revealed that women who were under-screened, including those who have never been screened, were more likely to prefer HPV self-sampling than those who had regular screening. This study found that the acceptability of HPV self-sampling was fairly positive among the respondents. The findings also indicated that HPV self-sampling was not only beneficial to enhance their health awareness but also to promote the cervical cancer screening uptake rate, especially among the under-screened or never screened populations. Conclusions: HPV self-sampling would be a solution to overcome the perceived barriers in clinician-based screening. The findings also indicated that it could be feasible to use as an alternative primary cervical cancer screening.


Assuntos
Programas de Rastreamento/métodos , Papillomaviridae/isolamento & purificação , Infecções por Papillomavirus/diagnóstico , Infecções por Papillomavirus/prevenção & controle , Aceitação pelo Paciente de Cuidados de Saúde , Grupos Populacionais/estatística & dados numéricos , Neoplasias do Colo do Útero/diagnóstico , Neoplasias do Colo do Útero/prevenção & controle , Adulto , Estudos Transversais , Detecção Precoce de Câncer , Estudos de Viabilidade , Feminino , Hong Kong/epidemiologia , Humanos , Área Carente de Assistência Médica , Pessoa de Meia-Idade , Infecções por Papillomavirus/etnologia , Aceitação pelo Paciente de Cuidados de Saúde/etnologia , Preferência do Paciente , Autocuidado , Manejo de Espécimes , Neoplasias do Colo do Útero/etnologia , Esfregaço Vaginal , Saúde da Mulher
2.
Stroke ; 51(10): 3107-3111, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32755454

RESUMO

BACKGROUND AND PURPOSE: The impact of the coronavirus disease 2019 (COVID-19) pandemic on stroke systems has not been systematically evaluated. Our study aims to investigate trends in telestroke consults during the pandemic. METHODS: We did retrospective chart review of consecutive patients seen through a telestroke network in South Carolina from March 2019 to April 2020. We dichotomized patients to preCOVID-19 pandemic (March 2019 to February 2020) and during COVID-19 pandemic (March to April 2020). RESULTS: A total of 5852 patients were evaluated during the study period, 613 (10.5%) were seen during the pandemic. The median number of weekly consults dropped from 112 to 77 during the pandemic, P=0.002. There was no difference in baseline features; however, Black patients were less likely to present with strokes during the pandemic (13.9% versus 29%, P≤0.002). CONCLUSIONS: The COVID-19 pandemic has led to a significant drop in telestroke volume. The impact seems to disproportionately affect Black patients.


Assuntos
Afro-Americanos , Infecções por Coronavirus , Pandemias , Aceitação pelo Paciente de Cuidados de Saúde/etnologia , Pneumonia Viral , Encaminhamento e Consulta/estatística & dados numéricos , Acidente Vascular Cerebral/etnologia , Telemedicina , Idoso , Betacoronavirus , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , South Carolina/epidemiologia , Acidente Vascular Cerebral/epidemiologia
3.
PLoS One ; 15(8): e0237081, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32764783

RESUMO

BACKGROUND: Approximately 18,000 Syrian refugees have resettled to the United States. Half of these refugees are children, whose age and refugee status jeopardize their abilities to attain quality healthcare. Information on Syrian refugees' health in the U.S. is limited. This qualitative study sought to explore Syrian refugee parents' beliefs, perspectives, and practices regarding their children's health through in-depth interviews. METHODS: Eighteen Syrian refugee parents residing in Cincinnati, Ohio were interviewed in Arabic by bilingual researchers using semi-structured in-depth interviews. The interviews were recorded, transcribed, and translated. Three members of the research team independently coded each interview using an inductive thematic analysis approach. RESULTS: Analysis identified four salient themes: stressors preclude health seeking behaviors, parents perceive health barriers, parents are dissatisfied with the healthcare system, and parents use resilience behaviors to overcome barriers. Stressors included poor housing and neighborhoods, reliving traumatic experiences, depression and anxiety, and social isolation. Dissatisfaction included emergency room wait times, lack of testing and prescriptions. Health barriers included missed appointments and inadequate transportation, translation services, health literacy and care coordination. Parents reported resilience through faith, by seeking knowledge, use of natural remedies, and utilizing community resources. CONCLUSION: This qualitative study provides information on the beliefs, practices, and behaviors of Syrian refugee parents related to health care utilization of pediatric refugees in the United States. Psychosocial and environmental stressors as well as perceived systemic health barriers, hinder health seeking behaviors in Syrian refugee parents. Culturally relevant care targeting perceived barriers and incorporating resilience behaviors may improve parental satisfaction and parental health seeking behaviors. Further study is needed to implement and evaluate interventions that target identified barriers.


Assuntos
Conhecimentos, Atitudes e Prática em Saúde/etnologia , Letramento em Saúde/estatística & dados numéricos , Pais/psicologia , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Refugiados/psicologia , Adolescente , Adulto , Criança , Pré-Escolar , Características da Família/etnologia , Feminino , Acesso aos Serviços de Saúde/estatística & dados numéricos , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Ohio , Poder Familiar/etnologia , Poder Familiar/psicologia , Aceitação pelo Paciente de Cuidados de Saúde/etnologia , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Pesquisa Qualitativa , Refugiados/estatística & dados numéricos , Síria , Adulto Jovem
4.
AIDS Patient Care STDS ; 34(8): 336-343, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32757980

RESUMO

Adolescent girls and young women (AGYW) are a priority population for HIV prevention in high-burden settings. We evaluated psychosocial characteristics, behavioral risk factors for HIV, and pre-exposure prophylaxis (PrEP) awareness and uptake among AGYW seeking contraceptive services at four public sector family planning (FP) clinics offering integrated PrEP delivery in Kisumu, Kenya. From October 2018 to June 2019, we approached all AGYW (aged 15-24 years) seeking contraception to participate in a survey following receipt of FP services and PrEP screening. Overall, 470 AGYW were screened for PrEP at their FP visit by facility staff and subsequently enrolled in the survey. Median age was 22 years (interquartile range 20-23), 22% of AGYW were in school, and 55% were married. The most frequent forms of contraception were implants and injectables (41% each). Over a third of AGYW (36%) reported low social support, 13% had symptoms of moderate to severe depression, and 3% reported intimate partner violence. Three-quarters (75%) of AGYW reported recent condomless sex and 42% suspected that their primary partner had other sexual partners. Most AGYW (89%) had previously heard of PrEP; 76% had at least one PrEP eligibility criterion as per national guidelines; however, only 4% initiated PrEP at their current FP visit. PrEP initiators more frequently had high HIV risk perception than noninitiators (85% vs. 10%, p < 0.001). Low perceived HIV risk (76%) and pill burden (51%) were common reasons for declining PrEP among AGYW with HIV behavioral risk factors. PrEP counseling should be tailored to AGYW to guide appropriate PrEP decision-making in this important population.


Assuntos
Fármacos Anti-HIV/administração & dosagem , Infecções por HIV/prevenção & controle , Conhecimentos, Atitudes e Prática em Saúde , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Profilaxia Pré-Exposição/estatística & dados numéricos , Prevenção Primária/métodos , Adolescente , Adulto , Conscientização , Serviços de Planejamento Familiar/organização & administração , Feminino , Humanos , Quênia , Aceitação pelo Paciente de Cuidados de Saúde/etnologia , Profilaxia Pré-Exposição/métodos , Gravidez , Adulto Jovem
5.
Med Care ; 58(9): 757-762, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32732786

RESUMO

BACKGROUND: The Affordable Care Act's Medicaid expansions (ME) increased insurance coverage for low-income Americans, among whom unmet need for mental health care is high. Empirical evidence regarding the impact of expanding insurance coverage on use of mental health services among low income and minority populations is lacking. METHODS: Data on mental health service use collected between 2007 and 2015 by the Medical Expenditures Panel Survey from nationally representative cross-sectional samples of low income (income<138% of the federal poverty line) adults were analyzed. Use trends among people in states that expanded Medicaid (ME states; n=29,827) were compared with concurrent trends among people in states that did not (non-ME states; n=22,873), with statistical adjustment for demographic characteristics and psychological distress. RESULTS: Annual outpatient visits for mental health conditions increased by 0.513 (0.053-0.974) visits per person, from a baseline rate in ME states of 0.894 visits per person. However, no significant changes were observed in number of mental health related hospital stays, emergency department visits or prescription fills. The increase outpatient visits was limited to Hispanics and non-Hispanic Whites, with no increase in service use observed among non-Hispanic Blacks. There was no apparent increase in the number of users of outpatient mental health care (AOR=0.992, P=0.942) and a marginally significant (P=0.096) increase of 3.144 visits per user. DISCUSSION: ME had a limited but positive impact on use of mental health services by low income Americans, although it may also have increased racial/ethnic disparities.


Assuntos
Serviços de Saúde/estatística & dados numéricos , Medicaid/estatística & dados numéricos , Serviços de Saúde Mental/estatística & dados numéricos , Patient Protection and Affordable Care Act/legislação & jurisprudência , Pobreza/estatística & dados numéricos , Adulto , Grupos de Populações Continentais/estatística & dados numéricos , Estudos Transversais , Grupos Étnicos/estatística & dados numéricos , Feminino , Gastos em Saúde/estatística & dados numéricos , Acesso aos Serviços de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Aceitação pelo Paciente de Cuidados de Saúde/etnologia , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Pobreza/etnologia , Fatores Socioeconômicos , Estresse Psicológico/epidemiologia , Estados Unidos
6.
Aust N Z J Public Health ; 44(5): 353-359, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32776658

RESUMO

OBJECTIVE: Latent tuberculosis (LTBI) case-finding and treatment are a focus of TB elimination in Australia. We sought the perspectives of migrants from two high-burden countries likely to be targeted by this strategy. METHODS: To understand perceptions of migrant groups in Australia on LTBI screening, 28 in-depth interviews were conducted with Indian and Pakistani community members recruited purposively through local organisations in the Illawarra region, New South Wales. Drawing on local TB policy, data collected qualitatively was analysed using framework methodologies. RESULTS: Australia's immigration system prioritises migrants of higher socioeconomic status. Participants supported elimination but perceived TB as a disease of the poor and not relevant to them. Lack of understanding of LTBI and sensitivity to being 'targeted' are further barriers to screening participation. CONCLUSION: Information provision and targeting rationale are an essential preamble to LTBI screening. Migration appears to modify cultural attitudes to TB, but not significantly. Despite less stigma surrounding TB in Australian contexts, testing privacy and confidentiality, and limiting public identification of specific groups remain important to program acceptability. Implications for public health: Progress towards TB elimination can be enhanced by consulting with targeted communities, using existing networks for communication and service provision; emphasising prevention benefits.


Assuntos
Assistência à Saúde Culturalmente Competente , Tuberculose Latente/diagnóstico , Programas de Rastreamento/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/etnologia , Vigilância da População/métodos , Migrantes/psicologia , Adolescente , Adulto , Idoso , Austrália/epidemiologia , Feminino , Política de Saúde , Humanos , Índia/etnologia , Entrevistas como Assunto , Tuberculose Latente/etnologia , Tuberculose Latente/psicologia , Masculino , Programas de Rastreamento/métodos , Pessoa de Meia-Idade , Paquistão/etnologia , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Pesquisa Qualitativa , Migrantes/estatística & dados numéricos , Adulto Jovem
7.
PLoS One ; 15(7): e0234876, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32645017

RESUMO

BACKGROUND: Access to neurology specialty care can influence outcomes in individuals with multiple sclerosis (MS), but may vary based on patient sociodemographic characteristics, including immigration status. OBJECTIVE: To compare health services utilization in the year of MS diagnosis, one year before diagnosis and two years after diagnosis in immigrants versus long-term residents in Ontario, Canada. METHODS: We identified incident cases of MS among adults aged 20-65 years by applying a validated algorithm to health administrative data in Ontario, Canada, a region with universal health insurance and comprehensive coverage. We separately assessed hospitalizations, emergency department (ED) visits, outpatient neurology visits, other outpatient specialty visits, and primary care visits. We compared rates of health service use in immigrants versus long-term residents using negative binomial regression models with generalized estimating equations adjusted for age, sex, socioeconomic status, urban/rural residence, MS diagnosis calendar year, and comorbidity burden. RESULTS: From 2003 to 2014, there were 13,028 incident MS cases in Ontario, of whom 1,070 (8.2%) were immigrants. As compared to long-term residents, rates of hospitalization were similar (Adjusted rate ratio (ARR) 0.86; 95% CI: 0.73-1.01) in immigrants the year before MS diagnosis, but outpatient neurology visits (ARR 0.93; 95% CI: 0.87-0.99) were slightly less frequent. However, immigrants had higher rates of hospitalization during the diagnosis year (ARR 1.20, 95% CI: 1.04-1.39), and had greater use of outpatient neurology (ARR 1.17, 95% CI: 1.12-1.23) but fewer ED visits (ARR 0.86; 95% CI: 0.78-0.96). In the first post-diagnosis year, immigrants continued to have greater numbers of outpatient neurology visits (ARR 1.16; 95% CI: 1.10-1.23), but had fewer hospitalizations (ARR 0.79; 95% CI: 0.67-0.94). CONCLUSIONS: Overall, our findings were reassuring concerning health services access for immigrants with MS in Ontario, a publicly funded health care system. However, immigrants were more likely to be hospitalized despite greater use of outpatient neurology care in the year of MS diagnosis. Reasons for this may include more severe disease presentation or lack of social support among immigrants and warrant further investigation.


Assuntos
Emigrantes e Imigrantes/psicologia , Aceitação pelo Paciente de Cuidados de Saúde/etnologia , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Adulto , Assistência Ambulatorial/tendências , Canadá/etnologia , Estudos de Coortes , Serviço Hospitalar de Emergência/tendências , Feminino , Hospitalização/tendências , Humanos , Masculino , Transtornos Mentais/terapia , Serviços de Saúde Mental/tendências , Pessoa de Meia-Idade , Esclerose Múltipla/psicologia , Ontário/etnologia , Atenção Primária à Saúde/tendências , Estudos Retrospectivos , Classe Social
8.
BMC Womens Health ; 20(1): 117, 2020 06 05.
Artigo em Inglês | MEDLINE | ID: mdl-32503576

RESUMO

BACKGROUND: Although intrauterine contraceptive device is highly effective, safe, long term and reversible method of contraception, the general population and physicians refuse. IUDs for nulliparous women due to persistent rumors about its side effects and complications. The aim of this study was to assess the acceptability of IUD use in nulliparous women by both women and health care providers in Egypt. METHODS: Five hundred thirty nulliparous women and 200 physicians were interviewed in 10 family planning clinics in Suez and Minia cities - Egypt. The knowledge and attitudes of women and health care providers towards IUD use in nulliparous women were assessed through a well designed questionnaire over 2 years. Those women who accepted using IUD were then followed up for 6 months. RESULTS: Most of nulliparous women sought for contraception reported a negative impression of IUD method (96.2%). 82.5% of physicians had the same attitude. The reasons for refusing IUD among nulliparous women are fear of side effects including infection (52.8%), and bleeding (37.7%).Also, fear of subsequent infertility 51.9% of women. Regarding the providers, increased pelvic inflammatory disease (PID) represented the highest percentage (70%) for non acceptability, followed by difficult insertion (52.5%). Ninety women who accepted use IUD were followed up 6 months later, 94.4% were still using the method and77.8% were happy with the results. CONCLUSION: The main barriers that hinder the use of IUD in nulliparous women are the women insufficient knowledge and attitude of their physicians. Good client counseling. Good training for physician to improve their experience would help increase the use of such effective and safe method.


Assuntos
Atitude do Pessoal de Saúde/etnologia , Conhecimentos, Atitudes e Prática em Saúde/etnologia , Pessoal de Saúde/psicologia , Dispositivos Intrauterinos/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/etnologia , Adolescente , Adulto , Anticoncepção , Estudos Transversais , Egito , Medo , Feminino , Pessoal de Saúde/estatística & dados numéricos , Humanos , Entrevistas como Assunto , Dispositivos Intrauterinos/efeitos adversos , Pessoa de Meia-Idade , Paridade , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Doença Inflamatória Pélvica , Gravidez , Adulto Jovem
9.
Artigo em Inglês | MEDLINE | ID: mdl-32486182

RESUMO

Objectives: To examine barriers to initiation and continuation of treatment among individuals with common mental disorders in the Saudi National Mental Health Survey (SNMHS). Methods: The SNMHS is a community-based epidemiological survey in a nationally representative household sample of respondents aged 15-65 in the Kingdom of Saudi Arabia. The World Health Organization Composite International Diagnostic Interview (CIDI) 3.0 was used. Predictors of barriers to treatment were analyzed with multivariable logistic regression. Results: Among participants with a 12-month DSM-IV/CIDI disorder (n = 711), 86.1% reported no service use. Of those (n = 597), 50.7% did not think they needed any help (categorized as "low perceived need") and 49.3% did perceive need. Of those who perceived need (n = 309), the majority (98.9%) reported attitudinal barriers to initiation. In contrast, 10.3% of those with a perceived need reported structural barriers. Respondents who were previously married or indicated below-average income were more likely to believe they needed help. Conclusions: Among people with a diagnosed mental disorder, low perceived need and attitudinal barriers are the primary barriers to mental health treatment in the KSA. The results suggest that addressing poor mental health literacy may be essential factor in reducing the unmet need for mental health treatment in the KSA.


Assuntos
Acesso aos Serviços de Saúde/estatística & dados numéricos , Transtornos Mentais/terapia , Serviços de Saúde Mental/estatística & dados numéricos , Saúde Mental/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Adolescente , Adulto , Idoso , Atitude do Pessoal de Saúde , Feminino , Comportamentos Relacionados com a Saúde , Inquéritos Epidemiológicos , Humanos , Masculino , Transtornos Mentais/epidemiologia , Transtornos Mentais/psicologia , Pessoa de Meia-Idade , Aceitação pelo Paciente de Cuidados de Saúde/etnologia , Arábia Saudita/epidemiologia , Inquéritos e Questionários , Adulto Jovem
10.
Psychol Trauma ; 12(5): 452-454, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32525364

RESUMO

The COVID-19 crisis can be defined as a collective trauma, which contributes to an upheaval of community connection and functioning. The current pandemic has also illuminated disparities in mental health supports. In this commentary, we highlight one community organization, located in metro Detroit, that has responded to the trauma by bolstering resources and supports for residents, many of whom are ethnoracial minorities. (PsycInfo Database Record (c) 2020 APA, all rights reserved).


Assuntos
Serviços Comunitários de Saúde Mental/organização & administração , Infecções por Coronavirus , Disparidades em Assistência à Saúde/etnologia , Pandemias , Aceitação pelo Paciente de Cuidados de Saúde/etnologia , Pneumonia Viral , Pobreza/etnologia , Trauma Psicológico/etnologia , Trauma Psicológico/terapia , Humanos , Michigan/etnologia , Trauma Psicológico/etiologia
11.
BMC Womens Health ; 20(1): 86, 2020 04 29.
Artigo em Inglês | MEDLINE | ID: mdl-32349724

RESUMO

BACKGROUND: Fertility preservation for both medical and non-medical reasons are gaining increasing attention world-wide. This study aimed to evaluate the awareness, knowledge and acceptance on fertility preservation in Hong Kong Chinese. METHODS: This was a cross-sectional study carried out between June 2016 to March 2017. A self-administered questionnaire was distributed by convenience sampling. RESULTS: Forty two percent of subjects returned the questionnaire (n = 296/697). Among them, only 54.3% were aware of any means of fertility preservation. Tertiary educated individuals are more aware than less educated individuals (73.6% versus 46.6%, p < 0.001). The most commonly known method is oocyte cryopreservation (94.3%). Most of the respondents (80%) were interested to know about fertility preservation, 84.1% considered fertility preservation counselling necessary and 83.3% would consider undergoing fertility preservation if a treatment has a high chance of causing infertility despite the possibility of delay in cancer treatment. Up to 93.9% agreed to set up a dedicated referral centre with government funding and 73.4% agreed that fertility preservation for medical indication should be provided as a government funded service. In terms of fertility preservation for non-medical reason, 65.5 and 70.4% agreed that fertility preservation should be offered to single men and women without partner respectively, while only 53.3 and 50% agreed that fertility preservation is acceptable for delay in childbearing for career development in female and male respectively. CONCLUSION: There was a low awareness but positive attitude towards fertility preservation among Hong Kong Chinese. Acceptance towards medically indicated fertility preservation is high while a considerable number also accepts it for non-medical reasons. Educational campaigns are required to arouse awareness of fertility preservation to prevent individuals being deprived of the option due to lack of knowledge. Dedicated referral centre with established efficient patient referral pathways and financial support should be provided to improve the provision and uptake of fertility preservation service to enhance the reproductive potential and life options of women.


Assuntos
Grupo com Ancestrais do Continente Asiático/psicologia , Criopreservação , Preservação da Fertilidade/psicologia , Conhecimentos, Atitudes e Prática em Saúde/etnologia , Aceitação pelo Paciente de Cuidados de Saúde/etnologia , Adolescente , Adulto , Estudos Transversais , Feminino , Hong Kong , Humanos , Masculino , Pessoa de Meia-Idade , Oócitos , Inquéritos e Questionários , Adulto Jovem
12.
BMC Health Serv Res ; 20(1): 318, 2020 Apr 16.
Artigo em Inglês | MEDLINE | ID: mdl-32299436

RESUMO

BACKGROUND: Dengue fever (DF) is a rapidly spreading mosquito-borne disease along the China-Myanmar border. Understanding treatment-seeking behaviors (TSBs) and associated factors of suspected DF patients in local communities helps to improve health services via promoting prompt treatment, improving patients' prognosis, finding DF information and timely response to DF foci. METHODS: A combination of qualitative semi-structured in-depth interview (SDIs) included 18 key-informants, and quantitative household questionnaire survey (HHSs) involved 259 households was carried out to investigate TSBs and associated factors of suspected DF patients in the Eastern Shan Special Region IV (ESSR4), Myanmar. RESULTS: The key informants mentioned that most of their fellow villagers did not seek treatment in public health facilities first. The HHS questionnaires were distributed to household heads, and 241 of the 259 HHS respondents were valid after data auditing. Only 102 (43.2%) household heads reported that their family sought treatment for suspected DF at a public health facility immediately; 111 (46.1%) respondents said that they chose self-medication first. The adjusted odds ratio of multivariate logistic analysis (MLA) predicting household heads' first seeking healthcare at a public hospital were 1.91 (95%CI: 1.03-3.53) for those who knew DF and 5.11 (95%CI: 2.08-12.58) for those who regarded DF as a deadly disease, indicating that families who knew DF and regarded DF as a deadly disease were more likely to seek treatment for suspected DF at a public health facility immediately. CONCLUSION: The inappropriateness of treatment-seeking behaviors for suspected DF hinders the improvement of the patient prognosis and dengue control in ESSR4, Myanmar. People's awareness of the potential seriousness of DF is a factor influencing appropriate healthcare-seeking behavior among Shan People.


Assuntos
Dengue/terapia , Conhecimentos, Atitudes e Prática em Saúde/etnologia , Aceitação pelo Paciente de Cuidados de Saúde/etnologia , Automedicação , Adolescente , Adulto , Animais , Estudos Transversais , Feminino , Medicina Herbária , Humanos , Masculino , Medicina Tradicional , Pessoa de Meia-Idade , Mianmar , Razão de Chances , Inquéritos e Questionários , Adulto Jovem
13.
BMC Public Health ; 20(1): 459, 2020 Apr 06.
Artigo em Inglês | MEDLINE | ID: mdl-32252712

RESUMO

BACKGROUND: Australian surveillance data document higher rates of sexually transmissible infections (STIs) among young Aboriginal people (15-29 years) in remote settings than non-Aboriginal young people. Epidemiological data indicate a substantial number of young Aboriginal people do not test for STIs. Rigorous qualitative research can enhance understanding of these findings. This paper documents socio-ecological factors influencing young Aboriginal people's engagement with clinic-based STI testing in two remote settings in the Northern Territory, Australia. METHODS: In-depth interviews with 35 young Aboriginal men and women aged 16-21 years; thematic analysis examining their perceptions and personal experiences of access to clinic-based STI testing. RESULTS: Findings reveal individual, social and health service level influences on willingness to undertake clinic-based STI testing. Individual level barriers included limited knowledge about asymptomatic STIs, attitudinal barriers against testing for symptomatic STIs, and lack of skills to communicate about STIs with health service staff. Social influences both promoted and inhibited STI testing. In setting 1, local social networks enabled intergenerational learning about sexual health and facilitated accompanied visits to health clinics for young women. In setting 2, however, social connectedness inhibited access to STI testing services. Being seen at clinics was perceived to lead to stigmatisation among peers and fear of reputational damage due to STI-related rumours. Modalities of health service provision both enhanced and inhibited STI testing. In setting 1, outreach strategies by male health workers provided young Aboriginal men with opportunities to learn about sexual health, initiate trusting relationships with clinic staff, and gain access to clinics. In setting 2, barriers were created by the location and visibility of the clinic, appointment procedures, waiting rooms and waiting times. Where inhibitive factors at the individual, social and health service levels exist, young Aboriginal people reported more limited access to STI testing. CONCLUSIONS: This is the first socio-ecological analysis of factors influencing young Aboriginal people's willingness to undertake testing for STIs within clinics in Australia. Strategies to improve uptake of STI testing must tackle the overlapping social and health service factors that discourage young people from seeking sexual health support. Much can be learned from young people's lived sexual health experiences and family- and community-based health promotion practices.


Assuntos
Serviços de Saúde do Indígena/estatística & dados numéricos , Grupo com Ancestrais Oceânicos/psicologia , Aceitação pelo Paciente de Cuidados de Saúde/etnologia , Vigilância da População , Doenças Sexualmente Transmissíveis/etnologia , Adolescente , Feminino , Acesso aos Serviços de Saúde , Humanos , Masculino , Northern Territory/epidemiologia , Grupo com Ancestrais Oceânicos/estatística & dados numéricos , Pesquisa Qualitativa , Saúde Sexual/etnologia , Doenças Sexualmente Transmissíveis/epidemiologia , Adulto Jovem
14.
BMC Public Health ; 20(1): 417, 2020 Mar 30.
Artigo em Inglês | MEDLINE | ID: mdl-32228537

RESUMO

BACKGROUND: European studies showed that women with a migration background are less likely to participate in mammography screenings than autochthonous women. However, the participation in the German mammography screening programme (MSP) among ethnic German migrants from countries of the former Soviet Union (called resettlers) is unclear so far. The aim of this study was to identify possible differences regarding MSP participation between resettlers from the FSU and the general German population. METHODS: Data from two independent, complementary studies from North Rhine-Westphalia, Germany (a retrospective cohort study 1994-2013; a cross-sectional study 2013/14) were used for comparisons between resettlers and the general population: Odds Ratios (ORs) for MSP participation utilizing the cross-sectional data and time trends of breast cancer incidence rates as well as Chi-Square tests for breast cancer stages utilizing the cohort data. RESULTS: Resettlers showed higher Odds to participate in the MSP than the general population (OR 2.42, 95% CI 1.08-5.42). Among resettlers, a large increase in incidence rates was observed during the MSP implementation (2005-2009), resulting in stable and comparable incidence rates after the implementation. Furthermore, pre-MSP implementation, the proportion of advanced breast cancer stages was higher among resettlers than in the German population, post-MSP implementation the proportion was comparable. CONCLUSIONS: MSP participating seems surprisingly high among resettlers. An explanation for the increased willingness to participate might be the structured invitation procedure of the MSP. However, the exact reasons remain unclear and future research is needed to confirm this hypothesis and rule out the possibility of selection bias in the cross-sectional study.


Assuntos
Neoplasias da Mama/epidemiologia , Detecção Precoce de Câncer/estatística & dados numéricos , Mamografia/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/etnologia , Migrantes/estatística & dados numéricos , Adulto , Idoso , Distribuição de Qui-Quadrado , Estudos de Coortes , Estudos Transversais , Detecção Precoce de Câncer/métodos , Feminino , Alemanha/epidemiologia , Humanos , Incidência , Pessoa de Meia-Idade , Razão de Chances , Sistema de Registros , Estudos Retrospectivos , U.R.S.S./etnologia
15.
BMC Womens Health ; 20(1): 55, 2020 03 19.
Artigo em Inglês | MEDLINE | ID: mdl-32192493

RESUMO

BACKGROUND: Self-sampling for HPV testing may be a method to increase overall cervical cancer screening rates among Black women, who are underscreened for cervical cancer in parts of the US. The purpose of this study was to assess preferred characteristics for delivery of HPV self-sampling kits, return of HPV self-sampling kits, and communication of HPV test results and explore sociodemographic factors (income, education, and marital status) associated with acceptability of self-sampling for HPV testing. METHODS: Survey data were gathered at an Indiana minority health fair. Participants evaluated 9 scenarios that varied along 3 dimensions: HPV self-sampling kit delivery (mail, pharmacy pick-up, or clinic pick-up), HPV self-sampling kit return (mail, pharmacy drop-off, or clinic drop-off), and HPV test results (mail, phone call, or text message). The 9 scenarios were produced from a fractional factorial design and rated on a 0 to 100 scale. Ratings-based conjoint analysis (RBCA) determined how each dimension influenced ratings. A measure for acceptability of self-sampling was obtained from the ratings of all 9 scenarios. The acceptability measure was regressed on sociodemographics. RESULTS: The 98 participants ranged in age from 21 to 65 (M = 45). Across the 9 scenarios, overall acceptability to self-sample had a mean of 60.9 (SD = 31.3). RBCA indicated that HPV self-sampling kit return had the most influence on ratings, followed by HPV self-sampling kit delivery, and finally, HPV test result communication. Thirty-six percent of participants rated all self-sampling scenarios the same. Sociodemographic characteristics were not associated with acceptability of self-sampling. CONCLUSIONS: Self-sampling for HPV testing was found to be generally acceptable to Black women in this pilot survey study. This information could be used by researchers developing self-sampling interventions and the implementation of self-sampling among providers.


Assuntos
Detecção Precoce de Câncer/estatística & dados numéricos , Programas de Rastreamento/métodos , Papillomaviridae/isolamento & purificação , Infecções por Papillomavirus/diagnóstico , Aceitação pelo Paciente de Cuidados de Saúde/etnologia , Autocuidado , Neoplasias do Colo do Útero/diagnóstico , Adulto , Idoso , Feminino , Humanos , Indiana/epidemiologia , Pessoa de Meia-Idade , Infecções por Papillomavirus/etnologia , Infecções por Papillomavirus/prevenção & controle , Manejo de Espécimes , Neoplasias do Colo do Útero/etnologia , Neoplasias do Colo do Útero/prevenção & controle , Esfregaço Vaginal
16.
J Stroke Cerebrovasc Dis ; 29(5): 104757, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32173228

RESUMO

BACKGROUND: Stroke education in adolescents has been established as an effective method of creating awareness about stroke, its warning signs and risk factors. It contributes to desired behavioural change in the adolescents as well as their parents. Thus, we aimed to determine the baseline knowledge of school attending adolescents about stroke and its risk factors as well as the effect of stroke education on their stroke awareness. METHODS: This study employed a quasi-experimental study design and was conducted in secondary schools in Ile-Ife, Osun State, Nigeria. The schools were divided into intervention and control groups. We assessed the baseline knowledge of the students on stroke, its risk factors, warning signs, and ways of preventing it using a pre-tested structured questionnaire in both intervention and control groups. In the intervention group, health talks on stroke consisting of oral presentation and distribution of fliers were presented for 30 minutes in each selected school. Each school was visited 2 weeks after the health education intervention to assess their knowledge on stroke, its risk factors, and ways of preventing it. The control group was also visited after 2 weeks for a re-assessment of their stroke knowledge and the conduct of heath talk on other aspects of neurology such as sleep, epilepsy, etc. Results: A total of 1259 adolescents were studied with 661 in the intervention group and 598 in the control group. The mean age of the respondents was 13.56 ± 2.87 the intervention group and 13.38 ± 2.06 in the control group. There were higher mean scores on knowledge of stroke and its risk factors among the intervention group than seen in the control group after the stroke education. CONCLUSIONS: Stroke education is an effective way of creating and maintaining stroke awareness among school-attending adolescents.


Assuntos
Comportamento do Adolescente/etnologia , Grupo com Ancestrais do Continente Africano/educação , Educação em Saúde , Conhecimentos, Atitudes e Prática em Saúde/etnologia , Letramento em Saúde , Promoção da Saúde , Serviços de Saúde Escolar , Acidente Vascular Cerebral/etnologia , Estudantes/psicologia , Adolescente , Fatores Etários , Criança , Humanos , Nigéria/epidemiologia , Ensaios Clínicos Controlados não Aleatórios como Assunto , Aceitação pelo Paciente de Cuidados de Saúde/etnologia , Reconhecimento Psicológico , Fatores de Risco , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/terapia
17.
J Stroke Cerebrovasc Dis ; 29(5): 104716, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32192843

RESUMO

BACKGROUND AND OBJECTIVES: Stroke is a global burden. In Lebanon, recent studies have shown that stroke prevalence may be higher than other developing countries. While older people are particularly vulnerable to stroke, research suggests that they have poor stroke awareness. Since awareness is crucial for early hospital admission, thereby outcome, the main objectives of this study were to assess knowledge of stroke ie, symptoms, risk factors, and intended behavior in case of stroke suspicion. METHODS: A community-based survey targeting adults aged 50 and above was conducted at 20 random pharmacies in Beirut from May to October 2018 through face to face interviews utilizing a structured questionnaire composed of open and closed ended questions. Descriptive and multivariable analyses were performed. MAIN RESULTS: In total, 390 participants completed the questionnaire. Sixty-eight percent were able to spontaneously recall at least 1 stroke symptom, most frequently headache (29.2%), hemiparesis (25.4%), and dizziness (19.5%). Furthermore, 85.4% spontaneously recalled at least 1 risk factor, most frequently hypertension (48.2%), smoking (20.5%), and stress (43.1%). In case of stroke suspicion 57.69% would call an ambulance. Knowing a stroke patient and educational level were predictors for recall of more symptoms and risk factors for stroke. Adequate response to stroke was positively associated with identification of more stroke symptoms but inversely associated with having diabetes. CONCLUSIONS AND RECOMMENDATIONS: There are major gaps in stroke knowledge among Beirut's older population. Culturally tailored awareness campaigns should be implemented at multiple levels using different media methods to target vulnerable populations at higher risk for stroke and their families. These campaigns should focus on improving stroke symptoms awareness and actions to take when suspecting stroke.


Assuntos
Comportamentos Relacionados com a Saúde/etnologia , Conhecimentos, Atitudes e Prática em Saúde/etnologia , Letramento em Saúde , Aceitação pelo Paciente de Cuidados de Saúde/etnologia , Acidente Vascular Cerebral/etnologia , Fatores Etários , Idoso , Ambulâncias , Estudos Transversais , Características Culturais , Escolaridade , Feminino , Inquéritos Epidemiológicos , Humanos , Líbano/epidemiologia , Masculino , Pessoa de Meia-Idade , Reconhecimento Psicológico , Fatores de Risco , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/terapia
18.
PLoS Med ; 17(3): e1003043, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32126079

RESUMO

BACKGROUND: Globally, international migration is increasing. Population growth, along with other demographic changes, may be expected to put new pressures on healthcare systems. Some studies across Europe suggest that emergency departments (EDs) are used more, and differently, by migrants compared to non-migrant populations, which may be a result of unfamiliarity with the healthcare systems and difficulties accessing primary healthcare. However, little evidence exists to understand how migrant parents, who are typically young and of childbearing age, utilise EDs for their children. This study aimed to examine the association between paediatric ED utilisation in the first 5 years of life and maternal migration status in the Born in Bradford (BiB) cohort study. METHODS AND FINDINGS: We analysed linked data from the BiB study-an ongoing, multi-ethnic prospective birth cohort study in Bradford. Bradford is a large, ethnically diverse city in the north of England. In 2017, more than a third of births in Bradford were to mothers who were born outside the UK. Between March 2007 and December 2010, pregnant women were recruited to BiB during routine antenatal care, and the children born to these mothers have been, and continue to be, followed over time to assess how social, genetic, environmental, and behavioural factors impact on health from childhood to adulthood. Data analysed in this study included baseline questionnaire data from BiB mothers, and Bradford Royal Infirmary ED episode data for their children. Main outcomes were likelihood of paediatric ED use (no visits versus at least 1 ED visit in the first 5 years of life) and ED utilisation rates (number and frequency of ED visits) for children who have accessed the ED. The main explanatory variable was mother's migrant status (foreign-born versus UK/Irish-born). Multivariable analyses (logistic and zero-truncated negative binomial regression) were conducted adjusting for socio-demographic and socio-economic factors. The final dataset included 10,168 children born between April 2007 and June 2011, of whom 35.6% were born to migrant mothers. Foreign-born mothers originated from South Asia (28.6%), Europe/Central Asia (3.2%), Africa (2.1%), East Asia/Pacific (1.1%), and the Middle East (0.6%). At recruitment the mothers ranged in age from 15 to 49 years old. Overall, 3,104 (30.5%) children had at least 1 ED visit in the first 5 years of life, with the highest proportion of visits being in the first year of life (36.7%). The proportion of children who visited the ED at least once was lower for children of migrant mothers as compared to children of non-migrant mothers (29.4% versus 31.2%). Children of migrant mothers were found to be less likely to visit the ED (odds ratio 0.88 [95% CI 0.80 to 0.97], p = 0.012). However, among children who visited the ED, the utilisation rate was significantly higher for children of migrant mothers (incidence rate ratio [IRR] 1.19 [95% CI 1.01 to 1.40], p = 0.040). Utilisation rates were higher for children born to mothers from Europe (IRR 1.71 [95% CI 1.07 to 2.71], p = 0.024) and established migrants (≥5 years living in UK) (IRR 1.24 [95% CI 1.02 to 1.51], p = 0.032) compared to UK/Irish-born mothers. Important limitations include being unable to measure children's underlying health status and the urgency of ED attendance, as well as the analysis being limited by missing data. CONCLUSIONS: In this study we observed that there is no higher likelihood of first paediatric ED attendance in the first 5 years of life for children in the BiB cohort for migrant mothers. However, among ED users, children of migrant mothers attend the service more frequently than children of UK/Irish-born mothers. Our findings show that patterns of ED utilisation differ by mother's region of origin and time since arrival in the UK.


Assuntos
Serviço Hospitalar de Emergência/tendências , Emigrantes e Imigrantes , Emigração e Imigração/tendências , Recursos em Saúde/tendências , Mães , Aceitação pelo Paciente de Cuidados de Saúde , Pediatria/tendências , Adolescente , Adulto , Pré-Escolar , Estudos Transversais , Grupos Étnicos , Feminino , Humanos , Lactente , Recém-Nascido , Pessoa de Meia-Idade , Aceitação pelo Paciente de Cuidados de Saúde/etnologia , Estudos Prospectivos , Fatores Raciais , Fatores Socioeconômicos , Adulto Jovem
19.
PLoS Med ; 17(3): e1003061, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32182239

RESUMO

BACKGROUND: Migrant women, especially from Indian and African ethnicity, have a higher risk of stillbirth than native-born populations in high-income countries. Differential access or timing of ANC and the uptake of other services may play a role. We investigated the pattern of healthcare utilisation among migrant women and its relationship with the risk of stillbirth (SB)-antepartum stillbirth (AnteSB) and intrapartum stillbirth (IntraSB)-in Western Australia (WA). METHODS AND FINDINGS: A retrospective cohort study using de-identified linked data from perinatal, birth, death, hospital, and birth defects registrations through the WA Data Linkage System was undertaken. All (N = 260,997) non-Indigenous births (2005-2013) were included. Logistic regression analysis was used to estimate odds ratios and 95% CI for AnteSB and IntraSB comparing migrant women from white, Asian, Indian, African, Maori, and 'other' ethnicities with Australian-born women controlling for risk factors and potential healthcare-related covariates. Of all the births, 66.1% were to Australian-born and 33.9% to migrant women. The mean age (years) was 29.5 among the Australian-born and 30.5 among the migrant mothers. For parity, 42.3% of Australian-born women, 58.2% of Indian women, and 29.3% of African women were nulliparous. Only 5.3% of Maori and 9.2% of African migrants had private health insurance in contrast to 43.1% of Australian-born women. Among Australian-born women, 14% had smoked in pregnancy whereas only 0.7% and 1.9% of migrants from Indian and African backgrounds, respectively, had smoked in pregnancy. The odds of AnteSB was elevated in African (odds ratio [OR] 2.22, 95% CI 1.48-2.13, P < 0.001), Indian (OR 1.64, 95% CI 1.13-2.44, P = 0.013), and other women (OR 1.46, 95% CI 1.07-1.97, P = 0.016) whereas IntraSB was higher in African (OR 5.24, 95% CI 3.22-8.54, P < 0.001) and 'other' women (OR 2.18, 95% CI 1.35-3.54, P = 0.002) compared with Australian-born women. When migrants were stratified by timing of first antenatal visit, the odds of AnteSB was exclusively increased in those who commenced ANC later than 14 weeks gestation in women from Indian (OR 2.16, 95% CI 1.18-3.95, P = 0.013), Maori (OR 3.03, 95% CI 1.43-6.45, P = 0.004), and 'other' (OR 2.19, 95% CI 1.34-3.58, P = 0.002) ethnicities. With midwife-only intrapartum care, the odds of IntraSB for viable births in African and 'other' migrants (combined) were more than 3 times that of Australian-born women (OR 3.43, 95% CI 1.28-9.19, P = 0.014); however, with multidisciplinary intrapartum care, the odds were similar to that of Australian-born group (OR 1.34, 95% CI 0.30-5.98, P = 0.695). Compared with Australian-born women, migrant women who utilised interpreter services had a lower risk of SB (OR 0.51, 95% CI 0.27-0.96, P = 0.035); those who did not utilise interpreters had a higher risk of SB (OR 1.20, 95% CI 1.07-1.35, P < 0.001). Covariates partially available in the data set comprised the main limitation of the study. CONCLUSION: Late commencement of ANC, underutilisation of interpreter services, and midwife-only intrapartum care are associated with increased risk of SB in migrant women. Education to improve early engagement with ANC, better uptake of interpreter services, and the provision of multidisciplinary-team intrapartum care to women specifically from African and 'other' backgrounds may reduce the risk of SB in migrants.


Assuntos
Emigrantes e Imigrantes , Emigração e Imigração , Conhecimentos, Atitudes e Prática em Saúde/etnologia , Recursos em Saúde , Disparidades em Assistência à Saúde/etnologia , Serviços de Saúde Materna , Aceitação pelo Paciente de Cuidados de Saúde/etnologia , Natimorto/etnologia , Adulto , Grupo com Ancestrais do Continente Africano , Grupo com Ancestrais do Continente Asiático , Recursos em Saúde/tendências , Disparidades em Assistência à Saúde/tendências , Humanos , Serviços de Saúde Materna/tendências , Pessoa de Meia-Idade , Grupo com Ancestrais Oceânicos , Educação de Pacientes como Assunto/tendências , Fatores Raciais , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Austrália Ocidental/epidemiologia , Adulto Jovem
20.
BMC Public Health ; 20(1): 344, 2020 Mar 17.
Artigo em Inglês | MEDLINE | ID: mdl-32183757

RESUMO

BACKGROUND: Early detection, identification, and treatment of chronic hepatitis B through screening is vital for those at increased risk, e.g. born in hepatitis B endemic countries. In the Netherlands, Moroccan immigrants show low participation rates in health-related screening programmes. Since social networks influence health behaviour, we investigated whether similar screening intentions for chronic hepatitis B cluster within social networks of Moroccan immigrants. METHODS: We used respondent-driven sampling (RDS) where each participant ("recruiter") was asked to complete a questionnaire and to recruit three Moroccans ("recruitees") from their social network. Logistic regression analyses were used to analyse whether the recruiters' intention to request a screening test was similar to the intention of their recruitees. RESULTS: We sampled 354 recruiter-recruitee pairs: for 154 pairs both participants had a positive screening intention, for 68 pairs both had a negative screening intention, and the remaining 132 pairs had a discordant intention to request a screening test. A tie between a recruiter and recruitee was associated with having the same screening intention, after correction for sociodemographic variables (OR 1.70 [1.15-2.51]). CONCLUSIONS: The findings of our pilot study show clustering of screening intention among individuals in the same network. This provides opportunities for social network interventions to encourage participation in hepatitis B screening initiatives.


Assuntos
Emigrantes e Imigrantes/psicologia , Hepatite B Crônica/diagnóstico , Programas de Rastreamento/psicologia , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Rede Social , Adulto , Análise por Conglomerados , Feminino , Hepatite B Crônica/etnologia , Humanos , Intenção , Masculino , Pessoa de Meia-Idade , Marrocos/etnologia , Países Baixos , Aceitação pelo Paciente de Cuidados de Saúde/etnologia , Projetos Piloto , Inquéritos e Questionários
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