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1.
BMC Public Health ; 19(1): 1485, 2019 Nov 08.
Artigo em Inglês | MEDLINE | ID: mdl-31703660

RESUMO

BACKGROUND: Refugees are particularly vulnerable to poor mental health outcomes due to exposure to pre migration trauma and post migration stressors. Research has demonstrated evidence to suggest that the professional help-seeking among refugee groups is low or problematic. This study seeks to examine help-seeking for emotional problems in two large samples of Iraqi and Afghan refugees in Australia. METHODS: This study uses data from two waves of the Building a New Life in Australia, the longitudinal study of Humanitarian migrants. The data was collected face-to-face between 2013 and 2016, among humanitarian migrants. All participants held a permanent protection visa and had arrived in Australia or been granted their visa between period of May to December 2013. The study sample included 1288 participants born in Iraq and Afghanistan (aged 15 and over). In the Wave 3 interview (2015-2016) participants reported on professional help received to deal with emotional problems. RESULTS: Approximately 36 and 37% of the Iraqi and Afghan groups respectively, reported seeking help for emotional problems. Within the Iraqi group, associations between mental health status, namely general psychological distress and PTSD and help-seeking were found but this was not present in the Afghan group, where age seemed to play a role in help-seeking. Frequency of help received was low with approximately 47% of the Iraqi and 57% of the Afghan groups reporting having received help 5 times or less in the last 12 months. CONCLUSIONS: Findings from this study provide clear directions on areas where culturally tailored mental health promotion programs should target in these two refugee communities. Further, the differences in help-seeking behaviour of these communities should be noted by both clinicians and policy makers as efforts to provide culturally responsive mental health services.


Assuntos
Transtornos Mentais/psicologia , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Refugiados/psicologia , Migrantes/psicologia , Adolescente , Adulto , Afeganistão/etnologia , Austrália , Bases de Dados Factuais , Feminino , Humanos , Iraque/etnologia , Estudos Longitudinais , Masculino , Transtornos Mentais/etnologia , Pessoa de Meia-Idade , Aceitação pelo Paciente de Cuidados de Saúde/etnologia , Adulto Jovem
2.
BMC Public Health ; 19(1): 1534, 2019 Nov 15.
Artigo em Inglês | MEDLINE | ID: mdl-31730454

RESUMO

BACKGROUND: Since Nepali cross-border migrants can freely enter, work and stay in India, they are largely undocumented. The majority is involved in semi-skilled or unskilled jobs with limited labour rights and social security, a fact which predisposes them to psychological distress. We aimed to assess the prevalence of and factors associated with psychological morbidity among Nepali migrants upon their return from India. METHODS: A community based cross-sectional study was conducted in six districts of Nepal between September 2017 and February 2018. A total of 751 participants who had worked at least six months in India and returned to Nepal were interviewed from 24 randomly selected clusters. The General Health Questionnaire (GHQ)-12 was used to measure the psychological morbidity. Data were analysed using Poisson regression analysis. RESULTS: The majority was younger than 35 years (64.1%), male (96.7%), married (81.8%), had at least a primary education (66.6%), and belonged to Dalit, Janajati and religious minorities (53.7%). The prevalence of psychological morbidity was 13.5% (CI: 11.2-16.1%). Participants aged 45 years and above (adjusted prevalence ratio (aPR) = 2.74), from the Terai (aPR = 3.29), a religious minority (aPR = 3.64), who received no sick leave (aPR = 2.4), with existing health problems (aPR = 2.0) and having difficulty in accessing health care (aPR = 1.88) were more likely than others to exhibit a psychological morbidity. CONCLUSION: This study demonstrated that psychological morbidity was prevalent in the study participants and varied significantly with individual characteristics, work conditions and health. Multifaceted approaches including psychological counselling for returnees and protection of labour and health rights in the workplace are recommended to help reduce psychological morbidity.


Assuntos
Emigração e Imigração , Transtornos Mentais/etnologia , Transtornos Mentais/epidemiologia , Migrantes/psicologia , Adolescente , Adulto , Análise por Conglomerados , Estudos Transversais , Emprego/psicologia , Feminino , Acesso aos Serviços de Saúde , Humanos , Índia/epidemiologia , Masculino , Pessoa de Meia-Idade , Nepal/etnologia , Aceitação pelo Paciente de Cuidados de Saúde/etnologia , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Distribuição de Poisson , Prevalência , Adulto Jovem
3.
Med Care ; 57(12): 960-967, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31730568

RESUMO

OBJECTIVES: Our objectives were to assess rates of perceived stigma in health care (clinical) settings reported by racially diverse New York City residents and to examine if this perceived stigma is associated with poorer physical and mental health outcomes. METHODS: We analyzed data from the 2016 New York City Community Health Survey. We applied bivariable and multivariable methods to assess rates of perceived stigma, and perceived stigma's statistical relationship with health care access, physical health status, and mental health status controlling for sociodemographics and health insurance status. RESULTS: Perceived stigma was associated with poorer health care access [odds ratio (OR)=7.07, confidence interval (CI)=5.32-9.41), depression (OR=3.80, CI=2.66-5.43), diabetes (OR=1.86, CI=1.36-2.54), and poor overall general health (OR=0.43, CI=0.33-0.57). Hispanic respondents reported the highest rate of perceived stigma among racial and ethnic minority groups (mean=0.07, CI=0.05-0.08). CONCLUSIONS: We found that perceived stigma in health care settings was a potential barrier to good health. Prior studies have illustrated that negative health outcomes are common for patients who avoid or delay care; thus, the unfortunate conclusion is that even in a diverse, heterogeneous community, stigma persists and may negatively affect well-being. Therefore, eliminating stigma in clinical settings should be a top priority for health care providers and public health professionals seeking to improve health equity.


Assuntos
Grupos de Populações Continentais/psicologia , Acesso aos Serviços de Saúde , Nível de Saúde , Saúde Mental/etnologia , Estigma Social , Adolescente , Adulto , Idoso , Atitude do Pessoal de Saúde , Depressão/etnologia , Diabetes Mellitus/etnologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Cidade de Nova Iorque , Aceitação pelo Paciente de Cuidados de Saúde/etnologia , Fatores Socioeconômicos , Adulto Jovem
4.
Med Care ; 57(11): 861-868, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31634267

RESUMO

OBJECTIVES: We examined changes in health care access and utilization associated with the Patient Protection and Affordable Care Act (ACA) for different Asian American subgroups relative to non-Latino whites (whites). RESEARCH DESIGN: Using 2003-2017 California Health Interview Survey data, we examined changes in 4 health care access measures and 2 utilization measures among whites and 7 Asian American subgroups. We estimated the unadjusted and adjusted percentage point changes on the absolute scale from the pre-ACA to post-ACA periods. Adjusted estimates were obtained from multivariable logistic regression models that controlled for predisposing, enabling, and need factors. We also estimated the pre-ACA to post-ACA changes between whites and Asian American subgroups using a difference-in-difference approach. RESULTS: After the ACA was implemented, uninsurance decreased among all Asian American subgroups, but improvements in disparities relative to whites in these measures were limited. In particular, Koreans had the largest absolute reduction in uninsurance (-16.8 percentage points) and were the only subgroup with a significant reduction in terms of disparities relative to whites (-10.1 percentage points). However, little or no improvement was observed in the other 3 access measures (having a usual source of care, delayed medical care in past year, or delayed prescription drug use in past year) and 2 utilization measures (having a physician visit or emergency department visit in past year). CONCLUSIONS: Despite coverage gains among Asian American subgroups, especially Koreans, disparities in access and utilization persisted across all Asian American subgroups.


Assuntos
Americanos Asiáticos/estatística & dados numéricos , Utilização de Instalações e Serviços/estatística & dados numéricos , Acesso aos Serviços de Saúde/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/etnologia , Patient Protection and Affordable Care Act , Adulto , Estudos Transversais , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Feminino , Disparidades em Assistência à Saúde , Humanos , Cobertura do Seguro/estatística & dados numéricos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Estados Unidos , Adulto Jovem
5.
BMC Health Serv Res ; 19(1): 668, 2019 Sep 18.
Artigo em Inglês | MEDLINE | ID: mdl-31533716

RESUMO

BACKGROUND: In England, people of Black Caribbean (BC) ethnicity are disproportionately affected by sexually transmitted infections (STI). We examined whether differences in sexual healthcare behaviours contribute to these inequalities. METHODS: We purposively selected 16 sexual health clinics across England with high proportions of attendees of BC ethnicity. During May-September 2016, attendees at these clinics (of all ethnicities) completed an online survey that collected data on health service use and sexual behaviour. We individually linked these data to routinely-collected surveillance data. We then used multivariable logistic regression to compare reported behaviours among BC and White British/Irish (WBI) attendees (n = 627, n = 1411 respectively) separately for women and men, and to make comparisons by gender within these ethnic groups. RESULTS: BC women's sexual health clinic attendances were more commonly related to recent bacterial STI diagnoses, compared to WBI women's attendances (adjusted odds ratio, AOR 3.54, 95% CI 1.45-8.64, p = 0.009; no gender difference among BC attendees), while BC men were more likely than WBI men (and BC women) to report attending because of a partner's symptoms or diagnosis (AOR 1.82, 95% CI 1.14-2.90; AOR BC men compared with BC women: 4.36, 95% CI 1.42-13.34, p = 0.014). Among symptomatic attendees, BC women were less likely than WBI women to report care-seeking elsewhere before attending the sexual health clinic (AOR 0.60, 95% CI 0.38-0.97, p = 0.039). No ethnic differences, or gender differences among BC attendees, were observed in symptom duration, or reporting sex whilst symptomatic. Among those reporting previous diagnoses with or treatment for bacterial STI, no differences were observed in partner notification. CONCLUSIONS: Differences in STI diagnosis rates observed between BC and WBI ethnic groups were not explained by the few ethnic differences which we identified in sexual healthcare-seeking and use. As changes take place in service delivery, prompt clinic access must be maintained - and indeed facilitated - for those at greatest risk of STI, regardless of ethnicity.


Assuntos
Assistência Ambulatorial/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Saúde Sexual , Adolescente , Adulto , Grupo com Ancestrais do Continente Africano/etnologia , Idoso , Instituições de Assistência Ambulatorial/estatística & dados numéricos , Região do Caribe/etnologia , Estudos Transversais , Inglaterra/epidemiologia , Grupos Étnicos/estatística & dados numéricos , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Utilização de Instalações e Serviços , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Aceitação pelo Paciente de Cuidados de Saúde/etnologia , Assunção de Riscos , Fatores Sexuais , Comportamento Sexual/etnologia , Parceiros Sexuais , Doenças Sexualmente Transmissíveis/diagnóstico , Doenças Sexualmente Transmissíveis/etnologia , Inquéritos e Questionários , Adulto Jovem
6.
Am J Surg ; 218(4): 712-715, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31542150

RESUMO

BACKGROUND: For female breast cancer (BC) patients undergoing mastectomy, post-mastectomy breast reconstruction (PMBR) confers significant psychosocial benefits and improved cosmetic outcomes. The objective of this study is to explore whether the utilization of PMBR varies by race, marital status, and geographical location of the patient. METHODS: Women ≥18 years old who underwent mastectomy for breast cancer diagnosed between 2000 and 2014 were eligible. Women with inflammatory BC, Stage IV BC diagnoses, and bilateral BC were excluded. Multivariable logistic regression, adjusting for patient and cancer characteristics, were used to assess the association between of race, marital status, and region on immediate PMBR utilization. RESULTS: 321,206 women were included and 24% underwent immediate PMBR (<4 months after mastectomy). Compared to white women, black and other non-white women (OR 0.67, 95% CI 0.65, 0.70 and OR 0.52, 95% CI 0.50, 0.53, respectively) were significantly less likely to receive PMBR. Additionally, women who were single (OR 0.72, 95% CI 0.70, 0.75) or no longer married (OR 0.84, 95% CI 0.82, 0.86) were significantly less likely to undergo breast reconstruction, compared to married women. Regional differences were also seen, with women in the Northeast (OR 2.11, 95% CI 2.05,2.17), Midwest (OR 1.53, 95% CI 1.48, 1.58) and South (OR 1.20, 95%CI 1.17, 1.23) all being more likely to undergo breast reconstruction compared to the West. DISCUSSION: Significant variations exist in the utilization of post-mastectomy breast reconstruction across race, marital status or geographical location of the patient. Further research is needed to elucidate these differences and identify areas for intervention to increase awareness, and access to reconstruction for all breast cancer patients.


Assuntos
Afro-Americanos/estatística & dados numéricos , Neoplasias da Mama/cirurgia , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Mamoplastia/estatística & dados numéricos , Mastectomia , Aceitação pelo Paciente de Cuidados de Saúde/etnologia , Adulto , Fatores Etários , Idoso , Neoplasias da Mama/etnologia , Feminino , Humanos , Estado Civil , Pessoa de Meia-Idade , Utilização de Procedimentos e Técnicas , Estados Unidos
7.
BMC Pregnancy Childbirth ; 19(1): 327, 2019 Sep 05.
Artigo em Inglês | MEDLINE | ID: mdl-31488080

RESUMO

OBJECTIVES: We examined the utilisation, equity and determinants of full antenatal care (ANC), defined as 4 or more antenatal visits, at least one tetanus toxoid (TT) injection and consumption of iron folic acid (IFA) for a minimum of 100 days, in India. METHODS: We analysed a sample of 190,898 women from India's National Family Health Survey 4. Concentration curves and concentration index were used to assess equity in full ANC utilisation. Multivariable logistic regression model was used to examine the factors associated with full ANC utilisation. RESULTS: In India, 21% of pregnant women utilised full ANC, ranging from 2.3-65.9% across states. Overall, 51.6% had 4 or more ANC visits, 30.8% consumed IFA for atleast 100 days, and 91.1% had one or more doses of tetanus toxoid. Full ANC utilisation was inequitable across place of residence, caste and maternal education. Registration of pregnancy, utilisation of government's Integrated Child Development Services (ICDS) and health insurance coverage were associated with higher odds of full ANC utilisation. Lower maternal education, lower wealth quintile(s), lack of father's participation during antenatal visits, higher birth order, teenage and unintended pregnancy were associated with lower odds of full ANC utilisation. CONCLUSIONS: Full ANC utilisation in India was inadequate and inequitable. Although half of the women did not receive the minimum recommended ANC visits, the utilisation of TT immunisation was almost universal. The positive association of full ANC with ICDS utilisation and child's father involvement may be leveraged for increasing the uptake of full ANC. Strategies to address the socio-demographic factors associated with low and inequitable utilisation of full ANC are imperative for strengthening India's maternal health program.


Assuntos
Saúde da Família , Equidade em Saúde , Aceitação pelo Paciente de Cuidados de Saúde , Gestantes , Cuidado Pré-Natal , Adolescente , Adulto , Feminino , Equidade em Saúde/organização & administração , Equidade em Saúde/estatística & dados numéricos , Inquéritos Epidemiológicos , Humanos , Índia/epidemiologia , Seguro Saúde/estatística & dados numéricos , Determinação de Necessidades de Cuidados de Saúde , Aceitação pelo Paciente de Cuidados de Saúde/etnologia , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Gravidez , Gravidez na Adolescência/estatística & dados numéricos , Gestantes/educação , Gestantes/etnologia , Cuidado Pré-Natal/métodos , Cuidado Pré-Natal/normas , Cuidado Pré-Natal/estatística & dados numéricos , Melhoria de Qualidade , Fatores Socioeconômicos
8.
Niger Postgrad Med J ; 26(3): 182-188, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31441457

RESUMO

Background: Despite women's adequate knowledge and the obvious unmet need for family planning (FP), contraceptive prevalence in Nigeria is low. A greater understanding of the barriers to FP that informs service utilisation and preferences is needed to improve service delivery. Aim: This study was aimed at assessing the use and preferences of FP services among women. Subjects and Methods: A community-based, descriptive, cross-sectional survey was carried out among 367 women (15-49 years of age) residing in Ikosi-Isheri, Kosofe local government area, who were selected by multistage sampling method. Data were collected using a pre-tested, semi-structured, interviewer-administered questionnaire and were analysed using SPSS software version 20. Frequency distributions and cross tabulations were generated. The Chi-square and Fisher's exact tests were used to determine associations, and the level of significance was set at P ≤ 0.05. Results: Although 64.0% were aware of FP, only 26.4% had ever used FP services. The contraceptive prevalence was 17.9%. Traditional or religious restrictions were given as the reasons for not using FP (40.9%). The preferred FP services were those offered at primary healthcare centres (45.2%) and teaching hospitals (33.9%) because of proximity (38.7%), privacy (14.5%) and health workers being female (22.6%). Age, level of education and marital status were associated with the utilisation of FP services (P < 0.001, P = 0.020 and P < 0.001, respectively). Conclusion: Although awareness was high, uptake was low. Government health facilities were preferred. Primary healthcare should be strengthened, and FP services should be scaled up to make FP more accessible. Services should be closer to where people live while providing the privacy they desire.


Assuntos
Comportamento Contraceptivo , Anticoncepção/psicologia , Serviços de Planejamento Familiar/estatística & dados numéricos , Acesso aos Serviços de Saúde/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Preferência do Paciente , Adolescente , Adulto , Atitude do Pessoal de Saúde , Comportamento de Escolha , Anticoncepção/estatística & dados numéricos , Estudos Transversais , Escolaridade , Feminino , Humanos , Governo Local , Estado Civil , Pessoa de Meia-Idade , Nigéria , Aceitação pelo Paciente de Cuidados de Saúde/etnologia , Inquéritos e Questionários , Adulto Jovem
9.
Eur J Oncol Nurs ; 42: 63-68, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31446265

RESUMO

PURPOSE: To examine associations of health belief and health literacy with Pap smear practice among Asian immigrant women in South Korea. METHODS: This study used a descriptive, cross-sectional study design. A survey was conducted among 196 migrant women who were married to South Korean men, using a questionnaire translated into English, Chinese, Vietnamese, and Korean. Trained research assistants read the questionnaire and the participants gave their answers. RESULTS: The most common birthplace of the immigrant women was Vietnam (43.0%), followed by China (12.2%) and the Philippines (5.6%). Of the participants, 76.5% answered that they had never had a Pap smear test. Multiple logistic regression analysis revealed that age and functional health literacy were associated with Pap smear practice among Asian immigrant women. With a one-year increase in participants' age, Pap smear practice increased 1.15 times (OR = 1.15, 95% CI: 1.07, 1.23). Furthermore, with a one point increase in functional health literacy, Pap smear practice increased 1.18 times (OR = 1.18, 95% CI: 1.02, 1.37). CONCLUSIONS: Results suggest that more information about Pap smear tests should be provided to young immigrant women. Health providers should be made aware that Pap smear practice among young immigrant women might be infrequent and should actively recommend that they receive the tests. To improve Pap smear practice among immigrant women, it is also crucial for educational strategies to include functional health literacy. Nurses could play an important role in explaining and recommending the Pap smear test through communication with immigrant women.


Assuntos
Grupo com Ancestrais do Continente Asiático/psicologia , Emigrantes e Imigrantes/psicologia , Conhecimentos, Atitudes e Prática em Saúde/etnologia , Alfabetização em Saúde , Teste de Papanicolaou , Esfregaço Vaginal , Adulto , China/etnologia , Estudos Transversais , Feminino , Humanos , Casamento , Pessoa de Meia-Idade , Aceitação pelo Paciente de Cuidados de Saúde/etnologia , Filipinas/etnologia , República da Coreia , Inquéritos e Questionários , Neoplasias do Colo do Útero/diagnóstico , Neoplasias do Colo do Útero/etnologia , Vietnã/etnologia , Adulto Jovem
10.
Ethiop J Health Sci ; 29(3): 343-352, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31447502

RESUMO

Background: The influence of socio-cultural factors on institutional birth is not sufficiently documented in Ethiopia. Thus, this study explores socio-cultural beliefs and practices during childbirth and its influences on the utilization of institutional delivery services. Methods: A qualitative study was conducted in three regions of Ethiopia through eight focus group discussions (with women) and thirty in-depth interviews with key informants which included health workers, community volunteers, and leaders. The data were analyzed thematically. Results: The study identified six overarching socio-cultural factors influencing institutional birth in the study communities. The high preference for traditional birth attendants (TBAs) and home as it is intergenerational culture and suitable for privacy are among the factors. Correspondingly, culturally unacceptable birth practices at health facilities (such as birth position, physical assessment, delivery coach) and inconvenience of health facility setting to practice traditional birth rituals such as newborn welcoming ceremony made women avoid health facility birth. On the other hand, misperceptions and worries on medical interventions such as episiotomy, combined with mistreatment from health workers, and lack of parent engagement in delivery process discouraged women from seeking institutional birth. The provision of delivery service by male health workers was cited as a social taboo and against communities' belief system which prohibited women from giving birth at a health facility. Conclusions: Multiple socio-cultural factors and perceptions were generally affected utilization of institutional birth in study communities. Hence, culturally competent interventions through education, re-orientation, and adaptation of beneficial norms combined with women friendly care are essential to promote health facility birth.


Assuntos
Cultura , Parto Obstétrico/métodos , Aceitação pelo Paciente de Cuidados de Saúde/etnologia , Etiópia , Feminino , Grupos Focais , Humanos , Entrevistas como Assunto , Masculino , Preferência do Paciente/etnologia , Gravidez , Privacidade , Pesquisa Qualitativa
11.
Med Care ; 57(10): 773-780, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31415338

RESUMO

INTRODUCTION: Colorectal cancer (CRC) is a common but largely preventable malignancy. Screening is recommended for all adults aged 50-75 years; however, screening rates are low nationally and vary by patient factors and across health care systems. It is currently unknown whether there are inequities in CRC screening rates by patient sociodemographic and/or clinical factors in the Veterans Health Administration (VA) where the majority of patients are CRC screening-eligible age and CRC is the third most commonly diagnosed cancer. METHODS: We performed a retrospective cohort study using VA national clinical performance and quality data to determine the overall CRC screening rate, rates by patient sociodemographic and clinical factors, and predictors of screening adjusting for patient and system factors. We also determined whether disparities in screening exist in VA. RESULTS: The overall CRC screening rate in VA was 81.5%. Screening rates were lowest among American Indians/Alaska Natives [75.3%; adjusted odds ratio (aOR)=0.77, 95% confidence interval (CI)=0.65-0.90], those with serious mental illness (75.8%; aOR=0.65, 95% CI=0.61-0.69), those with substance abuse (76.9%; aOR=0.76, 95% CI=0.72-0.80), and those in the lowest socioeconomic status quintile (79.5%; aOR=1.10-1.31 for quintiles 2-5 vs. lowest quintile 1). Increasing age, Hispanic ethnicity, black race, Asian race, and high comorbidity were significant predictors of screening uptake. CONCLUSIONS: Many racial/ethnic disparities in CRC screening documented in non-VA settings do not exist in VA. Nonetheless, overall high VA CRC screening rates have not reached American Indians/Alaska Natives, low socioeconomic status groups, and those with mental illness and substance abuse. These groups might benefit from additional targeted efforts to increase screening uptake.


Assuntos
Colonoscopia/estatística & dados numéricos , Neoplasias Colorretais/diagnóstico , Detecção Precoce de Câncer/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Saúde dos Veteranos/estatística & dados numéricos , Idoso , Neoplasias Colorretais/etnologia , Neoplasias Colorretais/psicologia , Grupos Étnicos/estatística & dados numéricos , Feminino , Disparidades em Assistência à Saúde , Hispano-Americanos/estatística & dados numéricos , Humanos , Índios Norte-Americanos/estatística & dados numéricos , Masculino , Saúde Mental/etnologia , Saúde Mental/estatística & dados numéricos , Pessoa de Meia-Idade , Razão de Chances , Aceitação pelo Paciente de Cuidados de Saúde/etnologia , Pobreza/etnologia , Pobreza/estatística & dados numéricos , Estudos Retrospectivos , Fatores Socioeconômicos , Estados Unidos , United States Department of Veterans Affairs , Saúde dos Veteranos/etnologia
12.
Niger J Clin Pract ; 22(7): 988-996, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31293266

RESUMO

Background: Health-seeking behavior is important as it reveals the preventive, curative, and rehabilitative actions taken by individuals to rectify perceived ill-health. Aim and Objectives: To identify existing eye health-seeking behavior, factors influencing such behavior, and suggest ways in which the system can respond to the needs of the target population in order to reduce visual impairment and blindness. Methods: This was a descriptive cross-sectional study; 600 respondents were interviewed using a semistructured pretested questionnaire administered to every fifth new patient attending the eye clinic of University of Calabar Teaching Hospital (UCTH) for a period of 5 months by a single interviewer. People unable to respond appropriately were interviewed alongside their caregivers. Results: Poor distant vision was the most frequent ocular complaint in this study. The mean duration of complaint before presentation to any health facility was 370.65 ± 889.48 days with a range of 0-9,125 days. Nature of eye complaint was the most significant factor that determined how early respondents sought help (P < 0.001). Place of residence, nature of eye complaint, and employment status were significant determinants of the choice of place of first presentation for ocular complaints. Conclusion: There is need for improved eye health education and awareness for prompt presentation to an appropriate eye care professional at the onset of symptoms and even case finding for potentially blinding eye conditions.


Assuntos
Oftalmopatias/diagnóstico , Comportamentos Relacionados com a Saúde/etnologia , Conhecimentos, Atitudes e Prática em Saúde , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Pessoas com Deficiência Visual/estatística & dados numéricos , Adolescente , Adulto , Idoso , Cegueira/epidemiologia , Cegueira/etiologia , Criança , Pré-Escolar , Estudos Transversais , Oftalmopatias/epidemiologia , Feminino , Acesso aos Serviços de Saúde , Hospitais de Ensino , Humanos , Lactente , Recém-Nascido , Entrevistas como Assunto , Masculino , Pessoa de Meia-Idade , Nigéria/epidemiologia , Aceitação pelo Paciente de Cuidados de Saúde/etnologia , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Atenção Primária à Saúde , Pesquisa Qualitativa , Fatores Socioeconômicos , Inquéritos e Questionários , Baixa Visão/epidemiologia , Baixa Visão/etiologia , Adulto Jovem
13.
BMC Public Health ; 19(1): 1008, 2019 Jul 29.
Artigo em Inglês | MEDLINE | ID: mdl-31357962

RESUMO

BACKGROUND: How and whether health shocks, care-seeking behaviour and coping strategies are interlinked and influence households resilience to ill-health remains an under-researched subject in the context of Bangladesh. This study investigates whether and how health shocks, care-seeking processes and coping strategies interplay and impact the resilience of extremely poor adivasi (ethnic minority) households in the Chittagong Hill Tracts (CHT), Bangladesh. METHODS: Our analysis draws from qualitative data collected through a range of methods (see Additional file 1). We conducted 25 in-depth interviews (IDIs) of two adivasi communities targeted by an extreme-poverty alleviation programme, 11 key informant interviews (KIIs) with project personnel (community workers, field officers, project managers), community leaders, and healthcare providers, and 9 focus group discussions (FGDs) with community members. Data triangulation was performed to further validate the data, and a thematic analysis approach was used to analyze the data. RESULTS: Health shocks were a defining characteristic of households' experiences of extreme poverty in the studied region. Care-seeking behaviours are influenced by an array of cultural and economic factors. Households adopt a range of coping strategies during the treatment or care-seeking process, which are often insufficient to allow households to maintain a stable economic status. This is largely due to the fact that healthcare costs are borne by the household, primarily through out-of-pocket payments. Households meet healthcare cost by selling their means of livelihoods, borrowing cash, and marketing livestock. This process erodes their wellbeing and hinders they attempt at achieving resilience, despite their involvement in an extreme poverty-alleviation programme. CONCLUSIONS: Livelihood supports or asset-transfers alone are insufficient to improve household resilience in this context. Therefore, we argue that extreme poor households' healthcare needs should be central to the design of poverty-alleviating intervention for them to contribute to foster resilience.


Assuntos
Adaptação Psicológica , Grupos Étnicos/psicologia , Características da Família/etnologia , Nível de Saúde , Grupos Minoritários/psicologia , Aceitação pelo Paciente de Cuidados de Saúde/etnologia , Pobreza/etnologia , Adulto , Bangladesh , Grupos Étnicos/estatística & dados numéricos , Feminino , Grupos Focais , Humanos , Masculino , Grupos Minoritários/estatística & dados numéricos , Pesquisa Qualitativa , Resiliência Psicológica , Adulto Jovem
14.
BMC Pregnancy Childbirth ; 19(1): 250, 2019 Jul 16.
Artigo em Inglês | MEDLINE | ID: mdl-31311501

RESUMO

BACKGROUND: China has made remarkable progress in maternal and child health (MCH) over the last thirty years, but socio-economic inequalities persist. Ethnicity has become an important determinant of poor MCH outcomes, but little rigorous analytical work has been done in this area. To understand the socio-economic factors that explain ethnic variation in uptake of MCH care, we report the findings from an analysis in Sichuan province. METHODS: We linked data from the 2003, 2008 and 2013 National Health Service Surveys in Sichuan Province. The ethnic disparities in uptake of maternal care (completing 5 antenatal visits, giving birth in hospital and receiving a caesarean section) and childhood immunization (Bacillus Calmette Guerin (BCG), three doses of diphtheria (DPT) and measles immunization) were examined by geographical (Han district/county vs. ethnic minority county) and individual-based (Han women/children vs. ethnic minority women/children) comparisons. We also examined variation by distance to township and county hospitals, women's education, parity and age using weighted multilevel Poisson regressions with random intercept at district/county level. RESULTS: Ethnic inequalities in maternal care were marked, both at the geographical (district/county) and the individual level. The % of births in hospital was 90.7% among women in Han districts, compared to 83.3% among women living in Han counties (crude RR 0.93; 95% CI 0.75-1.15), 53.8% among Han women living in ethnic minority counties (crude RR 0.57; 95% CI 0.36-0.93), and 13.5% among ethnic minority women living in ethnic minority counties (crude RR 0.18; 95% CI 0.06-0.57). Adjusting the analysis for survey year, education, parity and distance to county level hospital weakened the association between geographical/individual ethnicity and uptake of maternity care, but associations remained remarkably strong. Coverage of childhood immunization was much higher than uptake of maternity care, and inequalities by ethnicity were much less pronounced. CONCLUSION: Lessons can be learned from China's successful immunization programme to further reduce inequalities in access to maternity care among ethnic minority populations in remote areas. Bringing the services closer to the women's homes and strengthening health promotion from the township to the village level may encourage more women to seek antenatal care and give birth in hospital.


Assuntos
Disparidades em Assistência à Saúde/etnologia , Imunização/estatística & dados numéricos , Serviços de Saúde Materna , Aceitação pelo Paciente de Cuidados de Saúde , Adulto , Pré-Escolar , China/epidemiologia , Grupos Étnicos , Feminino , Pesquisas sobre Serviços de Saúde , Acesso aos Serviços de Saúde , Humanos , Imunização/métodos , Lactente , Serviços de Saúde Materna/organização & administração , Serviços de Saúde Materna/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/etnologia , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Gravidez , Fatores Socioeconômicos
15.
PLoS One ; 14(6): e0213882, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31220092

RESUMO

BACKGROUND: Vaccine hesitancy is one of the contributors to low vaccination coverage in both developed and developing countries. Sudan is one of the countries that suffers from low measles vaccine coverage and from measles outbreaks. In order to facilitate the future development of interventions, this study aimed at exploring the opinions of Expanded Program on Immunization officers at ministries of health, WHO, UNICEF and vaccine care providers at Khartoum-based primary healthcare centers. METHODS: Qualitative data were collected using semi-structured interviews during the period January-March 2018. Data (i.e. quotes) were matched to the categories and the sub-categories of a framework that was developed by the WHO-SAGE Working Group called ''Determinants of Vaccine Hesitancy Matrix''. FINDINGS: The interviews were conducted with 14 participants. The majority of participants confirmed the existence of measles vaccine hesitancy in Khartoum state. They further identified various determinants that were grouped into three domains including contextual, groups and vaccination influences. The main contextual determinant as reported is the presence of people who can be qualified as "anti-vaccination". They mostly belong to particular religious and ethnic groups. Parents' beliefs about prevention and treatment from measles are the main determinants of the group influences. Attitude of the vaccine providers, measles vaccine schedule and its mode of delivery were the main vaccine related determinants. CONCLUSION: Measles vaccine hesitancy in Sudan appears complex and highly specific to local circumstances. To better understand the magnitude and the context-specific causes of measles vaccine hesitancy and to develop adapted strategies to address them, there is clearly a further need to investigate measles vaccine hesitancy among parents.


Assuntos
Vacina contra Sarampo , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Países em Desenvolvimento , Humanos , Entrevistas como Assunto , Aceitação pelo Paciente de Cuidados de Saúde/etnologia , Cooperação do Paciente/etnologia , Cooperação do Paciente/psicologia , Religião , Sudão , Cobertura Vacinal
16.
Zhonghua Liu Xing Bing Xue Za Zhi ; 40(6): 643-647, 2019 Jun 10.
Artigo em Chinês | MEDLINE | ID: mdl-31238612

RESUMO

Objective: To analyze the epidemiological characteristics, trend and related factors of tuberculosis patients that delayed for care, in Wuhan from 2008 to 2017. Methods: Data regarding tuberculosis (TB) patients was collected from the tuberculosis management information system (TMIS), a part of the China information system for disease control and prevention from 2008 to 2017. A total of 64 208 tuberculosis patients, aged 0 to 95 years were included for the analysis. Unconditional logistic regression method was used to estimate those factors that associated with this study. Results: Days of delay among TB patients appeared as M=10 (P(25)-P(75): 3-28) day, in Wuhan, 2008-2017. The prevalence of the delay was 52.5% (33 703/64 208), presenting a downward trend from 2008 to 2017 (trend χ(2)=10.64, P<0.001), but the proportions of women and ≥65 year-olds were gradually increasing. Results from the multivariate logistic regression analysis showed that factors as: patients living far away from the city vs. near the city (OR=1.29, 95%CI: 1.25-1.35), and age above 45 years vs. younger than 25 years (the age 45-64 years group vs. aged less than 25 years group, OR=1.22, 95%CI: 1.15-1.29; the age 65 or above group vs. aged less than 25 years group, the OR=1.30, 95%CI: 1.22-1.39) were under higher risk on the delay of seeking care. Occupation, way of case-finding and classification of tuberculosis patients also appeared as influencing factors on this issue. Conclusions: Prevalence on the delay of care was 52.5% among tuberculosis patients in Wuhan, 2008-2017, but with an annual decrease. Attention should be paid to female, wrinkly or elderly tuberculosis patients regarding the delay of care on TB, in Wuhan.


Assuntos
Antituberculosos/uso terapêutico , Diagnóstico Tardio , Conhecimentos, Atitudes e Prática em Saúde , Acesso aos Serviços de Saúde , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Características de Residência/estatística & dados numéricos , Tuberculose Pulmonar/diagnóstico , Tuberculose Pulmonar/tratamento farmacológico , Adolescente , Adulto , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , China/epidemiologia , Assistência à Saúde/organização & administração , Feminino , Humanos , Lactente , Recém-Nascido , Pessoa de Meia-Idade , Aceitação pelo Paciente de Cuidados de Saúde/etnologia , Prevalência , Distribuição por Sexo , Tuberculose Pulmonar/epidemiologia , Tuberculose Pulmonar/microbiologia , Adulto Jovem
18.
AIDS Behav ; 23(9): 2432-2442, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31218545

RESUMO

African American women experience higher rates of HIV than other women in the United States, and stigma has been identified as an important determinant of engagement in HIV care. Our study examined whether key variables moderated the effect of an anti-stigma intervention on outcomes among African American women receiving treatment for HIV. Twelve potential moderators included: age, years lived with HIV, marital status, employment status, education level, PTSD diagnosis, alcohol use, social support, baseline CD4 count, baseline viral load, and number of children. Outcomes included changes in: HIV-related stigma, social support, depressive symptoms, PTSD symptoms, alcohol use, viral load, and engagement in HIV care. Results suggest that the intervention is associated with greater improvement in engagement in care among participants with PTSD or depression at baseline, and may help maintain engagement in care among participants experiencing certain mental health conditions. This provides opportunities to address discriminatory structural barriers that lead to stigma and drop-offs in HIV care.


Assuntos
Afro-Americanos/psicologia , Alcoolismo/psicologia , Depressão/psicologia , Infecções por HIV/psicologia , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Estigma Social , Apoio Social , Transtornos de Estresse Pós-Traumáticos/psicologia , Adolescente , Adulto , Afro-Americanos/estatística & dados numéricos , Idoso , Alcoolismo/epidemiologia , Fármacos Anti-HIV/uso terapêutico , Contagem de Linfócito CD4 , Depressão/epidemiologia , Feminino , Infecções por HIV/tratamento farmacológico , Infecções por HIV/etnologia , Humanos , Pessoa de Meia-Idade , Aceitação pelo Paciente de Cuidados de Saúde/etnologia , Educação de Pacientes como Assunto , Fatores Socioeconômicos , Transtornos de Estresse Pós-Traumáticos/epidemiologia , Estados Unidos/epidemiologia , Carga Viral
19.
AIDS Patient Care STDS ; 33(7): 336-341, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31194578

RESUMO

In the United States, undocumented African immigrants living with HIV enter care late, potentially leading to adverse individual and population health outcomes, yet little is known about the specific experiences of HIV diagnosis and linkage to care among this population. We conducted individual, semi-structured interviews with adults who were undocumented African immigrants living with HIV in New York City. Interviews explored perspectives regarding individual, social, institutional, and societal barriers and facilitators of HIV testing and linkage to care. Of 14 participants from 9 different African countries, 9 were women and the median age was 44 years (interquartile range: 42-50). Participants described fear of discovery by immigration authorities as a substantial barrier to HIV testing and linking to initial medical appointments. Actual and perceived structural barriers to both testing and care linkage included difficulty obtaining health insurance and a belief that undocumented immigrants are ineligible for any health services. Participants also expressed reluctance to be tested because of HIV-related stigma within the immigrant communities that they heavily relied on. After diagnosis, however, participants overwhelmingly described a positive role of health and social service providers in facilitating linkage to HIV care. Concerns about immigration status and HIV-related stigma are significant barriers to HIV testing and linkage to care among undocumented African immigrants. Multilevel efforts to reduce stigma and increase awareness of available services could enhance rates of HIV testing and care linkage in this population.


Assuntos
Continuidade da Assistência ao Paciente/estatística & dados numéricos , Infecções por HIV/diagnóstico , Acesso aos Serviços de Saúde , Seguro Saúde/estatística & dados numéricos , Programas de Rastreamento/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/etnologia , Imigrantes Indocumentados/psicologia , Adulto , África/etnologia , Feminino , Infecções por HIV/tratamento farmacológico , Infecções por HIV/etnologia , Conhecimentos, Atitudes e Prática em Saúde/etnologia , Humanos , Entrevistas como Assunto , Masculino , Pessoa de Meia-Idade , Cidade de Nova Iorque/epidemiologia , Pesquisa Qualitativa , Testes Sorológicos , Estigma Social , Imigrantes Indocumentados/estatística & dados numéricos , Estados Unidos/epidemiologia , Adulto Jovem
20.
Afr Health Sci ; 19(1): 1638-1646, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31148993

RESUMO

Background: Problems may arise with insulin treatment, due to patients' perspective towards it leading to refusal. Objectives: To evaluate diabetic patients' refusal towards insulin therapy, and to assess patients' perception and perceived barriers towards insulin. Methods: A cross-sectionalstudy, where type 2 diabetics participated in the study during a period, February through March 2017. They were interviewed in person by a questionnaire including three sections; socio-demography, medical history and a health belief model, comprising barriers to use insulin. Five points Likert scale was used to measure patients' perception and barriers towards insulin therapy. Results: One fourth (24.4%) of the diabetic patients refused insulin. Among the controlled group, 34.4% refused insulin, while 21% refused insulin among the uncontrolled group. The study showed different barriers towards insulin therapy, including fear of injection, pain, insulin injection needs help from others, fear of hypoglycaemia and embarrassment. Conclusion: Diabetics showed a negative attitude towards insulin therapy due to social and psychological factors. The results necessitate the development of a strategy to address problems related with a reluctance to initiate insulin and put a strategy to implement education and better interaction with diabetic team to the stigma from phobia from insulin use.


Assuntos
Diabetes Mellitus Tipo 2/tratamento farmacológico , Hipoglicemiantes/administração & dosagem , Insulina/administração & dosagem , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Estigma Social , Recusa do Paciente ao Tratamento/psicologia , Adulto , Idoso , Instituições de Assistência Ambulatorial , Estudos Transversais , Diabetes Mellitus Tipo 2/epidemiologia , Diabetes Mellitus Tipo 2/psicologia , Feminino , Humanos , Hipoglicemiantes/uso terapêutico , Masculino , Pessoa de Meia-Idade , Aceitação pelo Paciente de Cuidados de Saúde/etnologia , Arábia Saudita/epidemiologia , Autocuidado/psicologia , Inquéritos e Questionários , Recusa do Paciente ao Tratamento/etnologia
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