Attending Health Services Research Articles

Psychotic relapse and associated factors among patients attending health services in Southwest Ethiopia: a cross-sectional study.

BackgroundPsychotic relapse leads to repeated hospitalization and negatively affects the clinical prognosis of the patients. Information on prevalence of relapse among patients with psychotic disorders in Ethiopian setting is scarce. This study aimed to assess the prevalence of relapse among patients with psychotic disorders attending services in Jimma University Specialized Hospital (JUSH).MethodsData were collected using interviewer administered questionnaire. We used medication adherence rating scale (MARS) to assess compliance to medication and abnormal involuntary movement scale (AIMS) to detect medication side effects. Logistic regression analysis was used to identify independent predictors of psychotic relapse. All variables with P-value <0.25 in the bivariate analyses were entered into multivariate logistic regression and variables with P-value < 0.05 in the final model were declared to be significantly associated with the outcome variable.ResultsThe prevalence of relapse among patients with psychotic disorder was 24.6 % (n = 95). Of this, 25.4 and 22.4 % were males and females respectively. The odds of developing psychotic relapse among patients living with family was 72 % lower than that of patients living alone (aOR = 0.28, 95 % CI = 0.08, 0.93). The odds of developing psychotic relapse among patients compliant to medication was 69 % lower than that of patients who were not compliant to medications (aOR = 0.31, 95 % CI = 0.12, 0.80). The odds of developing psychotic relapse among patients having high score on social support score was 48 % lower than that of patients who were compliant to medications (aOR = 0.52, 95 % CI = 0.28, 0.95). The odds of developing psychotic relapse among patients reporting to have sought religious support was 45 % lower than that of patients who have not sought religious support (aOR = 0.55, 95 % CI = 0.31, 0.96). On the other hand, the odds of developing psychotic relapse among participants who have experienced medication side effects was 1.83 times higher when compared to those who have never experienced medication side effects (aOR = 1.83, 95 % CI = 1.01, 3.31).ConclusionsThe high prevalence of relapse among patients with psychotic disorder needs special attention. Clinicians need to pay attention to medication side effects the patient faces. Intervening noncompliance to medication and appropriately managing medication side effects may help in preventing psychotic relapse that may result because of non-compliance. The provision of counseling, psycho education, psycho social support may help patients in improving compliance to medication and reducing psychotic relapse. Developing and strengthening community based rehabilitation services should be emphasized as part of mental healthcare services.

Bundap Marram Durn Durn: Engagement with Aboriginal women experiencing comorbid chronic physical and mental health conditions

Objective:To explore antecedents of health service engagement and experience among urban AboriginalaaIn this paper, Aboriginal people encompass all Aboriginal and/or Torres Strait Islander people – Australia's First People. people with comorbid physical and mental health conditions. Methods:Focus groups and interviews were conducted with Aboriginal people who had comorbid health conditions and were accessing Aboriginal and/or mainstream services.bbMainstream services are services operating outside of the Aboriginal community‐controlled health sector and include hospitals, primary health care, community health and a broad range of specialist services. Results:Nineteen participants, all women, were recruited. Participants' personal histories and prior experience of health services affected effective service utilisation. Participants’ service experiences were characterised by long waiting times in the public health system and high healthcare staff turnover. Trusted professionals were able to act as brokers to other clinically and culturally competent practitioners. Conclusions:Many urban Aboriginal women attended health services with multiple comorbid conditions including chronic disease and mental health issues. Several barriers and enablers were identified concerning the capacity of services to engage and effectively manage Aboriginal patients’ conditions. Implications:Results indicate the need to explore strategies to improve health care utilisation by urban Aboriginal women.

Promise and pitfalls of pre-exposure prophylaxis for female sex workers.

We explore the potential benefits of integrating preexposure prophylaxis (PrEP) into combination HIV prevention for female sex workers (FSWs) and the likely challenges to implementation. Evidence for the biological effectiveness of PrEP in women who can adhere to daily dosing is strong. FSWs in many countries bear the brunt of the HIV epidemic. Current combination prevention approaches enable many FSWs to remain HIV-free, but in some settings FSWs are unable to mitigate their risk. PrEP provides a new prevention tool for these women. To benefit, HIV-negative FSWs need to perceive that they are at risk, be motivated and able to take PrEP daily and to attend health services for prescription refill and clinical monitoring. FSWs face particular structural challenges to PrEP uptake and use, including stigmatizing health services; fear of disclosure to other FSWs and clients; fear of the authorities; lack of social support; substance use; unplanned travel and risk compensation many of which can be addressed through combination prevention approaches. For those FSWs who are unable to mitigate their HIV risk, PrEP, if adequately supported and integrated with combination prevention, may empower them to remain HIV-free.

Human papillomavirus prevalence to age 60 years among Australian women prevaccination.

Background The prevalence of human papillomavirus (HPV) at the cervix varies with age, peaking following sexual debut and declining thereafter in most populations. In some populations, a second peak is observed. Here we describe the prevalence of HPV at the cervix among Australian women before the commencement of the HPV vaccination program. Women aged 15 to 60 years attending health services for cervical screening between 2005 and 2008 were invited to participate. Liquid based cervical specimens were tested for 37 types of HPV using linear array. The percentage and 95% confidence interval of women with any type of HPV, any of 13 high risk HPV types, and with vaccine-preventable HPV types (types 6, 11, 16 and 18) were estimated in 5-year age bands. Among 1929 women aged 15-60 years, HPV prevalence peaked at 64% at age 15-20 years, then declined gradually to 12% at age 41-45 years, whereafter it rose to 19% in women 51-55 years then returned to 14% in 56-60 year olds. Prevalence curves were similar for high-risk HPV types and vaccine-targeted HPV types 6, 11, 16 and 18 and when results were restricted to women with only normal cytology. The shape of the prevalence curve we observed is similar to those from other Western populations. Variation in prevalence curves is likely due to differences in sexual behaviour between populations and over time, reactivation of HPV during perimenopause, and possibly the presence of cervical screening programs. These data are the first such data from the Oceania region.

Current updates on early detection and prevention of oral cancer

Oral cancer is ranked among the top 10 cancers in the world. Oral squamous cell carcinoma (OSCC) constitutes more than 90% of oral cancers. The risk factors for OSCC are well-known. Tobacco and alcohol being the major causes make the disease preventable. Data reveal that only around half of the patients survive the disease over 5 years. Despite advances in treatment modalities over past decades, a significant improvement in prognosis is not achieved. This is attributable to the failure to detect small lesions and potentially malignant lesions early, which precludes successful treatment. Therefore, early detection is the key to improve survival rate in oral cancer patients. [1] Early detection is possible through screening programs and by employing specific diagnostic aids and biomarkers. [2] Although extensive research and clinical application of diagnostic aids and biomarkers are rising, they lack practical feasibility when applied to larger population at risk and low socio-economic groups. A recent systematic review on screening programs and preventive measures on oral cancer concludes that systematic visual oral examination by a clinician is by far the most common method for screening. Cost-effectiveness and feasibility increase its popularity. Visibility of the lesion may be enhanced by employing special dyes. [3] A cluster-randomized control trial conducted by Sankaranarayanan et al. (2013) reported a sensitivity of 67.4% for the visual examination in detecting oral cancer. They concluded that those who adhere to repeated screening rounds demonstrate a sustained reduction in oral cancer mortality, thus highlighting the significance of population-based screening programs targeting tobacco and/or alcohol users. [4] The National Institute of Dental and Craniofacial Research and World Health Organization propose that screening for oral cancer should involve a systematic visual inspection of the oral cavity and palpation of the tongue, floor of the mouth and regional lymph nodes. If any abnormality persists for more than 2 weeks, then it calls for a re-evaluation and should be considered for biopsy. [5,6] Screening may be targeted at high risk groups or opportunistic, that involves people who attend health services for other reasons or a population as a whole based on statistics. [3] In contrary, a review by the US Preventive Services Task Force (USPSTF) on the evidence on efficacy and accuracy of oral cancer screening programs revealed inadequate evidence on the diagnostic accuracy and benefits of oral cancer screening in asymptomatic adults. USPSTF has thus recommended counseling to prevent tobacco use and to reduce alcohol misuse. [7]

Characteristics and Risk Factors Attributed to Coronary Artery Disease in Women Attended Health Services in Gaza-Palestine Observational Study

Coronary artery disease (CAD) is the leading cause of death in both sexes worldwide, and becomes number one killer in women due to many factors including increase in traditional risk factors, delays in apparition of symptoms, under estimation of diagnosis test and treatment. Our study aims to identify risk factors for coronary artery disease among women with chest pain underwent coronary angiography during years (2010-2013) in cardiology center. The study design is an observational among 688 women-aged 32 - 96 years; the mean age of our study population is 61 years. Risk factors are abstracted from patients’ files. Women with documented coronaries disease tend to be older, have higher, systolic blood pressure, serum level of triglyceride, and impaired clearance creatinine. 59.4% of them are menopause with higher prevalence of hypertension and diabetes (58.6% and 63.6%). Significant positive association is found in women with myocardial infarction, unstable angina, stable angina and presence of obstructive coronary artery disease respectively (89.6%, 82.3%, 59.1%) in opposite women presented with atypical chest pain have high prevalence of normal coronaries (95.7%). About 57.6% have more than three risk factors, and 55.3% are obese or overweight. In addition, 42.1% of them have impaired systolic function. We conclude that cardiovascular risk factors are highly prevalent among Palestinians women in Gaza and the combination of risk factors is common. Interventions to minimize CAD in our population are needed.

The Connections Program: From Correctional to Community Integration

Prior to the Connections Program, patients leaving custody were generally provided with appointments to attend health services, with little practical assistance and fragmented service provision across Local Health Districts (LHDs). The Justice Health & Forensic Mental Health Network (JH&FMHN) Connections Program addressed this through a strategic state-wide approach to release planning. Meetings with key stakeholders within the correctional environment informed how Connections could work within existing structures and programs avoiding role duplication. Agreements were put in place improving and enhancing access to government and non-government organisations in the community, meeting identified patient needs. Comprehensive training, orientation and mentorship programs for staff were developed with supportive clinical review structures and mandatory clinical supervision imbedded. Connections works with illicit drug users in custody, assertively linking participants post release with existing community support services over four weeks. It operates within an assertive linkage model of engagement underpinned by the Personal Strengths Model of Care. This population tends to have higher morbidity and mortality rates than the general population and returns to custody at very high rates. Patients released from custody are often complex with limited coping skills and require an assertive approach to engagement currently not available within existing Drug and Alcohol service provision. Connections ensures patients receive integrated health care and welfare supports addressing their needs, avoiding duplication of provision and removing barriers to access. This assertive team approach through a series of agreements with health and welfare services throughout NSW resulted in an integrated approach that reduced recidivism, mortality and morbidity. These outcomes are not found in other jurisdictions. Since 2007, almost six thousand participants have been assisted by Connections. All complete comprehensive assessments, and collaborate in developing a release plan to meet their identified health and welfare needs. Following release, participants are provided with a worker for four weeks to achieve integration. Assistance provided includes obtaining identification, housing, education, employment, food, clothing and transporting patients as appropriate to health and welfare appointments while actively advocating and negotiating service access. A 2009 evaluation of Connections completed by the National Drug and Alcohol Research Centre found completing Connections was associated with significant improved health and remaining in the community for a longer time than previously. In 2012 a further internal analysis found participants who remained engaged during the four weeks follow up period reported significantly World Congress on Integrated Care 2014, Sydney, November 23-26, 2014. International Journal of Integrated Care – Volume 14, 8 December – URN:NBN:NL:UI:10-1-116633– http://www.ijic.org/ improved general health (p<0.001), mental health (p<0.01) and social functioning (p<0.001). No differences were found between Aboriginal (who are over-represented in custody and on the Connections Program – 25% v’s 2.2% of the NSW general population) and non-Aboriginal participants. In NSW 1988-2002 the conservative death rate for a prisoner within 4 weeks post release was 104 (2.2%). Since 2007, Connections has had 27 (0.4%) known deaths of participants compared with an expected 132 (2.2%). This approach to release planning could be replicated with other groups leaving institutions and across jurisdictions. Connections has received recognition at a number of awards and was a winner at the 2013 National Drug & Alcohol Awards and at the 2013 National Violence and Crime Prevention Awards.

The Maximising STI Control (MSTIC) webtool: a new approach to facilitate the planning of services for sexually transmitted infections to maximise public health benefit

BackgroundIn the UK, national guidelines have sought to improve access to sexual health care, in part by expanding community-based provision of sexually transmitted infection (STI) testing, diagnosis, and care. Although useful data sources exist, there is little evidence for or guidance on the effect of different combinations of sexual health services on STI control locally. With finite resources, service planners need to identify the most effective combinations of STI services for their population. We sought to develop an evidence-based webtool aimed at supporting local service planning by synthesising the key data to show the relative consequences of different service configurations for different types of population. MethodsWe used a decision analytic model (DAM) to identify and model the effects of the characteristics of STI service provision, demography, and sexual behaviour that are likely to have the greatest effect on the incidence of common STIs. The DAM synthesised data from a range of sources, including census, surveillance systems, and probability sample surveys. We validated the DAM using data obtained from a standardised survey of people attending health services in four geographically and sociodemographically contrasting populations across England. The results of the model were presented as a webtool, requiring users to enter routinely available demographic data for their population along with characteristics and outcomes data for existing, proposed, or both health services providing care for STIs locally. The results are processed to estimate the effect on incidence of chlamydia and gonorrhoea locally. We consulted intended users attending a national sexual health conference to gain feedback on our webtool by giving them the opportunity to try the instrument for themselves, as well as ask questions of the designer and the mathematical modeller, for example, regarding the assumptions underlying the webtool. FindingsThe DAM identified the following demographic and service-level characteristics as key for estimating likely STI incidence in a locality: population type (urban, suburban, or semi-rural, taking account of assumptions about the area's ethnic mix and the proportion of men who have sex with men); size of the population aged 16–44 years, stratified by sex; type or types and capacity of services offering STI testing; level of partner notification achieved by these services; and mean delay between STI test and result. Consultation and usability testing revealed that commissioners and service planners were keen to explore the relative effect on disease control of varying assumptions about the type or types and capacity of services. However, clinicians were concerned about its reductionism and absence of individual patient perspective, although interested in the potential for exploring population outcomes for their services using an interactive decision-making instrument. We addressed these concerns by revising the accompanying user guide to ensure that we clearly explained the assumptions and limitations of our webtool, as well as including a technical appendix that provided details of the mathematical model. InterpretationOur evidence-based webtool allows service planning stakeholders to exploit routine data to inform rational STI service planning for their local population, showing how a one-size-fits-all approach does not apply to STI service planning. However, a willingness of users to engage with new approaches to service planning cannot be assumed. To achieve the buy-in necessary for the deployment of such instruments, user involvement has proven vital, resulting in improved communication and clarification of its assumptions and limitations. Evidence-based service planning needs to be promoted to ensure that STI services benefit both individual and public health. FundingMRC/DH Sexual Health and HIV Research Strategy Committee (grant G0601685).

O22.6 Field Evaluation of Three Point-Of-Care Tests For Chlamydia and Gonorrhoea in Remote Health Services in Australia

IntroductionControl of sexually transmissible infections (STIs) can be compromised by delays in time to diagnosis and treatment. Point-of-care (POC) tests can provide results at time of consultation. We conducted field...

Contact Investigation in Households of Patients with Tuberculosis in Hanoi, Vietnam: A Prospective Cohort Study

SettingExisting tuberculosis control strategies in Vietnam are based on symptomatic patients attending health services for investigation. This approach has not resulted in substantial reductions in the prevalence of tuberculosis disease, despite the National Tuberculosis Program achieving high treatment completion rates. Alternative approaches are being considered.ObjectiveTo determine the feasibility and yield of contact investigation in households of patients with smear positive pulmonary tuberculosis among household members of tuberculosis patients in Hanoi, Vietnam.MethodsHousehold contacts of patients with smear positive pulmonary tuberculosis were recruited at four urban and rural District Tuberculosis Units in Hanoi. Clinical and radiological screening was conducted at baseline, six months and 12 months. Sputum microscopy and culture was performed in contacts suspected of having tuberculosis. MIRU-VNTR molecular testing was used to compare the strains of patients and their contacts with disease.ResultsAmong 545 household contacts of 212 patients, four were diagnosed with tuberculosis at baseline (prevalence 734 cases per 100,000 persons, 95% CI 17–1451) and one was diagnosed with tuberculosis during the subsequent 12 months after initial screening (incidence 180 cases per 100,000 person-years, 95% CI 44–131). Two of these cases were culture positive for M. tuberculosis and both had identical or near-identical MIRU-VNTR strain types.ConclusionHousehold contacts of patients with potentially infectious forms of tuberculosis have a high prevalence of disease. Household contact investigation is feasible in Vietnam. Further research is required to investigate its effectiveness.

Acesso à assistência odontológica no acompanhamento pré-natal

This study sought to evaluate the self-perceived response to dental care during prenatal assistance in the Unified Health System (SUS) in the Metropolitan Region of Vitória, Espírito Santo, Brazil. 1032 postpartum women were interviewed and 1006 prenatal records copied. Postpartum women's self-perceived response was measured by the Oral Health Index Profile-14. When an impact was identified, dental care rendered in educational, preventive and curative terms was considered adequate. When there was no impact, assistance was considered adequate in educational and preventive terms. The Chi-square test revealed an association between prenatal care and dental care. Oral health impact on quality of life was 14.7%. Dental care received by mothers in educational terms was rated at 41.3%, while in preventive terms it was 21% and in curative terms it was 16.6%. Six or more prenatal appointments coupled with educational activities was closely associated with adequate dental care (p < 0.05). Access to dental care is facilitated when pregnant women attend health services and become involved in educational activities during the prenatal period. Consequently, educational measures appear to indicate an improvement in prenatal care in the SUS.

Can we talk about the right to healthcare without language? A critique of key international human rights law, drawing on the experiences of a Deaf woman in Cape Town, South Africa

A case study in Cape Town, South Africa, explores the right to health for signing Deaf1 patients attending health services and who are unable to communicate in a language they understand. It argues that, without language, Deaf South Africans’ dignity and right to health is violated, resulting in serious consequences such as incorrect diagnosis, improper treatment and standard of care not being applied. It critiques the provisions of the Convention on the Rights of Persons with Disabilities (CRPD) and the limits of General Comment 14 of the International Covenant on Economic, Social and Cultural Rights. The paper demonstrates that Deaf patients do not have informational access to healthcare. It argues that language via professional interpreter services is essential to their South African constitutional right of access to healthcare. General Comment 14 addresses informational accessibility, but this is insufficient without addressing language as a pre-requisite. The CRPD imposes on the South African government human rights obligations to provide professional interpreter services for Deaf people, but unfortunately it allows a loophole by enabling cost to serve as reasonable grounds to defer action.

P35 A collaborative approach to controlling an HIV outbreak among intravenous drug users

BackgroundIn 2008 an intravenous drug user (IVDU) admitted to the infectious diseases unit was diagnosed with late-stage HIV. He named five injecting partners, of whom three tested negative for HIV,...

Men's attitudes towards chlamydia screening: a narrative review

Chlamydia trachomatis is a sexually transmissible infection (STI) that affects significant numbers of men. Research on men's perspectives on chlamydia screening (or testing) has been limited. We conducted a narrative review to examine: (1) what factors encourage or discourage men from attending health services for chlamydia screening, and/or from accepting screening once it has been offered to them, and (2) where men want chlamydia screening services to be located. A narrative review of the recent peer-reviewed literature (published between 1999 and 2009) on men's attitudes towards chlamydia screening. To be included, articles had to explore men's perspectives on screening (which could be ascertained through quantitative or qualitative studies, or from relevant discussion papers or reviews). Forty-eight articles were included in all. Men's attitudes towards chlamydia screening are influenced by their knowledge about the infection, their perceived vulnerability to the infection, the degree of embarrassment and shame that they associate with screening and the stigma that they associate with screening. Men prefer to be offered urine testing for chlamydia. Men want to be offered screening by non-judgemental professionals. Men's attitudes towards screening for chlamydia in general practice, genito-urinary medicine clinics, home and outreach settings are also explored in this review. Several factors influence men's attitudes towards screening. Two central themes underlie and influence many of these factors: men's needs to make positive impressions on others, and men's identification with particular ideals of masculinity. The review concludes with suggestions for future research on this topic.

Body mass index in individuals with HIV infection and factors associated with thinness and overweight/obesity

A cross-sectional study was conducted using body mass index (BMI) to estimate the prevalence of thinness and overweight/obesity and associated factors in 2,018 individuals with HIV/AIDS attending health services referral centers. The dependent variable was classified as thinness, overweight/obesity and eutrophy. Multinomial logistic regression analyses were performed considering eutrophy as the reference level. The prevalence of thinness was 8.8% and of overweight/obesity, 32.1%. The variables associated with thinness were anemia and CD4 cell count < 200mm³. The variables associated with risk of overweight/obesity were age > 40 years and diabetes, and the variables identified as decreasing likelihood of overweight/obesity were having no long-term partner, smoking, presence of an opportunistic disease, anemia, and albumin levels < 3.5mg/dL. The main nutritional problem observed in this population was overweight and obesity, which were much more prevalent than thinness. Older individuals with diabetes should be targeted for nutritional interventions and lifestyle changes.

P2-253 Alcohol misuse among partners: a potential effect modifier in the relationship between physical intimate partner violence and postpartum depression

IntroductionThis study evaluated if the probability of postpartum depression (PPD) increases with an upward gradient of physical intimate partner violence (IPV) during pregnancy and whether substance use by any member...

Estimating the Disease Burden of 2009 Pandemic Influenza A(H1N1) from Surveillance and Household Surveys in Greece

BackgroundThe aim of this study was to assess the disease burden of the 2009 pandemic influenza A(H1N1) in Greece.Methodology/Principal FindingsData on influenza-like illness (ILI), collected through cross-sectional nationwide telephone surveys of 1,000 households in Greece repeated for 25 consecutive weeks, were combined with data from H1N1 virologic surveillance to estimate the incidence and the clinical attack rate (CAR) of influenza A(H1N1). Alternative definitions of ILI (cough or sore throat and fever>38°C [ILI-38] or fever 37.1–38°C [ILI-37]) were used to estimate the number of symptomatic infections. The infection attack rate (IAR) was approximated using estimates from published studies on the frequency of fever in infected individuals. Data on H1N1 morbidity and mortality were used to estimate ICU admission and case fatality (CFR) rates. The epidemic peaked on week 48/2009 with approximately 750–1,500 new cases/100,000 population per week, depending on ILI-38 or ILI-37 case definition, respectively. By week 6/2010, 7.1%–15.6% of the population in Greece was estimated to be symptomatically infected with H1N1. Children 5–19 years represented the most affected population group (CAR:27%–54%), whereas individuals older than 64 years were the least affected (CAR:0.6%–2.2%). The IAR (95% CI) of influenza A(H1N1) was estimated to be 19.7% (13.3%, 26.1%). Per 1,000 symptomatic cases, based on ILI-38 case definition, 416 attended health services, 108 visited hospital emergency departments and 15 were admitted to hospitals. ICU admission rate and CFR were 37 and 17.5 per 100,000 symptomatic cases or 13.4 and 6.3 per 100,000 infections, respectively.Conclusions/SignificanceInfluenza A(H1N1) infected one fifth and caused symptomatic infection in up to 15% of the Greek population. Although individuals older than 65 years were the least affected age group in terms of attack rate, they had 55 and 185 times higher risk of ICU admission and CFR, respectively.

Factors determining access to and use of primary health care services in the Girona Health Region (Spain)

Increased population flowing from abroad has generated an intense debate regarding the economic consequences of migration in public services such as health, where new and specific demands are being created. This new demand for health care gives rise to the need to identify those factors which influence the user's decision to contact the health services and those which determine the quantity of services consumed. The aim of this study is to identify which variables affect these two stages of the use of such services in the Girona Health Region (RSG), where immigrant population represents 21.96% of the total population. Specification of a Hurdle model with a count response variable related to primary health care service visits in the RSG for 2006. The study data is based on a sample of users (immigrants and natives) taken from the population assigned to primary health care services in eight Basic Health Areas (ABS) of the RSG. Contacting primary health care services is associated with variables that ought to affect use of health care such as chronic illness and taking prescribed medication as well as being aged between 46 and 55. Using primary health care services once makes users more likely to make further visits. The number of visits is related not only with variables that ought affect use of health care but also with variables that ought not to affect use of health care such as working without a contract, living in rented accommodation, or being unemployed. Additionally, if we consider the birthplace of the user, we observe the same pattern, with different directions and intensities, depending on the origin of the patient. For example, a higher likelihood of first contact is shown in Eastern Europeans, South Americans, and North Africans that suffer from cholesterol. A higher attendance is observed in natives and Eastern Europeans that take prescribed medication as well as natives, Eastern Europeans, and North Africans living in rented accommodation. On the other hand, working without a contract supposes a higher attendance in natives but a lower attendance in Eastern Europeans and sub-Saharan Africans. We do not detect any socioeconomic barriers associated with making a first contact with primary health services for the users analyzed. However, we do note evidence of horizontal inequity in terms of attending health services, related to variables that ought to affect use of health care as well as socioeconomic factors (variables that ought not to affect use of health care). The user's origin is an important key in detecting different intensities of access and regular visits to primary health care services.

What Concerns do Young Adults in Ireland Have about Attending Health Services for STD Testing?

Thirty Irish young adults (between eighteen and twenty-nine years of age) were interviewed about their experiences of accessing and attending healthcare settings for STD (sexually transmitted disease) testing. Four principle themes emerged: the risk of stigma as a result of seeking STD testing; the need to engage in impression management activities while accessing information about STD testing; the importance of using healthcare settings that supported rather than undermined impression management attempts; and identity risks experienced while waiting in clinic reception areas. Findings are discussed in relation to previous research on this topic.

Alcohol misuse among partners: a potential effect modifier in the relationship between physical intimate partner violence and postpartum depression

This study evaluated if the probability of postpartum depression (PPD) increases with an upward gradient of physical intimate partner violence (IPV) during pregnancy and whether substance use by any member of the couple modifies this relationship. The sample comprised 811 randomly selected mothers of children under 5 months old attending primary health services of Rio de Janeiro, Brazil. The Revised Conflict Tactics Scale (CTS2) gauged physical IPV, and the Edinburgh Postnatal Depression Scale (EPDS) assessed PPD. A hierarchical logistic regression model was employed to deal with confounding. Specific interaction terms between physical IPV and alcohol misuse or use of illicit drugs were also tested. Physical IPV during pregnancy was reported by 37.8% of respondents and 24.3% were presumably depressed (EPDS score ≥ 12). Interaction between physical IPV and partners' alcohol misuse was statistically significant (p = 0.026). Although there was a significant increase in PPD with just one act of physical IPV in the absence of a partners' alcohol misuse, mounting acts did not have any further influence. Conversely, when partners misused alcohol, the probability progressively and steeply increased from two acts onwards, reaching almost sevenfold by six cumulative physical IPV events as opposed to none. The results reinforce the relevance of physical IPV as a risk factor to PPD. They also suggest that context matters, partners' alcohol misuse acting as an important effect modifier. These evidences justify tailored preventive, screening and intervention procedures for IPV and alcohol misuse during pregnancy and the postpartum period.