Fear Of Surgery Research Articles

Identifying Patient Perceived Barriers to Trichiasis Surgery in Kongwa District, Tanzania.

BackgroundTrachomatous trichiasis (TT), inturned eyelashes from repeated infection with Chlamydia trachomatis, is the leading infectious cause of blindness in the world. Though surgery will correct entropion caused by trachoma, uptake of TT surgery remains low. In this case-control study, we identify barriers that prevent TT patients from receiving sight-saving surgery.Methodology/Principal FindingsParticipants were selected from a database of TT cases who did (acceptors) and did not (non-acceptors) have surgery as of August 2015. We developed an in-home interview questionnaire, using open and closed-ended questions on perceived barriers to accessing surgical services. We compared responses between the acceptors and non-acceptors, examining differences in reasons for and against surgery, sources of TT information, and suggestions for improving surgical delivery. 167 participants (mean age 61 years, 79.7% females) were interviewed. Compared to acceptors, non-acceptors were more likely to report they had no one to accompany them to surgery (75.3% vs. 42.6%, p<0.0001), they could manage TT on their own (69.9% vs. 31.5%, p<0.0001), and the surgery camp was too far (53.4% vs. 28.7%, p = 0.001). Over 90% of both acceptors and non-acceptors agreed on the benefits of having surgery. Fear of surgery was the biggest barrier stated by both groups. Despite this fear, acceptors were more likely than non-acceptors to also report fear of losing further vision without surgery.Conclusions/SignificanceBarriers included access issues, familial and/or work responsibilities, the perception that self-management was sufficient, and lack of education about surgery. Fear of surgery was the biggest barrier facing both acceptors and non-acceptors. Increasing uptake will require addressing how surgery is presented to community residents, including outlining treatment logistics, surgical outcomes, and stressing the risk of vision loss.

Barriers responsible for delay in surgical correction of strabismus: A study among adults undergoing strabismus surgery at a tertiary care center in Kerala

Aim: The aim of this study is to analyze the factors responsible for delay in surgical treatment among adults with strabismus. Materials and Methods: A validated questionnaire-based study on fifty adult strabismic patients, enrolled through simple random sampling, who underwent surgical correction of strabismus at the strabismus clinic of a tertiary care eye hospital. Results: A total of fifty patients in the age group 18– 45 years, including 28 males (56%) and 22 females (44%) were studied. 24% were students, 22% were professionals, 18% were skilled laborers, and 18% were homemakers. Strabismus had significant psychological impact on the quality of life of the patient and 50% suffered from low self-esteem attributable to squint 32% reported peer pressure and bullying. Lack of awareness about surgery (32%), fear of surgery (24%), and nonaffordability were the most common reasons reported by patients for delayed the surgical correction. The reasons for seeking surgical treatment in adulthood were for improving self-esteem and quality of life (32%) and due to pressure from family and friends (24%). Conclusion: Social factors predominate as obstacles for timely correction of strabismus. Economic factors and lack of awareness among medical communities also contribute toward delay in treatment.

Ear, nose, and throat disorders in a nigerian rural community

Aims and Objectives: This study aimed at assessing the prevalence of ear, nose, and throat with head and neck diseases in a rural community in Oyo State, Nigeria. Materials and Methods: This is a prospective community-based study of ear, nose, and throat diseases. The study was carried out over a period of 3 months (January to March 2017). Verbal consent was obtained from the village head and participants. A total of 738 individuals were enrolled into the study. Interview-assisted questionnaire was administered to obtain bio data and otorhinolaryngological history from all participants, followed by examination and investigation. Data obtained were collated and statistically analyzed using SPSS version 16. Results: A total of 738 consented participants had various forms of ear, nose, and throat disorders. They constituted 435 (58.9%) males and 303 (41.1%) females, with a male: female ratio of 1:1. Majority of enrollee were dependent age groups. These age groups were 27.4% (1–10), 25.5% (11–20), and 14.1% (51–60). The occupational status revealed that 28.9% were employed; 9.3% were retired; 45.5% were children/students/apprenticeship; and 16.3% were artisans, homemakers, and farmers. Nasal diseases (34.4%) were the most common otorhinolaryngological, head and neck disorders while ear, nose, and throat with head and neck diseases were responsible for 43.4%, 14.6%, and 7.6%, respectively. The common diseases were wax impaction (11.7%), sinusitis (14.4%), and allergic rhinitis (22.6%). Less prevalent otorhinolaryngological, head and neck diseases were vertigo/balance disorder (0.9%), cervical spondylosis (1.6%), and pharyngitis/tonsillitis (2.0%). Common procedures performed included impacted earwax removal (22.8%), aural toilet/dressing (14.4%), pure tone audiometry (32.5%), tympanometry (18.4%), endoscopy (9.8%), and antral irrigation (5.7%). Referred cases of 7.2% were recorded. The barriers experienced by these villagers in seeking otorhinolaryngological, head and neck services were distance/transport (42.8%), cost of hospital service (38.4%), fear of surgery (24.1%), hospital protocol (37.0%), cumbersome investigation (17.5%), and hospital workers (27.6%). Conclusions: This study revealed that the nasal diseases were most prevalent in the community and highlighted the major challenges encountered in seeking otorhinolaryngological, head, and neck cares.

Attitudes and Concerns of Diabetic Patients towards Bariatric Surgery as Treatment of Diabetes

Bariatric surgery is increasingly recognised as an effective treatment for type 2 diabetes that significantly improves glycaemic control, even achieving remission. This study examined perceptions and concerns of diabetic patients towards bariatric surgery as a treatment option for diabetes. A total of 150 patients were recruited from a specialised diabetic outpatient clinic and completed a questionnaire (items were rated on a Likert scale from slightly important [lowest score of 1] to extremely important [maximum score of 5]). Logistic regression was performed to identify factors influencing decision for surgery. The 74 males and 76 females had mean age of 50 (range 20 to 78) and body mass index (BMI) of 29.6 kg/m2 (range 18.1 to 51); 61% considered surgery favourably. Predictive factors for interest in surgery: higher educational levels (OR = 2.3; 95% CI, 1.2 to 4.4), duration of diabetes (OR = 0.4; 95% CI, 0.2 to 1.0) and use of insulin (OR = 2.1; 95% CI, 1.1 to 4.1). Reasons for surgery: desire for remission (Likert scale 4.7 ± 0.7), to prevent complications (Likert scale 4.5 ± 0.9) and to reduce medications (Likert scale 4.3 ± 1.1). For those not keen on surgery, main reasons were fear of surgery (Likert scale 4 ± 1.5) and satisfaction with current therapy (Likert scale 3.7 ± 1.6). Many diabetic patients would consider surgery as an option to improve their metabolic disorder (greater interest in patients with higher educational levels, currently using insulin and with shorter duration of diabetes). Surgical complications, length of recovery and duration of benefits were the main concerns.

Assessment of Attitude and Knowledge of Personnel in the Intensive Care Unit of Tabriz University of Medical Sciences Hospitals Toward Organ Donation

The increasing gap between organ supply and demand remains a worldwide problem and can be attributed to several reasons. Because health care workers play an important role in management of brain dead patients, we performed a survey to evaluate the attitude and knowledge of personnel in the intensive care unit (ICU) at Tabriz University of Medical Sciences hospitals toward organ donation. This cross-sectional study was included personnel from 8 university affiliated ICUs in Northwest of Iran from May to July 2014. The questionnaire included parts of demographic data and socioeconomic situations as well as status of knowledge and attitude of personnel regarding organ donation. Gender, age, marital status, and type of department in which personnel work did not affect attitude toward organ donation. The most common reasons for disagreement for organ donation were religious considerations, fear of surgery, and body mutilation. Nurses have a better acceptance rate than assistants and nonmedical personnel. Increasing the knowledge of health care workers in ICUs has strong impact on transplantation rate. The most important thing that should be clarified for this group is the concept of brain death to achieve a multidisciplinary team that believes in organ donation and transplantation.

A giant inguinoscrotal hernia in the 21stcentury urban Nigeria setting? A case report and review of the literature

Negligence could make an inguinal hernia to increase in size and with the passage of time; it may assume a giant size with accompanying medical and social impacts on the patient. Traction on the ilioinguinal nerve and spermatic cord causes dragging sensation in the groin with the attendant discomfort. The inability to wear fitting pants, the disturbance of sexual activities, and the consequent gait abnormality were some of the compelling reasons in this patient that made him to seek surgical consult. Nylon darn herniorrhaphy was done without a mesh and without any untoward postoperative event in a level II surgical facility. This case report illustrates mainly, ignorance, negligence and fear of surgery as mitigating factors in the management of this condition in our sub-region and less of the surgical challenges a giant inguinoscrotal hernia may pose.

Lower Urinary Tract Symptoms: Prevalence, Perceptions, and Healthcare-Seeking Behavior amongst Nigerian Men.

PurposeThe aim of this study was to determine the prevalence of lower urinary tract symptoms (LUTS) and the factors influencing the healthcare-seeking behavior of men with LUTS.Materials and MethodsA cross-sectional survey was performed of 658 men selected using multi-staged sampling techniques. They were interviewed about LUTS and their healthcare-seeking behavior. The data were analysed using PASW Statistics ver. 18. Associations between specific factors and healthcare-seeking behavior were examined using the chi-square and Fisher exact tests.ResultsThe overall prevalence of LUTS was 59.1%. Storage symptoms (48.2%) were more prevalent than voiding (36.8%) or post-micturition (29.9%) symptoms. Approximately a quarter (25.5%) had a poor quality of life (QoL) score. The average duration of symptoms before seeking help was 3.4 years. Almost half (46.8%) of the men with LUTS had never sought help. Perceptions of LUTS as an inevitable part of ageing, subjective feelings of wellness, financial constraints, and fear of surgery were the most common reasons for not seeking help. The most common reasons for seeking help were to moderate-severe symptoms, impaired QoL, and fear of cancer. Severe LUTS, impaired QoL, and the concomitant presence of erectile dysfunction, dysuria, or haematuria were clinical factors that positively influenced healthcare-seeking behavior.ConclusionsIn this population-based study, we found that the prevalence of LUTS was very high amongst adult males. However, only about half of these men sought medical attention. Their healthcare-seeking behavior was influenced by severity of symptoms, QoL scores, and socio-demographic factors such as educational status.

A double blinded comparative study of oral premedication in children with midazolam alone or in combination with ketamine

Background: Surgery and anaesthesia induction cause considerable emotional stress upon children. In children pre-anaesthetic medications are frequently administered as pharmacological adjunction to alleviate the stress and fear of surgery as well as to ease child-parent separation and promote a smooth induction of anaesthesia. Methods: Prospective double blinded randomized comparative study of oral premedication in children with midazolam alone or combination of midazolam with low dose ketamine in the age group of 3-10 years undergoing surgical procedures under standardized general anesthesia . Results: In group M success rate of satisfactory sedation was 68.99% as against 76.59% in group MK, whereas success rate of anxiolysis was 80.00% in group M compared to 93.33% in group MK. 93.32% children were easily separated from parents in M Group compared to 96.66% in MK group. Also 73.32% children co-operated for IV line insertion in M group as against 96.66% in group MK and 83.33% children showed better mask acceptance in M group compared to 93.33% in MK group. Conclusions: From present study, it was concluded that addition of low dose of ketamine improves quality and success rate of satisfactory sedation, anxiolysis, parental separation, co-operation for IV line and mask acceptance.

Evaluation of quality of life and subjective experience of the disease before and after vaginal hysterectomy among women admitted to the University Hospital in Brazzaville

Toute maladie est un mal en soi qu’il faut éradiquer car elle altère souvent de façon significative la qualité de la vie. L’hystérectomie vaginale est indiquée pour les patientes qui présentent certaines affections gynécologiques graves, elle est donc bénéfique mais, peut également avoir une répercussion néfaste sur la qualité de vie de la femme. Ainsi nous avons voulu explorer le vécu de la maladie et de l’hystérectomie vaginale (HV) des femmes avant et après l’intervention chirurgicale. Nous avons effectué une étude prospective qualitative, à recueil clinique sur une période de 12 mois; qui a concerné les femmes, ayant subi une hystérectomie vaginale. Celles n’ayant pas accepté de participer à l’étude, ou n’ayant pas de contact téléphonique n’ont pas été incluses. Pendant la maladie, le vécu des femmes a été: l’inconfort sexuel 26/40 (65%); les saignements génitaux 12/40 (30%); les douleurs pelviennes 13/40 (32,5%). En Post-opératoire, ont été noté les dyspareunies transitoires30/40 (75%) ; les céphalées secondaires à l’anesthésie 4/40 (10%). Le vécu psychologique a été dominé avant l’HV par la peur de la chirurgie chez toutes les patientes, les troubles du sommeil 38/40 (95%), l’angoisse 30 /40(75%), un sentiment de honte lié aux difficultés à accomplir l’acte sexuel en raison du prolapsus 26/40(65%) et/ ou en raison des saignements génitaux, dus au fibrome utérin 14/40(35%). Le sentiment de la perte de féminité était déclaré par 26/40 femmes porteuses de prolapsus utérin (65%), la modification de l’estime de soi 26/40 (65%). Ces appréciations subjectives ont été améliorées avec l’HV, contre balançant la perte de leur organe de reproduction. Aucune information n’a été donnée par les femmes à leurs proches et aux membres de la famille avant la chirurgie, traduisant ainsi leur sentiment de gène ou de honte. L’arrêt des symptômes a été observé dans tous les cas, même si dans un cas (1,25%) un nouveau signe au titre des complications (plaie rectale) a éténoté. Concernant l’activité sexuelle, tous les couples ont déclaré leur satisfaction après le traitement. Le vécu dramatique de la maladie et de l’hystérectomie vaginale avant, est nettement amélioré après l’intervention chirurgicale.

Desarrollo de un instrumento para medir creencias y actitudes hacia la vasectomía

Male participation in family planning is relatively recent, since it began following the International Conference on Population and Development in Cairo in 1994. There are many myths about vasectomy that contribute to the reluctance to accept it, which makes its study indispensable. Most of the studies on the issue are qualitative, and in the literature reviewed on this topic, three questionnaires were found: one measures knowledge only, the second is only directed at medical personnel, and the third only considers negative attitudes without taking into account any positive aspects. The objective of this study was to design and validate a questionnaire to measure beliefs and attitudes towards vasectomy in Mexico, addressed to men without vasectomy, as well as women. A cross sectional study was conducted in two stages. In the first one 405 men and women from 35 to 55 years participated. Content validity and discriminatory power of the items were calculated. Principal component analysis was performed, and the reliability was calculated using the Cronbach's alpha. Four factors were obtained: Decreased virility, benefits, fear of surgery, and negative perception. The overall reliability was 0.85. In the second stage the sensitivity of the instrument was tested with 248 participants, finding significant differences in the four factors by comparing the results according to education level. A questionnaire is presented with different applications that can be used both by researchers and professionals in the field of reproductive health.

Preoperative Education and Decreasing Preoperative Anxiety Among Children Aged 8 - 10 Years Old and Their Mothers.

Background:Preoperative anxiety is associated with adverse clinical, behavioral, and psychological outcomes. Various effective interventions targeting preoperative anxiety in children exist.Objectives:The aim of this study was to evaluate the educational intervention by residents on children and maternal anxiety and their satisfaction from anxiety management.Patients and Methods:After obtaining the institutional ethics committee approval and written informed parental consent, 36 ASA-I, II children (age range, 8 - 10 years) underwent small operations were included in this prospective randomized study. The participants were allocated into the intervention (n =18) and control (n =18) groups. Children in the first group were prepared routinely. In the second group children and their mothers received data about anesthesia and operation by the booklet. Children-maternal anxiety was assessed using the anxiety level form, at the night and in the morning before surgery. Few days after surgery mothers, residents, and children experiences and satisfaction from anxiety management were assessed in the focus group discussion.Results:Mean scores and standard deviations of state anxiety in the intervention group before and after training were 33.1 ± 5.5 and 30.8 ± 6, respectively (P = 0.06). In the control group it was 32 ± 6.5 on the night and 34.1 ± 6.7 in the morning before surgery (P = 0.00). Comparison between groups was not significant (P = 0.6) and (P = 0.1). The mean levels of anxiety in the control group mothers on the night before and in the morning of surgery were 39.2 ± 13.1 and 42.8 ± 14 (P = 0.00), respectively. In the intervention group, mothers’ anxiety before education was 41 ± 12.7 and after education it was 35.6 ± 9.5 (P = 0.04). Comparison between groups was not significant (P = 0.7) and (P = 0.1). According to the focus group discussions, booklet study, provided education, sympathy of medical team, spiritual issues and beliefs reduced anxiety and fear of surgery. Anesthesia and lack of knowledge of what will happen, crying and restlessness of children increased preoperative anxiety.Conclusions:In this study, the preoperative anxiety was reduced by explaining anesthesia and surgery to the mothers and children (in mothers it was significant P < 0.05). Since there is a direct relation between mothers’ and their children’s anxiety, using an effective method to reduce anxiety in children and their mothers together at the same time would be very useful for children and their mothers.

Improved visual, acoustic, and neurocognitive functions after carotid endarterectomy in patients with minor stroke from severe carotid stenosis

Carotid endarterectomy (CEA) is an established operation performed to prevent strokes, but its other potential effects, such as improving neurocognitive, visual, and auditory functions, remain unconfirmed. This study examined these effects of CEA on patients with symptomatic carotid stenosis. This was a prospective controlled study that included 80 patients with minor strokes who had severe extracranial internal carotid stenoses (>70%). Forty patients, who did not receive or who postponed the CEA due to concerns about age, fear of surgery, limited life expectancy because of cancer, or financial problems, formed the medicine-treatment group. Another 40 patients who received CEA 1 week after recruitment formed the CEA group. For both groups, visual acuity chart tests, perimetry tests, audiometry tests, and neurologic scales (National Institutes of Health Stroke Scale, Mini Mental State Examination, and Barthel Index of Activities of Daily Living) were used to assess ophthalmic functions, auditory acuity, and neurocognitive functions before treatment and 3 months after treatment. Intragroup and intergroup comparisons were conducted to examine the effect of CEA. No deaths or strokes occurred during the 3-month follow-up. The intragroup and intergroup comparisons of ipsilateral function showed that CEA could improve visual acuity, visual field, and auditory acuity at all tested frequencies (250 Hz, 500 Hz, 1000 Hz, 2000 Hz, and 4000 Hz) and could improve the visual field and the auditory acuity for contralateral functions at 1000 Hz. The auditory acuity at 2000 Hz and 4000 Hz were unchanged in the intragroup comparison but showed no deterioration in the intergroup comparison with the medicine group. General neurocognitive function and independent living ability were significantly improved by CEA, as shown by intergroup comparisons (change rate of National Institutes of Health Stroke Scale: -8.1% ± 9.0% vs -2.7% ± 3.0%, P < .001; change rate of Mini Mental State Examination: 15.5% ± 10.5% vs 1.6% ± 2.6%, P < .001; change rate of Barthel Index: 28.0% ± 24.6% vs 2.0% ± 5.5%, P < .001). In patients with minor strokes caused by severe carotid stenosis, CEA improves neurocognitive, ophthalmic, and acoustic functions. Studies with a larger sample and longer follow-up are needed to substantiate these results, and the underlying mechanisms need further investigation.

Sedative premedication before surgery – A multicentre randomized study versus placebo

ObjectiveAnxiolytic premedication before non-ambulatory surgery in adult patients may have become of less importance in an era of better preoperative patient information. Moreover, an oral hypnotic given the night before surgery may be as efficient as an anxiolytic for relieving patient anxiety. These two strategies were compared for superiority to a placebo and to each other for non-inferiority. Study designDouble-blind, randomized, multicentre study versus placebo. Eight hospitals in France. June 2011 to February 2013. PatientsNon-ambulatory consecutive surgical patients undergoing general surgery. Methods and interventionsPatients received either zopiclone 7.5mg the night before surgery (n=204), or alprazolam 0.5mg the morning of surgery (n=206) and controls received placebo (n=68). Demographic data, preoperative anxiety, fear of surgery and anaesthesia, and mood were assessed the day before surgery using a visual analogue scale, the Spielberger scale and the APAIS scale. In the operating room, anxiety and comfort were assessed in addition to physiological data. ResultsPreoperative data did not differ between groups. In the operating room, anxiety and comfort were moderate and did not differ significantly between groups on a 1–10 scale (median [25–75 percentile]): zopiclone: 2 [1–4] and 2.5 [1–5]; alprazolam: 2 [1,4] and 2 [1–5]; placebo: 3 [1–5] and 3 [1–5]. The patients who were more anxious preoperatively remained so in the operating room, irrespective of the treatment received (r=0.31, p<0.001). A placebo effect was observed in 38% of patients in the corresponding group. Patients receiving zopiclone reported a significantly better sleep the night before surgery compared to other groups (median: 2 vs. 1, p<0.001). ConclusionsPremedication in non-ambulatory surgery is no more effective than a placebo, owing to the very moderate level of anxiety experienced by patients.

A Community-based Eye Care Intervention in Southern Egypt: Impact on Trachomatous Trichiasis Surgical Coverage.

Purpose:The purpose of this study was to measure the impact of a community-based intervention on uptake of trichiasis surgery in Southern Egypt.Methods:Four villages where trachoma is endemic were randomly selected in the Samalout district, Egypt. Two villages were selected for intervention (intervention villages) and two matched villages for nonintervention (nonintervention villages). The intervention model provided community information sessions, door-to-door health education, screening, and improvements in the clinical capacity of eye care providers. The intervention was evaluated through two pre- and post-intervention community-based surveys that included the prevalence of trachoma and the utilization of eye care services at local hospitals. All patients with trichiasis answered a questionnaire regarding surgical utilization and barriers.Results:In the baseline survey, the trachomatous trichiasis (TT) surgical coverage was 22.7% (38.9% males, 16.7% females) in all villages. Following the intervention, the TT surgical coverage increased to 68% in villages that received the intervention (81.5% males, 60% females). Nonintervention villages had a TT surgical coverage of 26.1% (37.5% males, 20% females). In the intervention villages, the prevalence of TT significantly decreased from 9.4% (5.7% males, 11.8% females) to 3.8% (1.9% males, 5.1% females) (P = 0.013), in 2008. In nonintervention villages, there was a slight, but insignificant decrease in TT from 10.1% (3.1% males, 14.4% females) to 8.2% (3% males, 11.5% females) (P = 0.580). The major barriers to uptake of TT surgical services were: “Feeling no problem” (17.3%), “fear of surgery” (12.7%) and “cost” (12.7%).Conclusion:A community-based eye health education program with door-to-door screening significantly increased the uptake of TT surgical services. Although improvements to the delivery of surgical service are essential, they did not lead to any significant improvements in the nonintervention villages.

Uptake, Barriers and Outcomes in the Follow-up of Patients Referred for Free-of-Cost Cataract Surgery in the Sao Paulo Eye Study

Purpose: To determine uptake, barriers and outcomes in the follow-up of patients referred for free-of-charge, expedited cataract surgery in the Sao Paulo Eye Study (SPES).Methods: SPES was a population-based study of urban, low-middle income residents aged ≥50 years. Presenting visual acuity (PVA), best-corrected visual acuity, refraction, and slit-lamp examination were performed in 3677 participants. For subjects with cataract as a principal cause of best-corrected visual acuity ≤20/40, surgery was offered free of charge. Two years after the baseline study, surgery uptake, barriers to surgery, and visual outcomes were analyzed.Results: Among 210 (5.71%) participants who had a cataract surgery indication at baseline, 164 (78.1%) were successfully contacted and 55 (33.5%) reported being operated on for cataract, with 51 agreeing to be re-examined. In a multiple logistic regression model, age, sex, schooling, previous cataract surgery, and PVA at baseline were not significantly associated with surgery uptake. Co-existing health conditions (20.4%), fear of surgery (12.2%) and fear of losing eyesight (11.6%) were the most frequent barriers to cataract surgery adherence. Among the 69 eyes operated on in the interval between baseline and follow-up, PVA ≥20/63 was observed in 50 (72.6%, 95% confidence interval, CI, 62.2–82.3%), PVA <20/63–20/200 in 11 (15.8%, 95% CI 8.9–22.9%) and PVA <20/200 in 8 (11.6%, 95% CI 5.3–17.9%).Conclusions: Quality of surgery is an increasing determinant of uptake rates. Although free-of-charge and expedited cataract surgery was offered, surgical outcomes might have influenced the low uptake. Aside from cataract surgery campaigns, improvement of surgeon skills, accurate biometry, treatment of ocular comorbidities, postoperative follow-up and eye-care education are needed.

Barriers for Poor Cataract Surgery Uptake among Patients with Operable Cataract in a Program of Outreach Screening and Low-cost Surgery in Rural China

Aims: To identify the reasons for poor uptake of cataract surgery in a program of outreach screening and low-cost surgery in Pucheng County, a rural area in northwestern China.Methods: Detailed interviews with a semi-structured questionnaire were conducted by telephone or face-to-face for participants who had been advised to attend a low-cost cataract surgery program but did not schedule the surgery within 3 months after the initial screening.Results: Among 432 eligible subjects, 355 (82.2%) were interviewed (mean age 70.6 ± 6.6 years, 73.8% female). A total of 138 subjects (38.9%) were interviewed by phone and 217 (61.1%) were interviewed face-to-face. Lack of family support (n = 106, 29.9%) and failure to understand the need for surgery (n = 96, 27.0%) were the two main reasons for not undergoing cataract surgery. Other factors included fear of surgery (n = 62, 17.5%), lack of faith in doctors (n = 36, 10.1%), financial constraints (n = 25, 7.0%) and lack of transportation (n = 4, 1.1%).Conclusion: The principal barriers to low-cost cataract surgery uptake in rural China included lack of family support and failure to understand the need for surgery. Education targeting entire families to eliminate these barriers and development of community support systems at the family level are required to achieve greater uptake of low-cost cataract surgery programs in rural China.

Determinants of Eye Lid Surgical Care Utilization among Trachomatous Trichiasis Patients in Rural Communities: In the Case of Basoliben District, North West Ethiopia

Background: Trachomatous trichiasis is worldwide leading cause of blindness. Surgical intervention is one of the means of prevention of this blindness. Objectives: To assess determinants of eyelid surgical care utilization among trichiasis patients and associated factors. Method: A community based cross- sectional study design was employed. Sample size was determined using a single population proportion formula. Result: Among 348 interviewed patients, 253(72.7%) were in the age group of 16–45 years. Two hundred eighty nine (83.1%) were non-operated and 59(16.9%) operated trichiasis cases. Bilateral eye trichiasis cases were 245(70.4%) and 195(56%) of them were ill for 5-8 years. Ninety-seven (27.9%) believe treatment of trichiasis is surgery. Reasons for not using trichiasis surgery were distance of treatment center (X2 = 36.2), lack of awareness (X2= 46.8), and false beliefs about treatment (X2= 14.6). Conclusion: Associated factors were distance, lack of information, lack of time, fear of surgery.

Compliance with Emergency Obstetric Care Referrals Among Pregnant Women in an Urban Informal Settlement of Accra, Ghana

This study examines the situation that women face when they require emergency obstetric care in urban Accra. The analysis clarifies the referral options available to women needing emergency obstetric care, assesses the constraints they face in accessing the obstetric referral system and identifies the drawbacks associated with the obstetric referral system for women living in informal settlements of a rapidly growing district in Ghana. This research was a descriptive cross-sectional study using structured questionnaires administered to antenatal care clinic attendees and in-depth interviews of principal healthcare personnel. Sixty-five women had referrals in their previous pregnancies of which 62 went to the referral centre at varying time intervals. Three respondents did not go due to lack of financial resources and preference for traditional services. With regard to adherence to referral advice, lack of finances was the major constraint (46.2%) followed by client complaints about the attitudes of nurses at the referral centres (10.8%), fear of surgery (7.7%) and concerns about the distance to referral centres (4.6%). Moreover, analysis identified a significant positive association between parity and time elapsed between service encounter and compliance with referral (p = 0.001). Major constraints are faced by women when they attempt to utilize referral healthcare services such as financial problems, perceived remoteness of care points, fear of surgical procedures and concerns about the discourteous attitude of nurses at the referral centres. Healthcare providers however, emphasized other elements of the climate of care such as their perceived need for increasing staff strength.

English

BACKGROUND: Cataract is a major cause of vision impairment in many low-income settings. Cataract blindness is a disease which has severe economic repercussions and adversely affects the productivity of country. However, despite rapid increase in the availability of quality services, surgical acceptance is still low in some segments of society. AIM: To study the various reasons for delayed utilization of cataract surgery. METHODS: In this cross sectional study 450 patients above 40 years of age who were admitted in ophthalmology ward for cataract surgery were enrolled by systematic random sampling technique. Socio-demographic data was collected by interviews in local language on predesigned and semi structured proforma. The various reasons for delayed utilization of cataract surgery were asked to them. Statistical tests applied were chi square test and percentages. RESULTS: Majority of the study subjects were illiterate females above 60 years of age belonging to lower socioeconomic status. Most of the study subjects were Hindus from rural area having unilateral blindness. The various reasons for delayed utilization of cataract surgery were economic problems (76.7%), ignorance by patient (29.1%), fear of operation (26.4%), ignorance by head of family (22.4%) and suspicion about improvement of vision after surgery (21.5%). Some subjects gave reasons as lack of accompanying person, fear of surgery causing death, lack of time, its God will and lack of transport. CONCLUSION: The predominant reason for delayed utilization of cataract surgery was economic constraints. Other reasons were ignorance by patients and head of family, fear of operation and death, suspicion about improvement of vision, God's will, lack of accompanying person and lack of transport.

Awareness, Attitude, and Expectations Toward Dental Implants Among Removable Prostheses Wearers

To assess removable denture patient awareness, expectations, and source of information about dental implants (DIs). Three hundred patients [150 removable partial denture (RPD) wearers and 150 complete denture wearers (CDWs)] attended the removable prosthodontic clinic at Faculty of Dentistry, Jordan University of Science and Technology. Patients were evaluated using a pilot-tested, 21-question questionnaire. Ninety-six percent of participants were aware of DIs, with no difference between CDWs and RPD wearers (p > 0.05). The participants' friends and relatives were the main source of information (63.4%), followed by dentists (32.4%). Improvement in function was the predominant reason (55.7%) for patients to consider DIs. Fear of unknown side effects was the major factor in preventing patients from choosing DIs (11.7%), followed by high cost (9.7%) and surgical risk (8.7%). Approximately 89% had no information or were poorly informed about DIs. Over two-thirds of patients did not know about the care (78.3%) of DIs, causes of DI failure (69.7%), or DI duration of service (80.7%). Only 24.7% knew that DIs would be anchored to the jawbone; however, 27.3% and 56.7% of CDWs and RPD wearers, respectively, preferred (p < 0.05) to have their teeth replaced with DIs. High costs were considered the major disadvantage of DIs in 45% of participants, followed by fear of surgery (27.3%), and long treatment times (24.7%). There was a high awareness about DIs among removable denture patients; however, this awareness was associated with a low level of accurate information.