Preferred Healthcare Provider Research Articles

Sexual health in Belgian cervical cancer survivors: an exploratory qualitative study.

To assess experiences of sexuality and of receiving sexual healthcare in cervical cancer (CC) survivors. A qualitative phenomenological study using semistructured one-on-one interviews was conducted with 15 Belgian CC survivors recruited in 5 hospitals from August 2021 to February 2022. The interviews were audiotaped and transcribed verbatim. Data were analyzed using inductive thematic analysis. COREQ and SRQR reporting guidelines were applied. Most participants experienced an altered sexuality after CC treatment with often long-term loss/lack of sex drive, little/no spontaneity, limitation of positions to avoid dyspareunia, less intense orgasms, or no sexual activity at all. In some cases, emotional intimacy became more prominent. Physical (vaginal bleeding, vaginal dryness, dyspareunia, menopausal symptoms) and psychological consequences (guilt, changed self-image) were at the root of the altered sexuality. Treatment-induced menopause reduced sex drive. In premenopausal patients, treatment and/or treatment-induced menopause resulted in the sudden elimination of family planning. Most participants highlighted the need to discuss their altered sexual experience with their partner to grow together toward a new interpretation of sexuality. To facilitate this discussion, most of the participants emphasized the need for greater partner involvement by healthcare providers (HPs). The oncology nurse or sexologist was the preferred HP with whom to discuss sexual health. The preferred timing for information about the sexual consequences of treatment was at treatment completion or during early follow-up. Both treatment-induced physical and psychological experiences were prominent and altered sexuality. Overall, there was a need for HPs to adopt proactive patient-tailored approaches to discuss sexual health.

Types of health service utilization in Mumbai slums: a community-based survey

ObjectiveSociodemographic factors play a crucial role in shaping the health-seeking behaviors of individuals residing in slum areas, particularly in their choice of healthcare facilities. Recognizing the importance of strengthening the existing healthcare systems, this research project was undertaken with the primary objective of comprehending the health-seeking behaviors among residents of Mumbai’s slum dwellings in India. To achieve this goal, a comprehensive cross-sectional community needs assessment was conducted spanning from October 2018 to January 2019.Results432 respondents reported utilizing at least one health facility in the past year. They reported using private hospitals (172), public hospitals (208), Community Health clinics [23], or other healthcare services (29). To gain further insights into the factors influencing these choices, logistic regression analysis was conducted. The analysis revealed that being female was found to be negatively associated with the selection of a general practitioner as a preferred healthcare provider. On the other hand, higher levels of education and income were found to have a positive association with the preference for private hospitals. Conversely, these factors were negatively associated with the choice of government hospitals.

Community pharmacy role in children's health in England: Experiences and opinions of parents and young people.

Little is known about the reason behind the underutilisation of community pharmacy (CP) for children. This study explored the experiences, barriers and recommendations of parents/carers and young people regarding their use of CP services for children. Two-stage facilitated, structured, audio-recorded interviews were conducted at each of four CPs in London, England, between May and November 2019 [1month in each CP]. Parents/carers or young persons (aged 16-18years) who visited CP for a child-related matter were invited to participate. Interviews were transcribed verbatim. Data were analysed both quantitatively and qualitatively, using thematic analysis to identify themes. In total, 249 (58.2% of 428 eligible) customers agreed to participate and completed the two interviews. Out of these, 82.3% (205/249) reported positive experiences with the CP. The general practitioner (GP) was the preferred healthcare provider for minor ailments (44.6%,111/249), while 35.7% (89/249) would choose CP. Eighty-two participants (33%) visited an Emergency Department in the last 12months, with 13.4% (11/82) of them visited for cold and cough reasons. Where a child was present with parents/carer (128/249), there was a low level of interaction between children and pharmacists (13.3%, 17/128). Lack of awareness about the CP services provided for children and privacy were among the barriers identified by participants. Advertising of CP services and creating a child-friendly environment were recommendations suggested by participants. The findings of this paper show that CP remains an underutilised health service for children by parents/carers and young persons. More work is needed to increase public awareness of the roles of CP in children's health and well-being.

Speech-Language Pathology Graduate Student Clinicians’ Self-Perceived Competency in Dysphagia Management

Speech-language pathologists (SLPs) are the preferred healthcare providers for managing the direct clinical care of patients with dysphagia. By assessing self-perceived competency during academic training, SLP graduate student clinicians may increase their understanding of their skills in dysphagia management. We modified the Dysphagia Competency Verification Tool (DCVT) to use a 5-point ordinal scale to explore how SLP graduate student clinicians’ self-perception of competency in dysphagia management changes over time and to determine the impact of clinical practicum experiences. Seventy-two SLP graduate student clinicians rated their self-perceived competency for four DCVT domains. We used Generalized Estimating Equations (GEE) models to analyze the statistical significance of self-perception of competency ratings for each of the DCVT domains across semesters while accounting for clinical practicum experiences. Overall, the SLP graduate student clinicians indicated an increase in DCVT scores from the beginning of their graduate training program to the time of graduation, but did not perceive themselves as Adequate on most items of the DCVT until their last semester. These results suggest that both SLP graduate student clinicians and SLP graduate training programs would benefit from using a standardized metric to assess self-perceived competence in dysphagia management. DCVT self-perceived competency ratings could inform SLP graduate student clinicians about areas of dysphagia management practice and skills that need further development, allowing them to target these specific areas and gain actual competence.

Duration of intervals in the care seeking pathway for lung cancer in Bangladesh: A journey from symptoms triggering consultation to receipt of treatment.

Timeliness in seeking care is critical for lung cancer patients' survival and better prognosis. The care seeking trajectory of patients with lung cancer in Bangladesh has not been explored, despite the differences in health systems and structures compared to high income countries. This study investigated the symptoms triggering healthcare seeking, preferred healthcare providers (including informal healthcare providers such as pharmacy retailers, village doctors, and "traditional healers"), and the duration of intervals in the lung cancer care pathway of patients in Bangladesh. A cross-sectional study was conducted in three tertiary care hospitals in Bangladesh among diagnosed lung cancer patients through face-to-face interview and medical record review. Time intervals from onset of symptom and care seeking events were calculated and compared between those who sought initial care from different providers using Wilcoxon rank sum tests. Among 418 study participants, the majority (90%) of whom were males, with a mean age of 57 ±9.86 years, cough and chest pain were the most common (23%) combination of symptoms triggering healthcare seeking. About two-thirds of the total respondents (60%) went to informal healthcare providers as their first point of contact. Living in rural areas, lower levels of education and lower income were associated with seeking care from such providers. The median duration between onset of symptom to confirmation of diagnosis was 121 days, between confirmation of diagnosis and initiation of treatment was 22 days, and between onset of symptom and initiation of treatment was 151 days. Pre-diagnosis durations were longer for those who had sought initial care from an informal provider (p<0.05). Time to first contact with a health provider was shorter in this study compared to other developed and developing countries but utilizing informal healthcare providers caused delays in diagnosis and initiation of treatment. Encouraging people to seek care from a formal healthcare provider may reduce the overall duration of the care seeking pathway.

Social-Cultural Determinants of Male Partner Involvement in Antenatal Care at Anti-Stock - Theft – Unit Kenya

Purpose: Male involvement in antenatal care is a problem identified by different researchers and experienced globally. It is a key component in the optimization of maternal health and universal maternal health achievement. Few men engage in care in developing countries. The current study sought to identify Social-cultural Determinants of Male Partner Involvement in Antenatal Care.Methodology: Descriptive cross-sectional research design. Simple random sampling was used to sample 334 subjects from 2582 population. Data was gathered using self- administered questionnaires, edited, coded, and organized with help of statistical Package for Social Sciences (SPSS), then analysed using descriptive and inferential statistics. Hypothesis was tested using Chi square tests of independence and information presented using tables and percentages.Results: Majority (92.8%) of subjects were affiliated to religion. On cross tabulation, (100%) of participants who accompanied the partners during the first ANC visit disagreed that religion impairs male partner participating in antenatal care unlike (100%) of those who did not. Chi squire tests of independence was (p=0.047). Majority (77.2%) of the respondents preferred traditional birth attendants for partner’s antenatal care compared to 15.6% for health care workers. On cross tabulation, (93.3%) of the participants who accompanied partners during the first ANC visit indicated that they preferred health care providers to traditional birth attendants while 81.8% of those who did not accompany the partners indicated preference for traditional birth attendants and 9.1% preferred care workers. Chi squire tests of (independence (p=0.001).Unique contribution to theory, practice and policy: Male partner involvement in maternal health is desirable at the study area and there is need of social supports such as informational, appraisal, instrumental and emotional supports to enhance physical, psychological well-being, social integration and social ties. Researcher highlights the need to address religion and traditional birth attendants’ reliance which were found significant and established as barriers of male partner participating in ANC and causes of low ANC attendances among pregnant women. Further, policy change is advocated so that the government can pass laws which oblige men to be responsible for pregnant partners by accompanying them to ANC, knowing ANC schedules, discussing interventions, supporting the ANC fees if applicable, and knowing what happens at the ANC during the current pregnancy.

Psychosocial care for cancer survivors: A systematic literature review on the role of general practitioners.

To explore the general practitioners (GP's) role in providing psychosocial care for cancer survivors through a systematic literature review. We searched MEDLINE, EMBASE, PsycINFO, and CINAHL and included the studies that complied with the predefined inclusion and exclusion criteria. At least two independent reviewers performed the quality appraisal and data extraction. We included 33 (five qualitative, 19 observational, and nine intervention) studies; the majority of these studies focused on care for depression and anxiety (21/33). Cancer survivors were more likely to contact their GP for psychosocial problems compared with noncancer controls. Survivors were more likely to use antidepressants compared with controls, although 71% of survivors preferred depression treatment to be "talking therapy only." Overall, GPs and patients mostly agreed that GPs are the preferred healthcare provider to manage psychosocial problems. The major exception is a survivor's fear of recurrence-here, the oncologist was the preferred healthcare provider. Only two interventions effectively decreased depression or anxiety; these studies included patients who had a clinical indication for psychosocial care, were specifically designed for decreasing depression/anxiety, and consisted of a multidisciplinary team approach. The other interventions evaluated GP-led follow-up for cancer survivors and found that this did not impact the patients' levels of anxiety, depression, or distress neither negatively nor positively. Cancer survivors often prefer psychosocial care by their GP, and GPs generally consider they are well placed to provide this care. Although evidence on the effectiveness of psychosocial care by GPs is limited, an active multidisciplinary team approach seems key.

The Positive Impact of Establishing an Internal Transfer Center

Health systems are facing greater pressures than ever before, with factors ranging from mergers and acquisitions and changing reimbursement models to capacity challenges and staffing shortages. A transfer center, where with 1 simple call from a referring physician, a decision to accept a critically ill patient can be made, placing them at the most appropriate level of care, the first time. Baptist Health in Jacksonville, Florida, went from an outsourced to an in-house center in 3 months—in the first 28 days alone, patient transfers increased from 900 to 1,500, growing to an average of 1,583 transfers per month.

‘Not everybody is an internet person’: Barriers for menopause‐related health literacy among immigrant women from the Horn of Africa nations

Changes in health require new learning. There are increased risks of chronic noncommunicable diseases after menopause and positive health behaviour during the peri-menopausal years and beyond are crucial for a healthy postmenopausal life. In order to implement health promotion messages, women require adequate health literacy skills in order to achieve better health and access to appropriate health care. This qualitative study explored menopause-related health literacy and experiences of menopause-related health care using semi-structured interviews with women from the Horn of Africa nations who had migrated to Melbourne, Australia. Participants viewed menopause as a normal life phase and did not see the need for accessing menopause-related information and care. Limited education, low literacy and being unfamiliar with the internet were barriers to health literacy. Participants' preferred health care providers who could converse in their first language, but regretted their lack of proactive engagement in providing menopause-related information. Primary health care providers need to be aware that immigrant women from the Horn of Africa nations have poor health literacy and may be unaware of the benefits of positive health behaviours during and after menopause. Offering menopause-related health promotion opportunistically may lead to better postmenopausal health for this group of women. SO WHAT?: Health promotion and education programs codesigned with community stakeholders may be effective in engaging immigrant communities to improve menopause-related health literacy.

Identifying Important Palliative Topics and Communication Preferences Among ALS Patients (QI618)

•Recognize and discuss the different subtopics that can be important to patients with Amyotrophic Lateral Sclerosis (ALS).•Recognize when to offer palliative care and understand which provider is most appropriate to deliver this information. ALS is a rapidly progressive, lethal neurodegenerative disease. Advanced care planning, palliation, and psychosocial needs must be discussed early. Literature recommends introducing palliation at dynamic points in a disease model clinic; however, this is not consistently practiced. There are no guidelines for when, with whom, or how palliation is discussed. Our QI study surveyed patients at our ALS clinic to assess their palliative needs and preferences. To assess palliation topic preferences about advance care, psychosocial, and end-of-life planning among ALS patients attending a multidisciplinary clinic. A mixed nine-question survey was given to 30 patients with ALS attending a multidisciplinary clinic over 1 year. Descriptive statistics were performed. Thirty patients (15 males, 27 Caucasians, mean age 66, age range 51–84) enrolled. Average number of ALS clinic visits were 2 (range 1-32). Patients were “very open” to their provider discussing advanced care planning (21, 70%), planning for when more help is likely needed (20, 66.7%), likely disease complications (19, 63.3%), end-of-life discussion (20, 66.7%). Fourteen (50%) patients ranked planning for when more help is likely needed as the most important topic. Twenty (71%) patients chose “my neurologist” as their preferred healthcare provider to initiate these topics. Seventeen (61%) patients preferred their physician to present these topics rather than themselves. Sixteen (53%) patients wanted their neurologists to decide when to initiate these topics. Only five (17%) patients wanted these topics discussed at the first visit. A bivariate correlation showed a moderate association between age and openness to end-of-life discussions (r=0.439, p=0.15). Patients with ALS want to plan for their future. Advance care planning, planning for needing more help, and end-of-life discussions were ranked highest. Although our patients want initiation and discussion by their neurologist, this may be a selection bias, as other providers (social worker, psychologist, and palliative staff) are unavailable in our clinic. We hope by understanding our patients' preferences we can appropriately introduce this service.

Insights and expectations for Tdap vaccination of pregnant women in Italy

Background Pertussis is a widespread vaccine-preventable disease, associated with an increasing trend to hospitalization among newborns. Pertussis in newborns can be fatal, and the most effective way to prevent it is maternal immunization (MI) with a reduced antigen content tetanus, diphtheria, and acellular pertussis vaccine (Tdap). In Italy, the National Immunization Plan (NIP) 2017–2019 introduced de novo Tdap vaccination during each pregnancy at no cost for the recipient. Despite this, vaccination coverage is suboptimal. This survey of pregnant women across Italy was conducted to investigate their knowledge and expectations of Tdap. Methods A cross-sectional survey was conducted. Pregnant women up to 28th gestational weeks were interviewed by Telephone using a questionnaire with 16 questions. Statistics were descriptive. Results The final sample recruited 600 respondents evenly distributed across Italy. The average duration of pregnancy at the time of the interview was 20.8 weeks (standard deviation [SD] 6.0). Most women (60.7%) were between 30 and 40 years of age. About half were aware of the risks of pertussis for newborns (54.5%) and the increased risk of hospitalization (59.8%); 47.2% were aware that Tdap MI was offered free of charge under the NIP. Safety information regarding the mother and newborn was considered the most important information in deciding whether to be vaccinated (47.4%), followed by safety information related only to the newborn (29.5%). About half (52.2%) stated that they would “certainly” accept MI, and 25.3% would like to receive more information. Gynecologists were the preferred healthcare providers (HCPs) for the provision of MI information (34.3%), followed by pediatricians (25.5%). Two-thirds of the respondents would prefer to be informed about MI before getting pregnant (66.0%). Vaccines investigated specifically for use in pregnancy were preferred by respondents. Overall, no relevant differences were observed between women pregnant for the first time and those with more than one pregnancy, nor between geographical regions. Conclusions The results show room for improving the awareness and understanding of the risks of pertussis for infants and the protective role of MI. The pregnant women preferred to receive advice on MI from an HCP, primarily their gynecologist. They were most interested in information on the safety profile of Tdap during pregnancy, on the mother, fetus, and newborn. The potential impact of this study to support clinical practice of Healthcare Providers is highlighted in the Focus on the Patient section.

Management and attitudes toward patients with epilepsy in general practice: How far have we come in three decades?

BackgroundPrevious surveys of Australian primary care physicians' attitudes regarding epilepsy and persons with epilepsy (PWE), conducted 20–30 years ago, identified the need for further education in epilepsy care for frontline clinicians. This follow-up study of general practitioners (GPs) in Sydney was conducted to determine the degree of changes in knowledge, attitudes, and management of PWE, with the purpose of evaluating if there had been significant improvement during this period. MethodsA questionnaire, evaluating various aspects of epilepsy care, including investigations, preferred healthcare provider (HCP), and attitudes toward epilepsy was developed, largely based on the previous work, piloted, and completed by a representative sample of Sydney GPs. ResultsA total of 52 completed responses were received. Thirty-six out of 47 GPs (77%) chose neurologists as the most important HCP followed by the GP (9/47; 18.7%). Almost half of the GPs (25/51; 49%) mentioned that they never initiated antiepileptic medication (AEM) therapy by themselves yet half of these GPs would alter the neurologist's regimen, without necessitating referral back to that neurologist. Another 27% (14/51 GPs) rarely commenced AEM therapy. Six out of 50 GPs did not mention an electroencephalogram (EEG) as a routine investigation, and 21/50 did not mention magnetic resonance imaging (MRI) as routine for PWE. The five most commonly used AEMs, identified by at least 10% of respondents, were sodium valproate (42), carbamazepine (37), levetiracetam (31), lamotrigine (16), and phenytoin (15). Emotional, behavioral, and psychosocial issues were perceived to be more common among PWE; however, they could contribute equally well to society as people without epilepsy. ConclusionThe results of the study indicate a perceptual shift regarding GP's attitudes to epilepsy; however, there remain deficiencies in knowledge, particularly with regard to investigations and management. The study highlights the need for more formal training of GPs in caring for PWE.

873-P: "I Had Nobody to Represent Me"—How Patient Perceptions of Diabetes Health Care Providers' Age, Gender, and Ethnicity Impact Shared Decision-Making

Background: When patients and clinicians establish diabetes care plans together, patients are more likely to successfully manage their diabetes. Although studies reveal diabetes healthcare provider (HCP) bias and healthcare inequities, the potential impact of patient perceptions of their diabetes HCP is unknown. We explored how patient perceptions of their diabetes HCP influences treatment plans and shared decision-making (SDM). Methods: Adult participants with diabetes receiving diabetes care at community sites, primary care, or specialty clinics were invited to participate in semi-structured 30- to 45-minute interviews. Interviews were conducted from Nov 2018 to Jan 2019. Responses were qualitatively analyzed with NVivo for emergent themes. Results: We conducted 28 interviews with participants aged 34-81. Participants were female (16), male (11), FtM (1), and white (9), black/Caribbean (11), Asian/South Asian (4), Middle Eastern (2) and Hispanic (2). We identified the following themes: 1) Hidden bias for stated preference of HCP ethnicity: While most participants stated no preference, we identified hidden preferences via cultural relatability as well as evidence of color blindness. 2) Impact of HCP characteristics on SDM: Participants felt junior HCPs had up-to-date knowledge, while others preferred senior HCPs’ clinical experience. HCP gender and ethnicity impacted SDM via relatability; participants who related to their HCP were more likely to engage in a care plan. 3) Other factors affecting HCP preference: Participants preferred HCPs who provided patient-centered care, characterized by individualized referrals, trusting relationships, and HCPs’ investment in patient success. Conclusion: Diabetes affects persons of all ages, genders, and ethnicities. Exploring how patient perceptions of HCPs inform shared decision-making offers insight into systemic barriers to equitable person-centered care. Disclosure T. Ahmad: None. S. Hari: None. D.E. Cleary: None. C. Yu: None.

Health-care availability, preference, and distance for women in urban Bo, Sierra Leone.

To examine the diversity of the health-care providers in urban Bo, Sierra Leone, identify the types of health-care facilities preferred by women for fevers, and analyze the road network distances from homes to preferred health-care providers. A population-based random sampling method was used to recruit 2419 women from Bo. A geographic information system was used to measure the road distance from each woman's home to her preferred provider. Preferred health-care providers for acute febrile illnesses (commonly referred to as "malaria" in the study communities) were hospitals (62.3%), clinics (12.6%), and pharmacies (12.4%). Participants lived a median distance of 0.6km from the nearest provider, but on average each woman lived 2.2km one-way from her preferred provider. Women living farther from the city center had preferred providers significantly farther from home than women living downtown. The diverse health-care marketplace in Bo allows women to select clinical facilities from across the city. Most women prefer a malaria care provider farther from home than they could comfortably walk when ill.

Knowledge, acceptability, and use of misoprostol for preventing postpartum hemorrhage following home births in rural Ethiopia.

To assess knowledge of, and intentions to use misoprostol to preventing postpartum hemorrhage by women in a pastoralist community of the Somali Region of Ethiopia. A cross-sectional study enrolled women aged 15-49years living in Adadle district, Ethiopia, between April 26 and May 3, 2012. A structured questionnaire was used to collect data on participants' knowledge of misoprostol and if they had any intention to use it in the future. Participants also detailed their preferred healthcare provider for administering misoprostol. A total of 829 women were enrolled in the study. Among the participants, 42 (5.1%) had knowledge of misoprostol and 302 (36.4%) described themselves as being willing to use misoprostol in the future. Among respondents who were willing to use misoprostol in the future, traditional birth attendants were the preferred healthcare practitioners to administer it. Awareness of misoprostol was low in the study sample but willingness to use the drug was somewhat higher. Raising awareness and knowledge among communities and traditional birth attendants regarding the advantages of misoprostol is crucial to enhance uptake and reduce the incidence of postpartum hemorrhage.

Who do you prefer? A study of public preferences for health care provider type in performing cutaneous surgery and cosmetic procedures in the United States.

The public preference for provider type in performing cutaneous surgery and cosmetic procedures is unknown in the United States. An internet-based survey was administered to the lay public. Respondents were asked to select the health care provider (dermatologist, plastic surgeon, primary care physician, general surgeon, and nurse practitioner/physician's assistant) they mostly prefer to perform different cutaneous cosmetic and surgical procedures. Three hundred fifty-four respondents undertook the survey. Dermatologists were identified as the most preferable health care provider to evaluate and biopsy worrisome lesions on the face (69.8%), perform skin cancer surgery on the back (73.4%), perform skin cancer surgery on the face (62.7%), and perform laser procedures (56.3%) by most of the respondents. For filler injections, the responders similarly identified plastic surgeons and dermatologists (47.3% vs 44.6%, respectively) as the most preferred health care provider. For botulinum toxin injections, there was a slight preference for plastic surgeons followed by dermatologists (50.6% vs 38.4%). Plastic surgeons were the preferred health care provider for procedures such as liposuction (74.4%) and face-lift surgery (96.1%) by most of the respondents. Dermatologists are recognized as the preferred health care providers over plastic surgeons, primary care physicians, general surgeons, and nurse practitioners/physician's assistants to perform a variety of cutaneous cosmetic and surgical procedures including skin cancer surgery, on the face and body, and laser procedures. The general public expressed similar preferences for dermatologists and plastic surgeons regarding filler injections.

Health Insurance in India—A Study of Provider’s Perceptions in Delhi &amp; the NCR

This study examines the Indian health insurance market by empirically observing the provider’s perceptions and its relationship with the insured, the insurer and the third party administrators (TPAs). The study tries to find out the awareness level among the insured population and their attitude towards treatment cost. It then examines the role of TPAs and the impact of cashless services on the cost of treatment by studying a few cost drivers. Apart from studying the provider’s per-ceptions it also tries to look at some of the evidence of moral hazards and that of fraudulent activity. The findings suggest that the awareness level regarding policy terms and condition is low among the insured population and most of them do not care for the cost of treatment. The providers increase their rates quite frequently and prefer the middle income group for extending cashless benefits. The TPA model has not been successful in bringing down the claim cost but has helped in providing unbiased services including cashless benefits. The price structure of healthcare services are linked to the room rent category and most of the insured patients, who are more demanding, prefer staying in higher category rooms. The concept of cost-sharing by the insured will help tackle this issue to some degree. The Indian health insurance market is not immune from supply-side moral hazards and fraudulent activities and there is a need to craft different strategies to tackle them. There exists an opportunity for the insurance companies to build long-term relationships with the preferred healthcare providers by using technology and by understanding each other’s roles in serving the common client.

Social and cultural features of cholera and shigellosis in peri-urban and rural communities of Zanzibar

BackgroundResponding to the high burden of cholera in developing countries, the WHO now considers vaccination as a supplement to the provision of safe drinking water and improved sanitation in the strategy for cholera control in endemic settings. Cultural concepts of illness affect many aspects of public health. In the first step of a two-step strategy to examine determinants of cholera vaccine acceptance, this study identified social and cultural features of diarrhoeal illness for cholera control in endemic communities.MethodsA cultural epidemiological study with locally adapted vignette-based interviews was conducted in two cholera-endemic communities of Zanzibar. A random sample of unaffected peri-urban (n = 179) and rural (n = 177) adults was interviewed to study community ideas of cholera and shigellosis, considering categories of distress, perceived causes, and help-seeking behaviour.ResultsCholera was recognised by 88%. Symptoms of dehydration were most prominent in reports at the peri-urban site. Interference with work leading to strain on household finances was frequently emphasised. Dirty environment was the most prominent perceived cause, followed by unsafe drinking water and germ-carrying flies. Causes unrelated to the biomedical basis of cholera were reported more often by rural respondents. Rural women had more difficulty (20%) to identify a cause than men (7.1%, p = 0.016). Peri-urban self treatment emphasised rehydration; the rural community preferred herbal treatment and antibiotics. Shigellosis was recognised by 70%. Fewer regarded it as very serious compared with cholera (76% vs. 97%, p < 0.001) and regarded it as less likely to be fatal (48% vs. 78%, p < 0.001). More respondents could not explain causes of shigellosis (23%) compared with cholera (7.3%, p < 0.001). Community respondents less frequently identified dehydration and contagiousness for shigellosis. Government facilities were preferred healthcare providers for both conditions.ConclusionsThis study clarified local views of cholera and shigellosis relevant for diarrhoeal disease control in Zanzibar. The finding that rural women were less likely than men to specify causes of cholera suggests more attention to them is required. Better health education is needed for cholera in rural areas and for shigellosis in general. This study also identified variables for subsequent analysis of social and cultural determinants of cholera vaccine acceptance.

Use of Dietary Supplements in Cancer Patients

Background: Dietary supplements (DS) have been increasingly utilized as a way of the promoting health and complementary therapy. This study aimed to evaluate the patterns of dietary supplement use in Korean cancer patients and to examine the related factors. Methods: Between April and May of 2008, 366 patients who were hospitalized for diagnosis and treatment of cancer in a university affiliated tertiary hospital were surveyed using a self-administered structured questionnaire after receiving written informed consent. Among them, 322 patients with adequate answers were fi nally included. Results: Two hundred forty patients (72.3%) reported to have ever taken DS with the mean number of 3.6 ± 2.98. Vitamins were the most frequently used, followed by ginseng steamed red, ginseng, and glucosamine. The most infl uential factor regarding DS use was the recommendation by family members or relatives. The main reason for DS use was for resolution of fatigue, followed by supplementation of therapy, and immune enhancement. Information concerning DS most eager to know about was the effect of DS (44.6%), followed by interaction of DS with therapeutics (33.2%). Doctor (74.4%) was the most preferred health care provider to be consulted concerning DS, but only 34% of DS users have actually consulted with a doctor. Multiple logistic regression analysis showed that increasing age, Catholicism, and higher educational level were associated with higher use of DS. Conclusion: DS use was very prevalent in cancer patients. In spite of the great need, only small proportion of cancer patients using DS has consulted with a doctor.

Healthcare-seeking behavior after seizures in children

Hardly any Indian data is available regarding practices employed by parents for preventing injuries and aspiration and controlling convulsions in children. To describe the health care-seeking behavior and practices employed by parents when a child has convulsions. Prospective questionnaire-based study in a tertiary care hospital setting. Parents of children (age: 1 month -12 years) admitted with history of convulsions were enrolled and information regarding demographic characteristics, time lag, preferred health care provider and measures taken in a convulsing child was elicited using a pretested questionnaire. Demographic parameters and measures employed described as percentages. One hundred and forty parents were interviewed. Seventy-six children had first episode. Forty-nine of 64 children with subsequent seizures had contact with a health care provider during the previous seizure episode. The median duration of seizures was 10 minutes (Mean: 54.15+/-366.39 min); but children were brought to the hospital after a median of 2 hours (Mean: 5.22+/-10.37 h). Measures such as smelling onions, oral administration of cold water, reading religious texts and insertion of mouth gag were employed. Although 45 with previous seizure-related health care contact agreed that they were informed about measures to be taken, none of them could remember more than one measure for preventing injuries and aspiration and controlling seizures. Only four narrated "per-rectal administration of diazepam" as a measure, although only one implemented it. Only four general practitioners used per-rectal diazepam to control seizures. Children with seizures reach health care providers after a considerable delay putting them at higher risk for developing neurological sequel. There is a need to develop appropriate strategies for disseminating information about "first aid" measures and steps for controlling convulsions and imparting relevant skills to parents.