Seeking Health Care Services Research Articles

Update on Irritable Bowel Syndrome Program of Research

This article provides an update and overview of a nursing research program focused on understanding the pathophysiology and management of irritable bowel syndrome (IBS). This review includes English language papers from the United States, Europe, and Asia (e.g., South Korea) from 1999 to 2013. We addressed IBS as a health problem, emerging etiologies, diagnostic and treatment approaches and the importance of a biopsychosocial model. IBS is a chronic, functional gastrointestinal disorder characterized by recurrent episodes of abdominal pain and alterations in bowel habit (diarrhea, constipation, mixed). It is a condition for which adults, particularly women ages 20-45, seek health care services in both the United States and South Korea. Clinically, nurses play key roles in symptom prevention and management including designing and implementing approaches to enhance the patients' self-management strategies. Multiple mechanisms are believed to participate in the development and maintenance of IBS symptoms including autonomic nervous system dysregulation, intestinal inflammation, intestinal dysbiosis, dietary intolerances, alterations in emotion regulation, heightened visceral pain sensitivity, hypothalamic-pituitary-adrenal dysregulation, and dysmotility. Because IBS tends to occur in families, genetic factors may also contribute to the pathophysiology. Patients with IBS often report a number of co-morbid disorders and/or symptoms including poor sleep. The key to planning effective management strategies is to understand the heterogeneity of this disorder. Interventions for IBS include non-pharmacological strategies such as cognitive behavior therapy, relaxation strategies, and exclusion diets.

The Influence of Mistrust, Racism, Religious Participation, and Access to Care on Patient Satisfaction for African American Men: The North Carolina-Louisiana Prostate Cancer Project

DisclaimerThe views expressed in this manuscript are those of the authors and do not reflect the official policy or position of the Department of the Army, Department of Defense, or the US Government. ObjectiveThe purpose of this study was to explore whether a particular combination of individual characteristics influences patient satisfaction with the health care system among a sample of African American men in North Carolina with prostate cancer. Patient satisfaction may be relevant for improving African American men’s use of regular care, thus improving the early detection of prostate cancer and attenuating racial disparities in prostate cancer outcomes. MethodsThis descriptive correlation study examined relationships of individual characteristics that influence patient satisfaction using data from 505 African American men from North Carolina, who prospectively enrolled in the North Carolina-Louisiana Prostate Cancer Project from September 2004 to November 2007. Analyses consisted of univariate statistics, bivariate analysis, and multiple regression analysis. ResultsThe variables selected for the final model were: participation in religious activities, mistrust, racism, and perceived access to care. In this study, both cultural variables, mistrust (p = < .0001, F = 95.58) and racism (p = < .002, F = 5.59), were significantly negatively associated with patient satisfaction and accounted for the majority of the variability represented by individual characteristics. ConclusionMistrust and racism are cultural factors that are extremely important and have been negatively associated with patient satisfaction and decreased desires to utilize health care services for African American men. To overcome barriers in seeking health care services, health care providers need to implement a patient-centered approach by creating a clinical environment that demonstrates cultural competence and eliminating policies, procedures, processes, or personnel that foster mistrust and racism.

Academia da Cidade: um serviço de promoção da saúde na rede assistencial do Sistema Único de Saúde

This is an analysis of the health and nutritional profile of users of the Unified Health System admitted to a City Academy in Belo Horizonte, Minas Gerais during a triennium. It is a cross-sectional study with users> 20 years and socio-demographic characteristics, health habits, food intake and anthropometrics were gathered. Kolmogorov-Smirnov tests, ANOVA, Kruskal-Wallis test, chi-square and Fisher exact test were applied. There was a high prevalence of hypertensive subjects (41.6%), overweight (70.6%) and metabolic risks associated with obesity (67.6%). About 40% of entrants had 1-3 chronic diseases and over 65% used medication daily. There was an imbalance in daily consumption of fruits and vegetables (75.3%), fatty meat (72.4%) and sweetened drinks (54.2%). They had low education and income, and inadequate eating habits and high prevalence of hypertension, overweight and metabolic risks associated with obesity, which suggests users seeking health care services for treatment of diseases. This illustrates the perceived quest for cure, further demonstrating the lack of healthcare initiatives in the population. This reveals the need to review the actions at different levels of health care, to promote greater comprehensiveness of care provided.

Standard Operating Procedures for Taking a Sexual History

While there is evidence of increased professional and public awareness of sexual problems, both male and female sexual dysfunctions remain underdiagnosed and undertreated by health care professionals around the world. Health care professionals (HCPs) are typically reluctant, disinterested, or unskilled in sexual problem management and regrettably are often disinclined to inquire about sexual issues. HCPs in all countries receive variable, nonstandardized, or inadequate training in sexual history taking and its treatment. This article presents a standard operating procedure (SOP) for taking a sexual history from men or women with sexual problems or performance concerns. Review of relevant evidence-based literature identified through a PubMed search, integrated with expert opinion. Guidelines for taking a sexual history are presented along with the relevant domains, opening and follow-up questions. The SOP presented in this article offers HCPs a brief, structured, and uniform method for obtaining a sexual history from men or women seeking health care services. Sexual history taking should be based on three basic principles, which serve as the foundation for managing sexual problems in men and women. These include the following: (i) a patient-centered approach; (ii) evidenced-based diagnostic and treatment recommendations; and (iii) use of a unified management approach for men and women. Sexual history taking should always be conducted in a culturally sensitive manner, taking account of the individual's background and lifestyle, status of the partner relationship, and the clinician's comfort and experience with the topic. Sexual inquiry should be incorporated into all new patient encounters, when possible, if only to ask one or two broad questions such as the following: "Are you sexually active? Do you have any sexual concerns or problems you would like to discuss?" Sexual history taking is a cornerstone of sexual medicine clinical practice. All patients should be provided an opportunity for frank and open discussion of sexual issues or concerns, conducted in an atmosphere of sensitivity and respect.

Patient-centred access to health care: conceptualising access at the interface of health systems and populations

BackgroundAccess is central to the performance of health care systems around the world. However, access to health care remains a complex notion as exemplified in the variety of interpretations of the concept across authors. The aim of this paper is to suggest a conceptualisation of access to health care describing broad dimensions and determinants that integrate demand and supply-side-factors and enabling the operationalisation of access to health care all along the process of obtaining care and benefiting from the services.MethodsA synthesis of the published literature on the conceptualisation of access has been performed. The most cited frameworks served as a basis to develop a revised conceptual framework.ResultsHere, we view access as the opportunity to identify healthcare needs, to seek healthcare services, to reach, to obtain or use health care services, and to actually have a need for services fulfilled. We conceptualise five dimensions of accessibility: 1) Approachability; 2) Acceptability; 3) Availability and accommodation; 4) Affordability; 5) Appropriateness. In this framework, five corresponding abilities of populations interact with the dimensions of accessibility to generate access. Five corollary dimensions of abilities include: 1) Ability to perceive; 2) Ability to seek; 3) Ability to reach; 4) Ability to pay; and 5) Ability to engage.ConclusionsThis paper explains the comprehensiveness and dynamic nature of this conceptualisation of access to care and identifies relevant determinants that can have an impact on access from a multilevel perspective where factors related to health systems, institutions, organisations and providers are considered with factors at the individual, household, community, and population levels.

Attachment and Mental Health Symptoms Among U.S. Afghanistan and Iraq Veterans Seeking Health Care Services

Attachment theory has become a primary framework for understanding adjustment to traumas. In a convenience sample of 157 U.S. service members from the Afghanistan and Iraq wars seeking health care services at a Veterans Administration (VA) hospital, this study examined (a) the impact of attachment characteristics on several key mental health symptoms in this new generation of veterans, (b) the relative frequencies of prominent attachment styles in the sample, and (c) how these higher order orientations related to study outcomes. First, with demographic and military background factors in the model, attachment-related anxiety and avoidance were each uniquely associated with posttraumatic stress symptoms (PTSS), psychiatric distress, and alcohol misuse, βs = .25 to .60. Second, latent class analysis highlighted the underrepresentation of avoidant veterans of a dismissive type in the sample. Third, of the different possible types of attachment insecurities, veterans with a fearful disorganized orientation were also shown to be particularly vulnerable to PTSS and other problems, even when compared to preoccupied-dependent persons. These findings yield further support for the protective benefit of attachment security, while also suggesting the importance of both attachment anxiety and avoidance in the context of postdeployment adjustment.

Cross-border health care utilization among the Hispanic population in the United States: implications for closing the health care access gap

Objectives. To examine predictors of health care service utilization in Mexico or any other country in Latin America among the US Hispanic population. Methods. This study used data from the 2007 Pew Hispanic Healthcare Survey, a nationally representative survey of 4013 Hispanic adults. Using the Behavioral Model of Health Service Use (BMHSU) model, we examined three levels of predictive factors: (1) predisposing characteristics (e.g., language proficiency), (2) enabling resources (e.g., health insurance status), and (3) need (e.g., self-perceived health status). Multivariate logistic regression analyses were conducted to predict odds of seeking health care services in Mexico or any other country in Latin America. Results. As hypothesized, lack of continuous health insurance coverage, perceived lack of quality health care, and low English proficiency increased the likelihood of seeking health care in Mexico or any other Latin American country among US Hispanic adults. Self-reported health status and usual source of care, however, were not significant predictors. Conclusions. Hispanic immigrants face critical access gaps to health care in the United States. Implications for closing the access gap for this population are discussed within the context of health care system reform and immigration reform in the United States.

“They Treat us Like Pests:” Undocumented Immigrant Experiences Obtaining Health Care in the Wake of a “Crackdown” Ordinance

This article presents findings from a qualitative study of Latino immigrant experiences seeking health care services in the wake of an anti-immigrant “crackdown” ordinance similar to Arizona's SB 1070. Prince William County, Virginia's 2007 “Rule of Law” ordinance escalated law enforcement efforts that targeted this population for deportation and ordered staff to ensure that no one receive social services other than those required by federal law. This article sought to answer the questions: (1) Were undocumented immigrants able to obtain health care? (2) How do immigrants characterize their experiences with health providers? Data were gathered via semi-structured interviews (n = 57) with Latinos in a low-income neighborhood. Analysis of Spanish-language narratives found that many were dissuaded from seeking care because of high costs as well as lack of familiarity with the health care system. Others perceived that they were treated with insensitivity or outright hostility—and believed this treatment was a deliberate effort to discourage them from seeking help.

Clinic Visits Common Before Service Members’ Suicide

Back to table of contents Previous article Next article Professional NewsFull AccessClinic Visits Common Before Service Members’ SuicideAaron LevinAaron LevinSearch for more papers by this authorPublished Online:6 Apr 2012https://doi.org/10.1176/pn.47.7.psychnews_47_7_10-aAbstractAbout 45 percent of military service members who died by suicide visited outpatient medical clinics in the 30 days prior to their deaths, according to Department of Defense researchers. Even higher percentages of cases of self-inflicted injury (73 percent) or likely self-harm (76 percent) sought medical care in the month before the event, according to a team from the National Center for Telehealth and Technology of the Defense Center of Excellence for Psychological Health and Traumatic Brain Injury in Tacoma, Wash.“The study reminds us to be aware of the risk of suicide even when the focus of the visit is not a mental health issue,” said coauthor Mark Reger, Ph.D., in an interview with Psychiatric News. “The problem is that the risk of suicide for any one case is so low that it is a challenge for clinicians to spot it.”These clinic visits may signal “a final call for help by individuals who have made specific plans to end their lives,” wrote Reger and colleagues in the February Military Surveillance Monthly Report, a publication of the Armed Forces Health Surveillance Center.The study looked at the death and medical records of all active-duty service members from the U.S. Army, Navy, Air Force, and Marines from 2001 through 2010. Over that time, 1,939 service members died by suicide, 19,955 were diagnosed with self-inflicted injuries, and 3,463 were hospitalized with injuries or poisoning classified as “likely self-harm.”Only 7.3 percent of the individuals who later died by suicide visited a mental health or psychiatric clinic in the month prior to suicide, but 26.2 percent showed up in family or primary care offices. Seven percent percent appeared in substance abuse clinics.About 8.2 percent sought medical care in nonmilitary health care facilities, despite having full military health insurance.Those who died by suicide made excessive clinic visits to nonmilitary facilities and to family practice, substance abuse, and emergency medical settings, said Reger and colleagues.However, greater proportions of the self-inflicted injury cases and the likely self-harm cases visited mental health or psychiatry clinics than suicide cases did.Among all three classifications, the most frequent primary diagnoses made by nonmilitary facilities were musculoskeletal disorders, “signs, symptoms, and ill-defined conditions,” injuries, and mental disorders, said the researchers.Overall, the three cohorts used health care in ways similar to their unaffected peers until shortly before their deaths or injuries.“The finding suggests that there may be one or more ‘triggering’ events during which thoughts of self-harm intensify and lead to increased health care usage in many clinical settings,” they said. “Distressed service members may seek health care services in the hope that clinicians might recognize or help ameliorate the distress.”Better training of primary care practitioners or easier access to mental health clinicians might improve detection of suicidal intentions, said Mark Kaplan, M.D., a professor of community health at Oregon’s Portland State University who studies suicide for the Department of Veterans Affairs.That is especially critical in military cohorts, said Kaplan in an interview with Psychiatric News, since about 70 percent of Army soldiers who die by suicide, die of gunshot wounds. So the first attempt at suicide is often the final attempt, given the lethality of firearms.“The opportunity to intervene and rescue an individual who is suicidal and who has access to a gun is fairly limited,” said Kaplan.Unfortunately, while 45 percent of suicide decedents appeared in a clinic before they died, the majority had no such contact, leaving no opportunity for intervention, noted Reger and colleagues.A separate study by some of the same researchers and other colleagues in the same publication, found that “mood disorders, partner relationships, and family-circumstance problems, but not mild TBI [traumatic brain injury], were associated with increased odds of suicidality.”They suggested that looking at constellations of these symptoms and diagnoses may offer clinicians better clues to suicidality. “Health Care Experiences Prior to Suicide and Self-inflicted Injury, Active Component, U.S. Armed Forces, 2001-2010” is posted at www.afhsc.mil/viewMSMR?file=2012/v19_n02.pdf#Page=02. ISSUES NewArchived

Geographical disparities of infant mortality in rural China

ObjectiveThe purpose of the study was to investigate the trends and causes of regional disparities of infant mortality rate (IMR) in rural China from 1996 to 2008.DesignA population-based, longitudinal study.SettingThe...

The experiences of Indigenous people in health care encounters in Western settings and contexts: A systematic review of qualitative evidence

Review question/objective The objective of this review is to analyse and synthesise the best available evidence on the experiences of Indigenous people who engage in health care encounters in Western settings and contexts. The review question is: What are the experiences of Indigenous people engaged in health care encounters in Western settings and contexts? Inclusion Criteria Types of Participants Studies including two groups of participants, regardless of age or gender, will be considered for this systematic review. The first group is persons of Indigenous descent from the following countries and continents appearing most frequently in the literature: North America, South America, New Zealand, Australia, and Scandinavian countries. These countries include peoples such as First Nations, Native Americans, Metis, Inuit, North American Indians, South American Indians, Inca, Maori, Aboriginal and Torres Strait Islander peoples of Australia, and Sapmi. This list is not exhaustive, and any Indigenous population identified in a study will be included. Indigenous populations who immigrate to new countries will be excluded, given that immigrant status can confound Indigenous status. The second group of participants to be considered for inclusion is health care providers who work in Western settings and context, including, but not limited to, nurses, physicians, nutritionists, midwives, social workers, physiotherapists, occupational therapists, speech and language therapists, and respirologists. Phenomena of Interest The phenomenon of interest is the experience of Indigenous people in health care encounters in Western health care settings and context. Health care encounters refer to any interactions between an Indigenous person and a health care provider within the scope of Western health care services. All reasons for health encounters will be considered. Context The context will be Indigenous persons seeking health care services in Western settings and context. These services may be located within urban, rural, or remote health care settings where Western health care services are delivered.

The experiences of Indigenous people in health care encounters in Western settings and contexts: A systematic review of qualitative evidence.

Review question/objective The objective of this review is to analyse and synthesise the best available evidence on the experiences of Indigenous people who engage in health care encounters in Western settings and contexts. The review question is: What are the experiences of Indigenous people engaged in health care encounters in Western settings and contexts? Inclusion Criteria Types of Participants Studies including two groups of participants, regardless of age or gender, will be considered for this systematic review. The first group is persons of Indigenous descent from the following countries and continents appearing most frequently in the literature: North America, South America, New Zealand, Australia, and Scandinavian countries. These countries include peoples such as First Nations, Native Americans, Metis, Inuit, North American Indians, South American Indians, Inca, Maori, Aboriginal and Torres Strait Islander peoples of Australia, and Sapmi. This list is not exhaustive, and any Indigenous population identified in a study will be included. Indigenous populations who immigrate to new countries will be excluded, given that immigrant status can confound Indigenous status. The second group of participants to be considered for inclusion is health care providers who work in Western settings and context, including, but not limited to, nurses, physicians, nutritionists, midwives, social workers, physiotherapists, occupational therapists, speech and language therapists, and respirologists. Phenomena of Interest The phenomenon of interest is the experience of Indigenous people in health care encounters in Western health care settings and context. Health care encounters refer to any interactions between an Indigenous person and a health care provider within the scope of Western health care services. All reasons for health encounters will be considered. Context The context will be Indigenous persons seeking health care services in Western settings and context. These services may be located within urban, rural, or remote health care settings where Western health care services are delivered.

Haitian Picuristes/Injectionists as Alternatives to Conventional Health Care Providers in South Florida

Barriers in seeking access to conventional health care services continue to be a problem in the United States, especially among recent racial and ethnic immigrants who tend to be least able to afford adequate health insurance coverage. Ethnic immigrants sometimes seek out traditional healers as unconventional providers of health care services to overcome barriers in accessing the conventional health care delivery system. The purpose of this work is to provide insight into the practices of Picuristes or Haitian “lay injectionists” in their role as alternative, unconventional providers of health care services among Haitian immigrants in South Florida. Based on in-depth interviews with 10 picuristes who were identified through venue and snowball sampling and who volunteered to participate in a larger exploratory study that examined various aspects of picuriste practices, findings revealed benefits and risks of seeking health care services from these traditional practitioners. Among the benefits reported to their services were greater accessibility, affordability, convenience, and cultural compatibility. Risks observed from analysis of picuriste interviews included the lack of formal medical training for picuristes, their nonadherence to established standards for safe injections and their potential to expose clients and the community to contaminated needles, syringes, and other biohazardous waste materials. Insight was also gained into how picuristes learned to practice their trade and to incorporate Haitian cultural beliefs regarding the relationship between clients and healers. Given the continuation of barriers to health care among ethnic immigrants, implications for conventional heath care practice and social policy are also discussed.

Physical, Behavioral, and Mental Health Issues in Asian American Women: Results from the National Latino Asian American Study

Asian American women's health has been understudied while the Asian American population is increasing. The purpose of this study was to examine the physical, behavioral, and mental health of Asian American women. Using a nationally representative sample (n=1097) from the National Latino Asian American Study (NLAAS), the first comprehensive epidemiologic survey in the United States, we examined the annual rates of behavioral, physical, and mental healthcare service use, including general medical, specialty mental health, and any medical services, in three major subgroups of Asian American women. Health problems varied with three major subgroups of Asian American women. In physical health, Chinese American women reported the highest rates of headache, other pain, hypertension, heart diseases, heart attacks, chronic lung diseases, and asthma. Vietnamese American women reported the highest rates of ulcer, stroke, and diabetes. Filipino American women had the highest rates of cancers and epilepsy. In behavioral health, Filipino women ranked highest on all types of drug use and cigarette smoking, compared with their counterparts. In mental health, Filipino American women reported significantly better mental health self-rating compared with their Chinese and Vietnamese American counterparts. Asian American women from each ethnic group sought health services at distinct rates. However, the help-seeking patterns of health services are similar. Asian American women encountered various physical, behavioral, and mental health problems, yet they had low rates of seeking healthcare services. Hence, it is critical to further examine factors associated with the underestimation of physical and mental health problems and underuse of health services by Asian American women.

Characteristics and Correlates of Cigarette Use Among Recent U.S. Veterans

Little is known about the smoking habits and cessation efforts of veterans returning from Iraq and Afghanistan, many of whom will seek health care services in the public sector. This project documents rates of smoking and quit attempts among veterans receiving Veteran's Health Administration (VHA) health care and describes the relationship between current smoking use/cessation and demographic characteristics, quality of life, and potential alcohol misuse. A large representative sample of Iraq/Afghanistan era veterans was surveyed using the VA Survey of Healthcare Experiences of Patients (Wright, Craig, Campbell, Schafer, & Humble, 2006). One third of respondents reported smoking during the past year and 24% reported currently smoking. Current smoking status was more prevalent among those who reported less education and lower household income. Current smoking status was also related to lower mental and physical health quality of life and higher potential alcohol misuse scores. Quit attempts were significantly less common among reserve component veterans and quitters reported higher incomes and were slightly older. The frequency of cigarette smoking among recent veterans underscores the importance of addressing smoking cessation efforts within this population. Individual characteristics associated with current smoking, cessation efforts, and relapse may help tailor cessation treatment for this growing cohort of new veterans.

When ordinary days become extraordinary: The response to H1N1 at the Izaak Walton Killam Health Centre

In April 2009, the H1N1 swine flu virus entered Canada with a sentinel case presenting in a private school in Windsor, Nova Scotia, signaling the beginning of wave 1 of a pandemic. By June, the World Health Organization raised the alert level to 6. Wave 2 was expected in 4 to 6 months. Between waves, the IWK took the opportunity to revise pandemic plans that had been prepared for the H5N1 avian influenza virus to ensure that the organization would be prepared for the emergency response that would be required to manage large numbers of ill people seeking healthcare services for the pending second wave of the swine flu.

DOES CHINA'S RURAL COOPERATIVE MEDICAL SYSTEM ACHIEVE ITS GOALS? EVIDENCE FROM THE CHINA HEALTH SURVEILLANCE BASELINE SURVEY IN 2001

I. INTRODUCTION China's rural health care system has undergone a significant transformation since the late 1970s, when China embarked on the process of moving from a planned to market economy. The reform has led to the collapse of the old Cooperative Medical System (CMS)--a health care safety net which was an integrated part of the overall collective welfare system under the Rural Communes. The percentage of the rural population covered by health insurance decreased from 90% in the 1970s to 4.8% in 1989 (Liu et al. 1996). Without access to health insurance, the majority of rural households paid for health services' out-of-pocket. These households had greater difficulty gaining access to essential health care (Akin, Dow, and Lance 2004; Hesketh and Zhu 1997) and were more likely to be pushed into poverty (van Doorslaer et al. 2006). Previous studies in China indicate that about 30% to 50% of poor households attributed their low economic status to paying for medical care to treat the illnesses of the family members ( Chinese Ministry of Health 1998. 2003; Gu 1991). The Chinese government has been aware of these issues since the 1990s and has sought to address them by planning a new rural CMS nationwide. In the mid-1990s, the government initiated pilot programs in some rural counties. But in 2003, about 80% of the rural population still lacked any type of health insurance (Chinese Ministry of Health 2003). In 2004, the Chinese government announced an initiative to accelerate the development of the CMS. whereby the CMS would be established in every rural county by 2011. The goals of the new CMS include ensuring access to essential health services for the rural population (particularly the poorest members) and providing financial risk protection to rural residents with catastrophic illnesses. Except for the special issue of Health Economics in China, published in June 2009, the literature contains few studies on the impact of CMS pilot programs. Among limited studies, Liu et al. (2003) found that rural residents with insurance coverage are more likely to obtain health services than those without insurance, even after controlling for severity of illness and other factors. Wagstaffet al. (2007) investigated the impact of the CMS in some rural areas and suggested that the CMS increased health service utilization, but had a positive impact on catastrophic spending. Similar findings are generated by Yi et al (2009) and Lei and Lin (2009). In this article, using the individual and household level data from the China Health Surveillance Baseline 2001 Survey (CHSS), we conducted a case study on two CMS pilot programs in two counties with low coverage for medical services and investigated whether or not enrolling in the CMS pilot programs increases medical visits when an individual feels sick and decreases the likelihood of facing catastrophic spending for a household. Individuals or households covered only by the CMS and individuals or households without insurance coverage are included in the analysis. The self-selection issue is examined. A matched data set is generated to further address this issue. Using a two-part hurdle model to analyze the impact of the CMS on utilization, we find that, for individuals who reported being ill in the previous 2 weeks, the coverage of CMS significantly increased the likelihood of seeking health care services and the number of outpatient visits. This finding is robust to various estimation methods. At the household level, results from a logistic regression show that the CMS programs did not have a significant impact on households' out-of-pocket health expenditure and catastrophic spending. The regression results generated from the matched data are consistent with those obtained from the full set of data. The article is organized into five sections. Section II gives some background to the CHSS and the benefits design of the CMS in the two pilot counties. …

Frequency of Pap smear testing in young women with an obstetric history in Teresina, Piauí, Brazil

To analyze the frequency of Pap smear testing in young women with at least one pregnancy in Teresina, capital of the state of Piauí, Brazil. A cross-sectional study was undertaken from May to December 2008. A convenience sample of 464 young women was selected, and data were collected using a pre-tested questionnaire. Women giving birth in the first four months of 2006, in six hospitals in Teresina, were included. Inadequate Pap smear frequency was defined as an interval of more than 1 year between tests. Mean age was 20 years. The frequency of Pap smear testing was every 6 months in 180 women (39.0%) and yearly in 160 (34.5%). Fifteen women (3.2%) had never had a Pap smear test. Simple logistic regression showed an increase of 48.0% in the risk of inadequate Pap smear frequency (P = 0.049) in women who did not use any contraceptive method at their first sexual intercourse, and 49.0% (P = 0.044) in those who were not able to choose between a male or female gynecologist when seeking health care services. On multivariate logistic regression, having more than one pregnancy increased the risk of inadequate Pap smear frequency by 71.4% in comparison to having only one pregnancy (P = 0.011). The fact that many young women had Pap smear testing at intervals shorter than 1 year does not improve cervical cancer screening and may burden the health care system. Multiparity was a risk factor for inadequate Pap smear frequency, an aspect that must be taken into account when providing gynecological care to young women.

Stigma, Health Care Access, and HIV Knowledge Among Men Who Have Sex With Men in Malawi, Namibia, and Botswana

Same-sex practices are stigmatized in much of sub-Saharan Africa. Cross-sectional relationships between discrimination, access to and use of health care services, and HIV knowledge among men who have sex with men (MSM) were assessed in Malawi, Namibia, and Botswana. A survey and HIV screening were used to explore these variables and the prevalence of HIV. Overall, 19% of men screened positive for HIV infection. Ninety-three percent knew HIV is transmitted through anal sex with men, however, only 67% had ever received information of how to prevent this transmission. Few (17%) reported ever disclosing same sex practices to a health professional and 19% reported ever being afraid to seek health care. Men reported ever been denied health care services (5%) and 21% had ever been blackmailed because of their sexuality. Strong associations were observed between experiences of discrimination and fear of seeking health care services. Characterizing the relationship between stigma and health care seeking practices and attitudes can inform the development and implementation of HIV interventions for African MSM.

Adesão e reações de usuários ao tratamento da malária: implicações para a educação em saúde

Estudo exploratório-descritivo cujo objetivo foi descrever a adesão e reações de usuários em relação ao tratamento antimalárico em um município de Mato Grosso, Brasil. Os dados foram coletados com 16 usuários através de entrevistas semi-estruturadas e analisados usando-se a Análise de Conteúdo. O estudo revelou que há pessoas que aderem parcialmente ao tratamento antimalárico e outras que procuram tratamentos alternativos. Aos primeiros sinais e sintomas da malária, a maior parte dos usuários procura os serviços de saúde para diagnóstico e tratamento, provavelmente por ter conhecimento sobre a doença, a transmissão e o tratamento da mesma; pela facilidade de acesso ao serviço que oferece diagnóstico e tratamento gratuito; e pelo bom relacionamento com os agentes de saúde. Concluiu-se que apesar do sucesso de algumas ações do governo para controle da malária, ainda há necessidade de investimento em ações educativas e de vigilância em saúde.