Visiting Health Centers Research Articles

Factors affecting acceptance of immunization among children in rural Bangladesh.

This paper uses the Bangladesh Fertility Survey 1989 data to identify the factors affecting acceptance of immunization among children in rural Bangladesh. Acceptance of DPT, measles and BCG vaccinations were the dependent variables. The independent variables included proximity to health facilities, frequency of visit by health worker, respondent's mobility, media exposure, education, age, economic status of household, region of residence, and gender of child. Logistic regression analysis was performed to assess the net effects of the variables in addition to univariate analysis. Among the independent variables, proximity to health facility, frequency of health worker's visit, mother's mobility, education, age, gender of child, ownership of radio, economic condition of household, and region of residence showed statistically significant association with acceptance of immunization. The effect of frequency of health worker's visit was dependent on region of residence, possession of radio, and mother's education. The effect of mother's ability to visit health centre alone was also dependent on ownership of radio, economic condition of household, and mother's education.

Health-seeking behavior of Rwandan women

The responses of Rwandan women in a highland region to their own and their children's illness episodes are examined. Over 85% of diarrhea cases from monthly morbidity recalls were treated by health-center visits, use of Western medicine, or no treatment. Factors such as the age of the child at the time of the illness, previous child death in the household, and the women's control of various categories of household expenditures exert some influence on health-seeking behavior, according to results of cross-tabulations. Women at the highest altitudes tend to respond less actively to children's diarrhea, possibly because of the relative difficulty of their journey to the health center. Recommendations are offered for policy and further study.

Use of primary health services in sparsely populated country districts by patients with musculoskeletal symptoms: consultations with a physician.

To examine the extent to which people consult health centre doctors about various musculoskeletal symptoms and to identify those groups of patients who are responsible for the main workload in primary health care caused by musculoskeletal complaints. A cross sectional investigation based on case records of people who visited health centre physicians. The population of six Finnish health centre districts (93,000 inhabitants, 64 physicians' posts in primary care centres). 6526 patients (7634 visits) who consulted a physician at any of six health centres during a two week period, of which 1380 consulted for musculoskeletal symptoms. The reasons for the visits were abstracted from the case records and were analysed by cross tabulation. The rate of people visiting for musculoskeletal symptoms during a two week period was on average 15 per 1000 inhabitants. It was highest in men aged 45-54 years (25/1000) and in women aged 55-64 years (26/1000); the rate fell to the average in men over 54 and women over 64 years. Patients with musculoskeletal symptoms accounted for 21% of all patients and 27% of those over 15 years of age. Low back pain was the most common reason for consultation in men aged 25-54 years, while for women aged 35-74 years, the most common reason was neck and shoulder pain. Over one quarter of adults visiting a health centre doctor do so because of musculoskeletal disorders. This fact must be considered when developing health care services and organising basic education and further in-service training for doctors.

Obstacles to Achieving Immunization for all 2000: Missed Immunization Opportunities and Inappropriately Timed Immunization

Missed opportunities and inappropriately time immunization substantially reduced the coverage achieved in Mozambique and Guinea Conakry. During coverage surveys in Mozambique, we noted dates of attendance at a health facility for growth monitoring or vaccination, and in Conakry we also abstracted dates of curative care visits from home-based documents. In Mozambique, an average of 84 per cent of children aged 12-23 months had documents, and an average of 53 per cent of children were fully and correctly vaccinated. Among children with cards, 11 per cent had received all vaccines, but at least one dose was applied before the recommended age or with too short an interval between doses (inappropriately timed vaccinations). A further 8 per cent of children had sufficient documented contacts with preventive services to be fully vaccinated, but immunization opportunities had been missed. In Conakry, 54 per cent of 12-23 month-old children had immunization cards, and only 19 per cent were fully and correctly vaccinated. Among children with cards, 9 per cent had received all vaccines, but some were inappropriately timed, and 19 per cent had enough contacts with curative or preventative services to be fully vaccinated, but opportunities had been missed. We recommend that home-based records document all health centre visits, including those for curative care, and that missed opportunities and vaccination timing be routinely evaluated during vaccine coverage surveys.

ANXIETY AND ITS RELATIONSHIP TO SOMATIC COMLAINTS IN COLLEGE STUDENTS

The following study was undertaken to elucidate the relationships between psychosomatic symptoms and anxiety in college-age adolescents. 194 subjects, students at an Ivy League college and patients of its health service, were studied. Half of the subjects were making visits to the health service and half were randomly selected university students who ware recruited for the study. 63% of the subjects were female; 23% were freshmen, 26% sophomores, 19% juniors, 26% seniors and 6% fifth year or greater. 8% of students listed a chronic health problem such as asthma. All subjects completed the State-Trait Anxiety Inventory (STAI) and the SUNYA Ravision of the Psychosomatic Symptom Checklist (PSC) a measure of somatic symptoms (e.g. headache, abdcminal pain, etc.) assessed for frequency and intensity. Mean State anxiety score was 40.3 (40.8 in fanales--76th percentile, 38.3 in males--61st percentile). Mean Trait anxiety score was 39.7 (40.3 for females--65th percentile and 37.3 for males--53rd percentile). The mean PSC score was 24.6 (60th percentile). There were no significant differences between the health center visit group and the recruited group for any of these scores. There was a significant correlation between the total PSC score and the State (r=.51, P<.001) and Trait (r=.60, p<.001) anxiety scores, respectively. There were also significant correlations (at P≤.01) between 10 of the 17 individual somatic symptoms on the PSC and State and Trait scores. There ware no significant differences in STAI and PSC scores between different classes, nor between those with/without reported chronic health problems. A significant correlation between some psychosomatic complaints and anxiety in one group of college students suggests that nonorganically based somatic complaints should prompt sane discussion of anxiety in this age group.

A serological survey for human immunodeficiency virus types 1 and 2 of individuals who visited health centers in Tokyo.

The serum antibodies to human immunodeficiency virus types 1 (HIV-1) and 2 (HIV-2) were examined for among individuals who visited health centers in Tokyo. Of 8,198 sera screened, one was true-positive and 37 false-positive for HIV-1 antibodies. These 37 false-positives and 305 sera from the population groups at risk for HIV-2 (42 sojourners in Africa, 251 homo- and bisexuals, and 19 prostitutes) were further examined for HIV-2 antibodies by indirect immunofluorescence and Western blotting. No antibodies reactive with HIV-2 were detected in the sera examined. Serological cross-reactivity between HIV-1 and HIV-2 was examined by use of rabbit antisera.

Patient exposition and provider explanation in routine interviews and hypertensive patients' blood pressure control.

Hypertensive patients' expressing themselves in their own words (Exposition) and providers' giving information (Explanation) during medical interviews were hypothesized to be associated with subsequent blood pressure control. Transcripts of routine return visits to clinics in low-income areas of Houston, TX, were coded using the Verbal Response Modes (VRM) system. VRM indexes of Patient Exposition and Provider Explanation were tested in relation to systolic and diastolic blood pressure obtained during home interviews 2 weeks after the clinic visits. Patient Exposition was significantly correlated with reductions in systolic and diastolic blood pressure from clinic visit to home interview, and Provider Explanation was significantly correlated with lower diastolic blood pressure at home interview. The results suggest that patients' and providers' verbal behavior in medical interviews should be included in predictive models of blood pressure control.

A SOCIO-MEDICAL SURVEY ON PULMONARY TUBERCULOSIS CASES NEWLY DIAGNOSED

A socio-medical survey was carried out on 603 cases of Pulmonary Tuberculosis who had been diagnosed by means of X-ray examination at Health Centers and the Clini of the Seoul Branch of the Korean National Tuberculosis Association During the period from 5 September to 5 November, 1965. 1. Newly diagnosed pulmonary tuberculosis cases were more prevalent in 30~39 years of age group with 29.2%. Regarding extent of the pulmonary lesion among the newly confirmed 603 cases, 25.7% were in the minimal stage, 34.7% moderately advanced, and 39.6% far advanced according to U.S.A. - NTA classification. 2. Among the total number of patients, laborers and production process workers showed the highest rate with 18.2%. 3. The majority of the patients(about 85%) were living in poor economic conditions and 47.9% patients had families to support. The type of house in which the majority of cases were living was board-framed and the typical Korean type of dwelling house was accounted with 30%. 4. The majority of new TB cases had heard or read some information on tuberculosis from Health Centres, newspapers and magazines. 5. the patients who had been initially diagnosed at Health Centers without previous TB history were 47.4% of the fottal TB patients. Among the reasons for visiting Health Centers, hospitals and clinics etc., the patients with symptoms were accounted with 45.9%. 6. Cechst pain was the most frequent symptom; 42.6% among those patients had their symptom and 29.2% had no symptom. 7. It was confirmed that 10.3% of the patients already had precious TB history among their family and 3.5% had some members of family who had died of TB. 8. Among 603 cases, 145 TB cases had 2,851 family members who were living in the same rooms and those who were sharing alone in one room was 5.8%. 9. As the extent of the disacase was advanced hose-hold contacts among these patients were more numerous. It was found that 42.4% of family members were in contact with far advanced cases. Among children under five years of age living with patients, contacts with far advanced cases occupied 4.8%. 10. It was demonstrated that 17.4% of the patients wished to pay for treatments, and 11.1% for home treatments. Furthermore, 54.4% desired free treatments through the authorities concerned.