Background Cumulative evidence demonstrates that primary percutaneous coronary intervention（PCI）is a mperfusion strategy for ST-elevation myocardial Infarction（STEMI）.This study was undertaken to evaluate the pre-...Background Cumulative evidence demonstrates that primary percutaneous coronary intervention（PCI）is a mperfusion strategy for ST-elevation myocardial Infarction（STEMI）.This study was undertaken to evaluate the pre-hospital care-seeking pathway and subsequent care quality in patients with STEMI in the Beijing health care system,which offers patients a choice between seeking care in a small community hospital（SH group）or a large hospital（LH group）.Methods Between January 1 and December 31,2006, a cross-sectional and multicenter survey was conducted in 11 hospitals qualified as tertiary centers in Beijing and included consecutive patients with STEMI admitted within 24 hours after onset of symptoms.Results Among the 566 patients interviewed,28.3%first arnved at a small community hospitaI and were transferred to large hospitals with the ability to perform primary PCI.The median total pre-hospital delay in the SH group（n=160）was significantly longer than in the LH group（n=406）（225 vs.120 minutes,P〈0.001）.Multivariate analysis showed that interpreting symptoms to non-cardiac origin（OR,1.996;95%CI： 1.264-3.155）,absence of history of myocardial infarction（OR,1.595;95%CI：1.086-3.347）,non-health insuranca coverage（OR,1.931;95%Cl：1.079-3.012）and absence of sense of impending doom （OR,4.367;95%CI：1.279-1 4.925） were independent predictors for choosing small hospitals.After adjusting for demographics and medical history,patients in the SH group were 1.698 times（95% CI： 1.1 82-3.661） less likely to receive primary PCI compared with those in the LH group. Conclusions Above one fourth of the STEMI patients in Beijing experienced inter-hospital transfer.Factors including symptoms interpretation,symptoms,history of myocardial infarcUon,and insurance coverage were associated with the patients＇pre-hospital care-seeking pathway.The patients who were transferred had longer pre-hospital delays and were less Iikely to receive primary PCI.展开更多
Background Delay in seeking medical care in patients with acute myocardial infarction （AMI） is receiving increasing attention. This study aimed to examine the association between expected symptoms and experienced sy...Background Delay in seeking medical care in patients with acute myocardial infarction （AMI） is receiving increasing attention. This study aimed to examine the association between expected symptoms and experienced symptoms of AMI and its effects on care-seeking behaviors of patients with AMI. Methods Between November 1, 2005 and December 31, 2006, a cross-sectional and multicenter survey was conducted in 19 hospitals in Beijing and included 799 patients with ST-elevation myocardial infarction （STEMI） admitted within 24 hours after onset of symptoms. Data were collected by structured interviews and medical record review. Results The median （25%, 75%） prehospital delay was 140 （75, 300） minutes. Only 264 （33.0%） arrived at the hospital by ambulance. The most common symptoms expected by patients with STEMI were central or left chest pain （71.4%）, radiating arm or shoulder pain （68.7%）, shortness of breath or dyspnea （65.5%）, and loss of consciousness （52.1%）. The most common symptoms experienced were central or left chest pain （82.1%）, sweats （71.8%）, shortness of breath or dyspnea （43.7%）, nausea or vomiting （32.3%）, and radiating pain （29.4%）. A mismatch between symptoms experienced and those expected occurred in 41.8% of patients. Patients who interpreted their symptoms as noncardiac in origin were more likely to arrive at the hospital by self-transport （86.5% vs. 52.9%, P 〈0.001） and had longer prehospital delays （medians, 180 vs. 120 minutes, P 〈0.001） compared to those who interpreted their symptoms as cardiac in origin. Conclusions Symptom interpretation influenced the care-seeking behaviors of patients with STEMI in Beijing. A mismatch between expectation and actual symptoms was associated with longer prehospital delay and decreased use of emerqency medical service （EMS）.展开更多
Purpose:The aim of this study was to examine the self-care practices and health-seeking behaviours of older adults in urban Indonesia.Methods:The cross-sectional study was performed from January to March 2014 in the T...Purpose:The aim of this study was to examine the self-care practices and health-seeking behaviours of older adults in urban Indonesia.Methods:The cross-sectional study was performed from January to March 2014 in the Tammua sub-district of Indonesia.At the time of the study,273 older adults resided in Tammua,and half of them(51.2%)participated in this study.Data collection was carried out including self-care practices,health literacy,self-efficacy and basic conditioning factors.Results:It was found that most respondents(124;88.6%)always ate various protein sources daily.However,many participants never limited consumption of sugar(55;39.3%)or salt(40;28.6%),and more than half of respondents(96;68.6%)did not regularly visit MHCs.Health status(p<0.05),health maintenance(p<0.01)and salt limitation(p<0.05)were all significantly associated with salt limitation.It was found that respondents with higher selfefficacy,those who did not want to get information,and those of younger ages are less likely to visit MHCs regularly.Conclusion:An understanding of self-care practices and self-efficacy is needed to improve health care in developing countries.High self-efficacy should be promoted along with adequate health literacy.Older persons should learn the importance of regular health examinations to promote health,prevent diseases,and slow the progress of chronic diseases.The number of respondents who never limit their sugar and salt intake was especially surprising.An intervention program should be developed to limit salt and sugar intake of Indonesian elderly and to motivate older persons to use primary health services.展开更多
<strong>Introduction:</strong> For seriously ill women of childbearing age, perceived health warning signs may influence decision of whether or not to seek care. Inaccurate perceptions of patients and thos...<strong>Introduction:</strong> For seriously ill women of childbearing age, perceived health warning signs may influence decision of whether or not to seek care. Inaccurate perceptions of patients and those around them may lead to attitudes that delay seeking care. This study analyzes perceptions of danger and related delays to seek care in Kinshasa. <strong>Methods:</strong> Sixty deceased women who died between March and April 2004 were taken away from two Kinshasa mortuaries. History of disease and deaths were reconstructed through medical records and semi-structured interviews of family members and leaders. The Qualitative Software Research was used to conduct a qualitative analysis. <strong>Results:</strong> Perceived health warning signs had five manifestations: Specific clinical health warning signs, aggravation of non-specific signs, persistence of signs, indirect danger signs and superstitious signs. The incorrect perception of the signs was an important cause of late awareness of the danger and delayed decision to seek care. <strong>Conclusion: </strong>Misunderstandings of signs often delayed awareness of danger as well as decisions to seek appropriate care. Educational programs teaching health warning signs should be designed to promote the timely use of facilities.展开更多
Background:Health policy formulations in India have witnessed a shift from a reactive approach to a more proactive approach over the last decade.It is therefore important to understand the effectiveness of recent nati...Background:Health policy formulations in India have witnessed a shift from a reactive approach to a more proactive approach over the last decade.It is therefore important to understand the effectiveness of recent national health policies(such as the National Rural Health Mission and the National Urban Health Mission)in addressing the varied needs of the heterogeneous population of India.Methods:We use datasets from the National Sample Surveys carried out in 2004 and 2014 to understand the change in the health seeking behavior as a result of these policies.The choice of health care facilities and the associated expenditures are compared through descriptive analyses.A multinomial logistic regression is used to identify the significant parameters which contribute towards the share of health care providers in India.The health status of two economically disparate Indian states(Bihar and Kerala)are also compared through specific metrics of performance.Results:It is seen that due to increased availability of facilities in close proximity,both rural and urban residents prefer to avail of those facilities which will result in minimization of transportation cost.The effectiveness of national health policies is found to vary on a regional scale.Literacy and health status have a strong correlation,thereby reinforcing that Bihar still lags far behind Kerala in terms of access to equitable health care.Conclusion:Therefore,a hierarchical system,incorporating medical pluralism and tailor-made policies targeted at diverse health care demands,needs to be put in place to achieve Goal 3 of the Sustainable Development Goals as decreed by the United Nations,i.e.,“health for all”.展开更多
Background Prehospital delay remains one of the main causes of reduced benefit of reperfusion therapy for patients with acute myocardial infarction (AMI) The largest proportion of prehospital delay involves the interv...Background Prehospital delay remains one of the main causes of reduced benefit of reperfusion therapy for patients with acute myocardial infarction (AMI) The largest proportion of prehospital delay involves the interval between the onset of symptoms and the decision to seek medical treatment The purpose of this study was to examine the factors associated with the extent of care seeking delay in Beijing for patients with AMI Methods A structured interview was conducted in 102 patients with AMI in eight hospitals in Beijing Results The mean decision time in patients with AMI was (204±43) minutes, and prehospital delay time was (311±54) minutes Only 34% of patients sought medical care within one hour and a further 36% of patients presented to one of the eight hospitals within two hours after onset Educational level, atypical presentation of AMI, and family members at the site where AMI occurred were associated with longer delay time in seeking medical assistance ( P <0 05, respectively), whereas the intensity of chest pain was inversely related to patients’ delay time ( P <0 01) Patients who perceived their family relationship as good, attributed their symptoms to AMI origin, knew the time dependent nature of reperfusion therapy, or used emergency medical service tended to seek medical care in a more rapid manner ( P <0 05, respectively) Conclusions Patients with AMI in Beijing delay seeking medical care to a great extent Health education to increase the level of awareness of the target population at increased risk of AMI, including patients and their family members, is probably beneficial to reduce patients’ care-seeking delay展开更多
目的探讨获取服务的障碍评估量表(Barriers to Access to Care Evaluation,BACE)在中国严重精神障碍患者中的信度、效度及初步应用。方法以203例精神分裂症患者(精神分裂症组)、77例双相障碍患者(双相障碍组)及35例抑郁障碍患者(抑郁障...目的探讨获取服务的障碍评估量表(Barriers to Access to Care Evaluation,BACE)在中国严重精神障碍患者中的信度、效度及初步应用。方法以203例精神分裂症患者(精神分裂症组)、77例双相障碍患者(双相障碍组)及35例抑郁障碍患者(抑郁障碍组)作为受访对象,其中自愿住院患者111例,非自愿住院患者152例,未住院患者52例。对入组患者进行BACE、简明精神病量表(BPRS)、功能大体评定量表(GAF)、精神疾病内在病耻感调查表(ISMI)、自尊量表(SES)进行评估。结果信度分析显示,BACE的Cronbach’sα系数为0.899,分半相关系数r=0.885,总分的重测信度r=0.693。效度分析显示,BACE总分、亚量表一总分与ISMI总分均呈正相关(P<0.05);BACE总分与BPRS总分呈正相关(P<0.05),与GAF总分呈负相关(P<0.05)。秩和检验结果显示,非自愿住院患者BACE总分及BACE亚量表一总分高于自愿住院患者(P<0.05)。精神分裂症组、双相障碍组及抑郁障碍组三组间BACE总分及BACE亚量表一总分的差异有统计学意义(P<0.05);方差分析结果显示,精神分裂症组、双相障碍组及抑郁障碍组三组间刻板认同因子分和歧视经历因子分的差异有统计学意义(P<0.05)。结论 BACE中文版具有良好的信度和效度,可应用于中国严重精神障碍患者。展开更多
文摘Background Cumulative evidence demonstrates that primary percutaneous coronary intervention（PCI）is a mperfusion strategy for ST-elevation myocardial Infarction（STEMI）.This study was undertaken to evaluate the pre-hospital care-seeking pathway and subsequent care quality in patients with STEMI in the Beijing health care system,which offers patients a choice between seeking care in a small community hospital（SH group）or a large hospital（LH group）.Methods Between January 1 and December 31,2006, a cross-sectional and multicenter survey was conducted in 11 hospitals qualified as tertiary centers in Beijing and included consecutive patients with STEMI admitted within 24 hours after onset of symptoms.Results Among the 566 patients interviewed,28.3%first arnved at a small community hospitaI and were transferred to large hospitals with the ability to perform primary PCI.The median total pre-hospital delay in the SH group（n=160）was significantly longer than in the LH group（n=406）（225 vs.120 minutes,P〈0.001）.Multivariate analysis showed that interpreting symptoms to non-cardiac origin（OR,1.996;95%CI： 1.264-3.155）,absence of history of myocardial infarction（OR,1.595;95%CI：1.086-3.347）,non-health insuranca coverage（OR,1.931;95%Cl：1.079-3.012）and absence of sense of impending doom （OR,4.367;95%CI：1.279-1 4.925） were independent predictors for choosing small hospitals.After adjusting for demographics and medical history,patients in the SH group were 1.698 times（95% CI： 1.1 82-3.661） less likely to receive primary PCI compared with those in the LH group. Conclusions Above one fourth of the STEMI patients in Beijing experienced inter-hospital transfer.Factors including symptoms interpretation,symptoms,history of myocardial infarcUon,and insurance coverage were associated with the patients＇pre-hospital care-seeking pathway.The patients who were transferred had longer pre-hospital delays and were less Iikely to receive primary PCI.
文摘Background Delay in seeking medical care in patients with acute myocardial infarction （AMI） is receiving increasing attention. This study aimed to examine the association between expected symptoms and experienced symptoms of AMI and its effects on care-seeking behaviors of patients with AMI. Methods Between November 1, 2005 and December 31, 2006, a cross-sectional and multicenter survey was conducted in 19 hospitals in Beijing and included 799 patients with ST-elevation myocardial infarction （STEMI） admitted within 24 hours after onset of symptoms. Data were collected by structured interviews and medical record review. Results The median （25%, 75%） prehospital delay was 140 （75, 300） minutes. Only 264 （33.0%） arrived at the hospital by ambulance. The most common symptoms expected by patients with STEMI were central or left chest pain （71.4%）, radiating arm or shoulder pain （68.7%）, shortness of breath or dyspnea （65.5%）, and loss of consciousness （52.1%）. The most common symptoms experienced were central or left chest pain （82.1%）, sweats （71.8%）, shortness of breath or dyspnea （43.7%）, nausea or vomiting （32.3%）, and radiating pain （29.4%）. A mismatch between symptoms experienced and those expected occurred in 41.8% of patients. Patients who interpreted their symptoms as noncardiac in origin were more likely to arrive at the hospital by self-transport （86.5% vs. 52.9%, P 〈0.001） and had longer prehospital delays （medians, 180 vs. 120 minutes, P 〈0.001） compared to those who interpreted their symptoms as cardiac in origin. Conclusions Symptom interpretation influenced the care-seeking behaviors of patients with STEMI in Beijing. A mismatch between expectation and actual symptoms was associated with longer prehospital delay and decreased use of emerqency medical service （EMS）.
基金This study was part of a doctoral study funded by the Indonesia Directorate General of Higher Education
文摘Purpose:The aim of this study was to examine the self-care practices and health-seeking behaviours of older adults in urban Indonesia.Methods:The cross-sectional study was performed from January to March 2014 in the Tammua sub-district of Indonesia.At the time of the study,273 older adults resided in Tammua,and half of them(51.2%)participated in this study.Data collection was carried out including self-care practices,health literacy,self-efficacy and basic conditioning factors.Results:It was found that most respondents(124;88.6%)always ate various protein sources daily.However,many participants never limited consumption of sugar(55;39.3%)or salt(40;28.6%),and more than half of respondents(96;68.6%)did not regularly visit MHCs.Health status(p<0.05),health maintenance(p<0.01)and salt limitation(p<0.05)were all significantly associated with salt limitation.It was found that respondents with higher selfefficacy,those who did not want to get information,and those of younger ages are less likely to visit MHCs regularly.Conclusion:An understanding of self-care practices and self-efficacy is needed to improve health care in developing countries.High self-efficacy should be promoted along with adequate health literacy.Older persons should learn the importance of regular health examinations to promote health,prevent diseases,and slow the progress of chronic diseases.The number of respondents who never limit their sugar and salt intake was especially surprising.An intervention program should be developed to limit salt and sugar intake of Indonesian elderly and to motivate older persons to use primary health services.
文摘<strong>Introduction:</strong> For seriously ill women of childbearing age, perceived health warning signs may influence decision of whether or not to seek care. Inaccurate perceptions of patients and those around them may lead to attitudes that delay seeking care. This study analyzes perceptions of danger and related delays to seek care in Kinshasa. <strong>Methods:</strong> Sixty deceased women who died between March and April 2004 were taken away from two Kinshasa mortuaries. History of disease and deaths were reconstructed through medical records and semi-structured interviews of family members and leaders. The Qualitative Software Research was used to conduct a qualitative analysis. <strong>Results:</strong> Perceived health warning signs had five manifestations: Specific clinical health warning signs, aggravation of non-specific signs, persistence of signs, indirect danger signs and superstitious signs. The incorrect perception of the signs was an important cause of late awareness of the danger and delayed decision to seek care. <strong>Conclusion: </strong>Misunderstandings of signs often delayed awareness of danger as well as decisions to seek appropriate care. Educational programs teaching health warning signs should be designed to promote the timely use of facilities.
文摘Background:Health policy formulations in India have witnessed a shift from a reactive approach to a more proactive approach over the last decade.It is therefore important to understand the effectiveness of recent national health policies(such as the National Rural Health Mission and the National Urban Health Mission)in addressing the varied needs of the heterogeneous population of India.Methods:We use datasets from the National Sample Surveys carried out in 2004 and 2014 to understand the change in the health seeking behavior as a result of these policies.The choice of health care facilities and the associated expenditures are compared through descriptive analyses.A multinomial logistic regression is used to identify the significant parameters which contribute towards the share of health care providers in India.The health status of two economically disparate Indian states(Bihar and Kerala)are also compared through specific metrics of performance.Results:It is seen that due to increased availability of facilities in close proximity,both rural and urban residents prefer to avail of those facilities which will result in minimization of transportation cost.The effectiveness of national health policies is found to vary on a regional scale.Literacy and health status have a strong correlation,thereby reinforcing that Bihar still lags far behind Kerala in terms of access to equitable health care.Conclusion:Therefore,a hierarchical system,incorporating medical pluralism and tailor-made policies targeted at diverse health care demands,needs to be put in place to achieve Goal 3 of the Sustainable Development Goals as decreed by the United Nations,i.e.,“health for all”.
文摘Background Prehospital delay remains one of the main causes of reduced benefit of reperfusion therapy for patients with acute myocardial infarction (AMI) The largest proportion of prehospital delay involves the interval between the onset of symptoms and the decision to seek medical treatment The purpose of this study was to examine the factors associated with the extent of care seeking delay in Beijing for patients with AMI Methods A structured interview was conducted in 102 patients with AMI in eight hospitals in Beijing Results The mean decision time in patients with AMI was (204±43) minutes, and prehospital delay time was (311±54) minutes Only 34% of patients sought medical care within one hour and a further 36% of patients presented to one of the eight hospitals within two hours after onset Educational level, atypical presentation of AMI, and family members at the site where AMI occurred were associated with longer delay time in seeking medical assistance ( P <0 05, respectively), whereas the intensity of chest pain was inversely related to patients’ delay time ( P <0 01) Patients who perceived their family relationship as good, attributed their symptoms to AMI origin, knew the time dependent nature of reperfusion therapy, or used emergency medical service tended to seek medical care in a more rapid manner ( P <0 05, respectively) Conclusions Patients with AMI in Beijing delay seeking medical care to a great extent Health education to increase the level of awareness of the target population at increased risk of AMI, including patients and their family members, is probably beneficial to reduce patients’ care-seeking delay
文摘目的探讨获取服务的障碍评估量表(Barriers to Access to Care Evaluation,BACE)在中国严重精神障碍患者中的信度、效度及初步应用。方法以203例精神分裂症患者(精神分裂症组)、77例双相障碍患者(双相障碍组)及35例抑郁障碍患者(抑郁障碍组)作为受访对象,其中自愿住院患者111例,非自愿住院患者152例,未住院患者52例。对入组患者进行BACE、简明精神病量表(BPRS)、功能大体评定量表(GAF)、精神疾病内在病耻感调查表(ISMI)、自尊量表(SES)进行评估。结果信度分析显示,BACE的Cronbach’sα系数为0.899,分半相关系数r=0.885,总分的重测信度r=0.693。效度分析显示,BACE总分、亚量表一总分与ISMI总分均呈正相关(P<0.05);BACE总分与BPRS总分呈正相关(P<0.05),与GAF总分呈负相关(P<0.05)。秩和检验结果显示,非自愿住院患者BACE总分及BACE亚量表一总分高于自愿住院患者(P<0.05)。精神分裂症组、双相障碍组及抑郁障碍组三组间BACE总分及BACE亚量表一总分的差异有统计学意义(P<0.05);方差分析结果显示,精神分裂症组、双相障碍组及抑郁障碍组三组间刻板认同因子分和歧视经历因子分的差异有统计学意义(P<0.05)。结论 BACE中文版具有良好的信度和效度,可应用于中国严重精神障碍患者。
