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
Background: In areas where malaria has been eliminated, delayed care-seeking and diagnosis of imported malaria are constant threats. This study aimed to describe the profile and determinants of delayed care-seeking an...Background: In areas where malaria has been eliminated, delayed care-seeking and diagnosis of imported malaria are constant threats. This study aimed to describe the profile and determinants of delayed care-seeking and diagnosis among patients with imported malaria in China.Methods: This retrospective study assessed surveillance data obtained from 2014 to 2021 in the Chinese provincial-level administrative divisions (PLADs) of Anhui, Henan, Hubei, and Zhejiang, and Guangxi. Epidemiological characteristics were analyzed using descriptive statistics. Furthermore, factors associated with delayed care-seeking and diagnosis among imported malaria cases were identified using multivariate logistic regression.Results: Overall, 11.81% and 30.08% of imported malaria cases had delays in seeking care and diagnosis, respectively. During the study period, there was a decreasing trend in the proportion of imported malaria cases with delayed care-seeking (χ^(2) = 36.099,P < 0.001) and diagnosis (χ^(2) = 11.395,P = 0.001). In multivariate analysis, independent risk factors associated with delayed care-seeking include PLADs (Guangxi as reference), consultations in high-level facilities for the first medical visit, infections with non-Plasmodium falciparum species, and older age. However, PLADs (Guangxi as reference), the purpose of traveling (labour as reference), and infections with non-P. falciparum species increased the risk of delayed diagnosis. Delayed care-seeking (adjusted odds ratio: 1.79,P = 0.001) and diagnosis (adjusted odds ratio: 1.62,P = 0.004) were risk factors for severe disease development.Conclusions: Based on this study’s findings, we strongly advocate for improved access to quality healthcare to reduce the rate of misdiagnosis at the first visit. Infections caused by non-P. falciparum species should be highlighted, and more sensitive and specific point-of-care detection methods for non-P. falciparum species should be developed and implemented. In addition, education programs should be enhanced to reach targ展开更多
Introduction:Fever is one of the most frequent reasons for paediatric consultations in Burkina Faso,but health care-seeking behaviours and the factors associated with health care-seeking in the event of childhood feve...Introduction:Fever is one of the most frequent reasons for paediatric consultations in Burkina Faso,but health care-seeking behaviours and the factors associated with health care-seeking in the event of childhood fever are poorly documented.This study aims to analyse the health care-seeking behaviours and the factors associated with health care-seeking for childhood fever in Burkina Faso.Methods:This study used the data from the baseline and endline surveys conducted to evaluate the impact of the Performance-Based Financing program in Burkina Faso.Univariate and multivariate binary logistic regression analyses were used to identify the factors associated with appropriate healthcare-seeking for childhood fever.Odds ratios were estimated to assess the strength of associations and 95%confidence intervals(CIs)were used for significance tests.Data were cleaned,coded and analysed using Stata software version 16.1.Results:Among the children under five who had a fever,75.19%and 79.76%sought appropriate health care in 2013 and 2017,respectively.Being 24-59 months old(AOR:0.344,95%CI 0.182-0.649 in 2013 and AOR:0.208,95%CI 0.115-0.376 in 2017),living in a very wealthy household(AOR:2.014,95%CI 1.149-3.531 in 2013 and AOR:2.165,95%CI 1.223-3.834 in 2017),having a mother with a secondary or higher level of education or having made at least four antenatal care visits were significantly associated with seeking appropriate health care for childhood fever.Living in an area where the health facility is safe was also significantly associated with seeking appropriate care for childhood fevers.Conclusions:The findings underscore the need to concentrate efforts aiming at sensitizing the population(especially women of childbearing age)to improve sanitation and the use of family planning(household composition),skilled antenatal care and postnatal care to help reduce the prevalence of fever in children under five and improve the use of medical healthcare for childhood fever.展开更多
Background:Acute Respiratory Infections(ARIs)as a group of diseases/symptoms constitute a leading cause of pediatric morbidity and mortality in sub-Saharan Africa where over 10%of all children die before reaching thei...Background:Acute Respiratory Infections(ARIs)as a group of diseases/symptoms constitute a leading cause of pediatric morbidity and mortality in sub-Saharan Africa where over 10%of all children die before reaching their fifth birthday.Although the burden of ARIs is highest in the African countries,there is little evidence in the current literature regarding their prevalence and treatment seeking.The objective of this study was therefore to assess the secular trend in the prevalence of ARIs as well as their treatment seeking-behaviour among Ugandan infants.Methods:This cross-sectional study was based on data from Uganda Demographic and Health Surveys(conducted between 1995 and 2016)on 26,974 singleton infants aged 0-5 months.Mothers(aged 15-49 years)were interviewed to collect information on the prevalence of recent occurrences of fever,cough and dyspnea.The adjusted trend in the prevalence and predictors of ARIs and care seeking were measured by multivariate regression methods.Results:In 2016,the prevalence of fever,cough and dyspnea was respectively 36.23,42.55 and 19.27%.The prevalence of all three symptoms has been declining steadily since 1995,and the percentage of children receiving treatment for fever/cough has also more than doubled during the same time.In multivariable analysis,several sociodemographic factors emerged as significant predictors of ARIs including child’s age and high birth order,mother’s age,educational level,occupation,intendedness status of the child,BMI,household wealth status,and place of residency.Conclusions:The overall prevalence common ARIs(fever,cough,dyspnea)has been declining at a slow but steady rate,however,remains noticeably high in comparison with countries with similar level of per capita GDP in Africa.Findings of this study has important implications for health policy making regarding the prevention of ARIs among infants in the country.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National Natural Science Foundation of China(No. 32161143036).
文摘Background: In areas where malaria has been eliminated, delayed care-seeking and diagnosis of imported malaria are constant threats. This study aimed to describe the profile and determinants of delayed care-seeking and diagnosis among patients with imported malaria in China.Methods: This retrospective study assessed surveillance data obtained from 2014 to 2021 in the Chinese provincial-level administrative divisions (PLADs) of Anhui, Henan, Hubei, and Zhejiang, and Guangxi. Epidemiological characteristics were analyzed using descriptive statistics. Furthermore, factors associated with delayed care-seeking and diagnosis among imported malaria cases were identified using multivariate logistic regression.Results: Overall, 11.81% and 30.08% of imported malaria cases had delays in seeking care and diagnosis, respectively. During the study period, there was a decreasing trend in the proportion of imported malaria cases with delayed care-seeking (χ^(2) = 36.099,P < 0.001) and diagnosis (χ^(2) = 11.395,P = 0.001). In multivariate analysis, independent risk factors associated with delayed care-seeking include PLADs (Guangxi as reference), consultations in high-level facilities for the first medical visit, infections with non-Plasmodium falciparum species, and older age. However, PLADs (Guangxi as reference), the purpose of traveling (labour as reference), and infections with non-P. falciparum species increased the risk of delayed diagnosis. Delayed care-seeking (adjusted odds ratio: 1.79,P = 0.001) and diagnosis (adjusted odds ratio: 1.62,P = 0.004) were risk factors for severe disease development.Conclusions: Based on this study’s findings, we strongly advocate for improved access to quality healthcare to reduce the rate of misdiagnosis at the first visit. Infections caused by non-P. falciparum species should be highlighted, and more sensitive and specific point-of-care detection methods for non-P. falciparum species should be developed and implemented. In addition, education programs should be enhanced to reach targ
基金The baseline(2013)and end-line(2017)surveys for the impact evaluation of Performance-Based Financing(PBF)in Burkina Faso were supported by the World Bank through the Health Results Innovation Trust Fund(HRITF).
文摘Introduction:Fever is one of the most frequent reasons for paediatric consultations in Burkina Faso,but health care-seeking behaviours and the factors associated with health care-seeking in the event of childhood fever are poorly documented.This study aims to analyse the health care-seeking behaviours and the factors associated with health care-seeking for childhood fever in Burkina Faso.Methods:This study used the data from the baseline and endline surveys conducted to evaluate the impact of the Performance-Based Financing program in Burkina Faso.Univariate and multivariate binary logistic regression analyses were used to identify the factors associated with appropriate healthcare-seeking for childhood fever.Odds ratios were estimated to assess the strength of associations and 95%confidence intervals(CIs)were used for significance tests.Data were cleaned,coded and analysed using Stata software version 16.1.Results:Among the children under five who had a fever,75.19%and 79.76%sought appropriate health care in 2013 and 2017,respectively.Being 24-59 months old(AOR:0.344,95%CI 0.182-0.649 in 2013 and AOR:0.208,95%CI 0.115-0.376 in 2017),living in a very wealthy household(AOR:2.014,95%CI 1.149-3.531 in 2013 and AOR:2.165,95%CI 1.223-3.834 in 2017),having a mother with a secondary or higher level of education or having made at least four antenatal care visits were significantly associated with seeking appropriate health care for childhood fever.Living in an area where the health facility is safe was also significantly associated with seeking appropriate care for childhood fevers.Conclusions:The findings underscore the need to concentrate efforts aiming at sensitizing the population(especially women of childbearing age)to improve sanitation and the use of family planning(household composition),skilled antenatal care and postnatal care to help reduce the prevalence of fever in children under five and improve the use of medical healthcare for childhood fever.
文摘Background:Acute Respiratory Infections(ARIs)as a group of diseases/symptoms constitute a leading cause of pediatric morbidity and mortality in sub-Saharan Africa where over 10%of all children die before reaching their fifth birthday.Although the burden of ARIs is highest in the African countries,there is little evidence in the current literature regarding their prevalence and treatment seeking.The objective of this study was therefore to assess the secular trend in the prevalence of ARIs as well as their treatment seeking-behaviour among Ugandan infants.Methods:This cross-sectional study was based on data from Uganda Demographic and Health Surveys(conducted between 1995 and 2016)on 26,974 singleton infants aged 0-5 months.Mothers(aged 15-49 years)were interviewed to collect information on the prevalence of recent occurrences of fever,cough and dyspnea.The adjusted trend in the prevalence and predictors of ARIs and care seeking were measured by multivariate regression methods.Results:In 2016,the prevalence of fever,cough and dyspnea was respectively 36.23,42.55 and 19.27%.The prevalence of all three symptoms has been declining steadily since 1995,and the percentage of children receiving treatment for fever/cough has also more than doubled during the same time.In multivariable analysis,several sociodemographic factors emerged as significant predictors of ARIs including child’s age and high birth order,mother’s age,educational level,occupation,intendedness status of the child,BMI,household wealth status,and place of residency.Conclusions:The overall prevalence common ARIs(fever,cough,dyspnea)has been declining at a slow but steady rate,however,remains noticeably high in comparison with countries with similar level of per capita GDP in Africa.Findings of this study has important implications for health policy making regarding the prevention of ARIs among infants in the country.
