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Sample records for qualified medical care-seeking

  1. Self-reported health and medical care-seeking behaviour of uninsured Jamaicans

    PubMed Central

    Bourne, Paul Andrew

    2010-01-01

    Background: On examination of the literature in Latin America and the Caribbean, and in particular Jamaica, no study could be found that investigated the health and health care-seeking behaviour of uninsured people. This study bridges the gap in the literature by evaluating uninsured Jamaicans’ medical care-seeking behaviour and good health status. Material & Method: The study extracted a sample of 5,203 uninsured respondents 15 years and older from a national probability cross-sectional survey of 6,782 Jamaicans. Descriptive statistics were used to provide background information on the sample; cross-tabulations evaluated bivariate analyses, and logistic regression was used to model health and medical care-seeking behaviour. Results: Good health of uninsured Jamaicans is correlated -reported biological condition (OR =0.114, 95% CI = 0.090 -0 .145) followed by age (OR =0.952, 95% CI = 0.946- 0.959); gender (OR = 1.501, 95% CI = 1.221–1.845); consumption (OR = 1.000, 95% CI = 1.000–1.000); social class (upper class OR = 0.563, 95% CI = 0.357–0.888); education (secondary and above OR = 0.622, 95%CI = 0.402–0.963), and area of residence (other towns OR = 1.351, 95% CI = 1.026–1.778). Medical care-seeking behaviour is associated with age (OR = 1.020, 95% CI = 1.006 – 1.033); poor health status (OR = 2.303, 95% CI = 1.533–3.461), and marital status (married OR = 0.518, 95% CI = 0.325–0.824). Conclusion: The findings are far reaching and provide an understanding of the uninsured, and the information can be used to aid public health intervention and education programmes. PMID:22624118

  2. The importance of job characteristics in determining medical care-seeking in the Dutch working population, a longitudinal survey study.

    PubMed

    Steenbeek, Romy

    2012-08-31

    The working population is ageing, which will increase the number of workers with chronic health complaints, and, as a consequence, the number of workers seeking health care. It is very important to understand factors that influence medical care-seeking in order to control the costs. I will investigate which work characteristics independently attribute to later care-seeking in order to find possibilities to prevent unnecessary or inefficient care-seeking. Data were collected in a longitudinal two-wave study (n = 2305 workers). The outcome measures were visits (yes/no and frequency) to a general practitioner (GP), a physical therapist, a medical specialist and/or a mental health professional. Multivariate regression analyses were carried out separately for men and women for workers with health complaints. In the Dutch working population, personal, health, and work characteristics, but not sickness absence, were associated with later care-seeking. Work characteristics independently attributed to medical care-seeking but only for men and only for the frequency of visits to the GP. Women experience more health complaints and seek health care more often than men. For women, experiencing a work handicap (health complaints that impede work performance) was the only work characteristic associated with more care-seeking (GP). For men, work characteristics that led to less care-seeking were social support by colleagues (GP frequency), high levels of decision latitude (GP frequency) and high levels of social support by the supervisor (medical specialist). Other work characteristics led to more care-seeking: high levels of engagement (GP), full time work (GP frequency) and experiencing a work handicap (physical therapist). We can conclude that personal and health characteristics are most important when explaining medical care-seeking in the Dutch working population. Work characteristics independently attributed to medical care-seeking but only for men and only for the

  3. The relationship between type 2 diabetic patients' early medical care-seeking consistency to the same clinician and health care system and their clinical outcomes.

    PubMed

    Liao, Pei-Ju; Lin, Zu-Yu; Huang, Jui-Chu; Hsu, Kuang-Hung

    2015-02-01

    The literature has demonstrated that the continuity of diabetes care can lower medical service utilization and expenses. However, few studies have examined the effects of patients' medical care-seeking behaviors in the early stage after the diagnosis of diabetes on their long-term prognoses. This study aimed to examine the association of medical care-seeking behavior in the first year following diabetes diagnosis on the occurrence of diabetes-related complications among patients in Taiwan. This is a retrospective data collection with follow-up analysis and a nationwide population-based dataset in Taiwan. A total of 89,428 newly diagnosed type 2 diabetes mellitus patients during the period from 2000 to 2006 were followed up until 2010. The patients' medical care-seeking behaviors were classified as follows: high consistency to a physician, high consistency to a medical setting, medium consistency to providers, and low consistency to providers. The occurrence of diabetes-related complications and all-cause mortality were the primary outcomes of this study. Chi-square tests, ANOVAs, and Cox proportional hazard models were applied to examine the relationships between the predictors and medical outcomes. Compared to the patients with high medical care-seeking consistency to a physician, the multivariate-adjusted hazard ratios of diabetes-related complications occurrence among patients in the high consistency to a medical setting, medium consistency, and low consistency categories were 1.112 (95% CI 1.089-1.136, P < 0.001), 1.226 (95% CI 1.205-1.248, P < 0.001), and 1.536 (95% CI 1.504-1.567, P < 0.001) in outpatient visits and 1.032 (95% CI 0.992-1.074, P = 0.121), 1.056 (95% CI 1.022-1.092, P = 0.001), and 1.208 (95% CI 1.164-1.254, P < 0.001) in complication-incurred hospitalizations, respectively. The monotonic trend was sustained across different strata of age, gender, and disease complexity. The findings of this study suggest that the incentives of continuity of

  4. The Association Between the New Rural Cooperative Medical System and Health Care Seeking Behavior Among Middle-Aged and Older Chinese.

    PubMed

    Li, Min; Wang, Cuntong

    2017-01-01

    The new rural cooperative medical system (NCMS) is the primary form of social insurance in rural China. This study aims to explore how the NCMS influences the health care seeking behaviors of middle-aged and older Chinese, considering the family and community contexts. A series of multi-level (three-level) models using data from the first wave of the China Health and Retirement Longitudinal Study (CHARLS) are used. We find that the presence of NCMS coverage has a statistically significant association with seeking inpatient and outpatient care but not physical checkups among middle-aged and older rural Chinese: Rural residents insured by NCMS were more likely to seek inpatient and outpatient care than people who were not insured. Other factors at the individual level (such as self-perceived health and number of doctor-diagnosed chronic diseases), the family level (such as living arrangements and household expenditures), and the community level (such as the presence of township hospitals within the community) are also significant predictors of health care seeking behaviors.

  5. 46 CFR 4.03-6 - Qualified medical personnel.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 46 Shipping 1 2010-10-01 2010-10-01 false Qualified medical personnel. 4.03-6 Section 4.03-6... AND INVESTIGATIONS Definitions § 4.03-6 Qualified medical personnel. The term qualified medical personnel means a physician, physician's assistant, nurse, emergency medical technician, or other...

  6. 46 CFR 4.03-6 - Qualified medical personnel.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 46 Shipping 1 2012-10-01 2012-10-01 false Qualified medical personnel. 4.03-6 Section 4.03-6... AND INVESTIGATIONS Definitions § 4.03-6 Qualified medical personnel. The term qualified medical personnel means a physician, physician's assistant, nurse, emergency medical technician, or other person...

  7. 46 CFR 4.03-6 - Qualified medical personnel.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 46 Shipping 1 2011-10-01 2011-10-01 false Qualified medical personnel. 4.03-6 Section 4.03-6... AND INVESTIGATIONS Definitions § 4.03-6 Qualified medical personnel. The term qualified medical personnel means a physician, physician's assistant, nurse, emergency medical technician, or other person...

  8. Impact of chronic pain on health care seeking, self care, and medication. Results from a population-based Swedish study

    PubMed Central

    Andersson, H. I.; Ejlertsson, G.; Leden, I.; Schersten, B.

    1999-01-01

    STUDY OBJECTIVE: To explore individual and social factors that could predict health care utilisation and medication among people with chronic pain in an unselected population. DESIGN: A mailed survey with questions about pain and mental symptoms, disability, self care action, visits to health care providers, and medication. SETTING: General populations in two Swedish primary health care (PHC) districts. Medical care was given in a state health system. PARTICIPANTS: A random sample (from the population register) of 15% of the population aged 25-74 (n = 1806). MAIN RESULTS: Among people reporting chronic pain 45.7% (compared with 29.8 of non-chronic pain persons, p < 0.05) consulted a physician and 7.2% (compared with 1.2%, p < 0.05) a physiotherapist during three months. Primary health care was the most frequent care provider. High pain intensity, aging, depression, ethnicity, and socioeconomic level had the greatest impact on physician consultations. Alternative care, used by 5.9%, was associated with high pain intensity and self care. Use of self care was influenced by high pain intensity, regular physical activity, and ethnicity. Alternative care and self care did not imply lower use of conventional health care. Women reporting chronic pain consumed more analgesics and sedatives than corresponding men. Besides female gender, high pain intensity, insomnia, physician consultation, social network, and self care action helped to explain medication with analgesics. Use of herbal remedies and ointments correlated to self care action, visit to an alternative therapist, high pain intensity, and socioeconomic level. CONCLUSIONS: The presence of chronic pain has an impressive impact on primary health care and medication. Various therapeutic actions are common and are partly overlapping. The use of health care among people with chronic pain depends above all on pain perception and intensity of pain but is also affected by ethnicity, age, socioeconomic level, and depressive

  9. Participation in the Qualified Medical Beneficiary Program.

    PubMed

    Neumann, P J; Bernardin, M D; Evans, W N; Bayer, E J

    1995-01-01

    This article has three objectives: to estimate how many eligible elderly beneficiaries are participating in the Qualified Medicare Beneficiary (QMB) program; to determine the characteristics of participating and non participating eligibles; and to identify the most significant barriers to program participation. We used data from the Medicare Current Beneficiary Survey (MCBS) and the Medicare Buy-In file. We found that 41 percent of QMB eligibles are enrolled in the program; participation is higher for poor and less educated beneficiaries, those in poorer health, rural residents, African Americans, and Hispanics. Finally, we found that, in general, eligible beneficiaries are ill informed about the program.

  10. Care seeking for fatal illness episodes in Neonates: a population-based study in rural Bangladesh

    PubMed Central

    2011-01-01

    Background Poor neonatal health is a major contributor to under-five mortality in developing countries. A major constraint to effective neonatal survival programme has been the lack of population level data in developing countries. This study investigated the consultation patterns of caregivers during neonatal fatal illness episodes in the rural Matlab sub-district of eastern Bangladesh. Methods Neonatal deaths were identified through a population-based demographic surveillance system in Matlab ICDDR,B maternal and child health (MCH) project area and an adjoining government service area. Trained project staff administered a structured questionnaire on care seeking to mothers at home who had experienced a neonatal death. Univariate, bivariate and binary multivariate logistic regressions were performed to describe care seeking during the fatal illness episode. Results Of the 365 deaths recorded during 2003 and 2004, 84% died in the early (0-7 days) neonatal period, with the remaining deaths occurring over the subsequent 8 to 28 days. The first resort of care by parents was a qualified doctor or paramedic in 37% of cases, followed by traditional and unqualified health care providers in 25%, while 38% sought no care. Thus, almost two thirds (63%) of neonates who died received only traditional and unqualified care or no care at all during their final illness episode. About 22% sought care from more than one provider, including 6% from 3 or more providers. Such plurality in care seeking was more likely among male infants, in the late neonatal period, and in the MCH project area. Conclusions The high proportion of neonatal deaths that had received traditional care or no medical care in a rural area of Bangladesh highlights the need to develop community awareness about prompt medical care seeking for neonatal illnesses and to improve access to effective health care. Integration of traditional care providers into mainstream health programs should also be considered. PMID

  11. Relatives' advice and health care-seeking behaviour in oman.

    PubMed

    Al-Mandhari, Ahmed; Al-Adawi, Samir; Al-Zakwani, Ibrahim; Al-Shafaee, Mohammed; Eloul, Liyam

    2009-12-01

    It has been well established that pathways to care are considerably modified by local, social and psychological characteristics as well as the doctor-patient relationship. Scant attention has been paid to the role of family advice in care-seeking. In Omani society, traditional family values and a collective mindset are the norm rather than the exception. This paper examines how family advice affects the trajectory of care seeking. During 2006-2007, data was collected through face-to-face interviews among a randomised sample of patients seeking medical consultation in various primary health care centres in the northern region of Oman. This study enrolled a total of 493 patients. The association between the advice of family members as a reason to seek health care and other predictors was analysed using multivariable logistic regression. The data suggest that the advice of family members in care-seeking is strongly associated with gender, education, history of chronic illness, previous exposure to traditional medicine, and health education, as well as the history of immunisation. These findings suggest that the advice of family members remains a strong catalyst for care-seeking in Oman. The psychosocial factors affecting care-seeking leading to underutilisation of services or otherwise are discussed.

  12. [A national qualifying internal medicine examination for Israeli medical students].

    PubMed

    Notzer, N; Shalev, O; Alkan, M; Levinski, U; Rubin, A; Melamed, R

    1995-08-01

    In 1991 the deans of the 4 medical schools in Israel decided to institute a national qualifying examination in internal medicine. This marked the beginning of the process of unifying the qualifying examinations in all major medical fields. We describe the development of the examination, experience with its administration to 720 students in 1992-1994, and the outcome of this initial effort. The examinations were prepared by a committee of senior faculty from the 4 schools, representing all the relevant clinical areas. Professional consultation was provided by the Unit for Medical Education of Tel Aviv University. Each examination consisted of 180 multiple choice items, reflecting an agreed representation of the various medical specialties, and was designed to test both comprehension and problem-solving ability. A syllabus was published by the committee and distributed to students and faculty in preparation for the examination. In composing the examination, the committee took into consideration differences in general policy and varying emphases in the curricula of the 4 schools. Analysis of the results of the 3 annual examinations showed both a high level of reliability and high quality of the majority of the individual test items. There was a trend with time to slightly lower average scores, and fewer passed the exam last year. There was improvement in the results after the first 2 years in the area of problem-solving related to interpretation of imaging, blood smears and clinical photographs, but this trend did not continue into 1994. The introduction of a high level examination based on a common syllabus provided important feedback, improving both student motivation and clinical teaching. For all schools, the outcome of the examination served as an important external indicator of teaching standards. Following this positive experience, uniform examinations in surgical subjects and pediatrics were introduced for the first time in 1993. The committee recommends that

  13. Health care seeking among Mexican American men.

    PubMed

    Sobralske, Mary C

    2006-04-01

    This focused ethnography explored health care seeking beliefs and behaviors of Mexican American men living in south central Washington State. Data collection included interviews with 36 research participants living in the community, participant observation in the research setting, and examination of ethnographic documents and cultural artifacts. Four major themes were identified: the identity of manhood dictates health care seeking, health means being able to be a man by fulfilling cultural obligations, illness means not being able to be a man, and men seek health care when their manhood is threatened or impaired. Machismo, the cultural concept of manliness, persisted among men despite the level of acculturation and other factors. Women influenced men's health care seeking behaviors. To fulfill their obligations, men must stay healthy and seek care when needed. Knowing when and why men do not seek health care enables nurses to better understand and serve the Mexican American community.

  14. Care-seeking practices in rural Rajasthan: barriers and facilitating factors.

    PubMed

    Mohan, P; Iyengar, S D; Agarwal, K; Martines, J C; Sen, K

    2008-12-01

    Poor care seeking contributes significantly to high neonatal mortality in developing countries. The study was conducted to identify care-seeking patterns for sick newborns in rural Rajasthan, India, and to understand family perceptions and circumstances that explain these patterns. Of the 290 mothers interviewed when the infant was 1 to 2 months of age, 202 (70%) reported at least one medical condition during the neonatal period that would have required medical care, and 106 (37%) reported a danger sign during the illness. However, only 63 (31%) newborns with any reported illness were taken to consult a care provider outside home, about half of these to an unqualified modern or traditional care provider. In response to hypothetical situations of neonatal illness, families preferred home treatment as the first course of action for almost all conditions, followed by modern treatment if the child did not get better. For babies born small and before time, however, the majority of families does not seem to have any preference for seeking modern treatment even as a secondary course of action. Perceptions of 'smallness', not appreciating the conditions as severe, ascribing the conditions to the goddess or to evil eye, and fatalism regarding surviving newborn period were the major reasons for the families' decision to seek care. Mothers were often not involved in taking this critical decision, especially first-time mothers. Decision to seek care outside home almost always involved the fathers or another male member. Primary care providers (qualified or unqualified) do not feel competent to deal with the newborns. The study findings provide important information on which to base newborn survival interventions in the study area: need to target the communication initiatives on mothers, fathers and grandmothers, need for tailor-made messages based on specific perceptions and barriers, and for building capacity of the primary care providers in managing sick newborns.

  15. Health Care Seeking Behavior in Southwest Ethiopia

    PubMed Central

    Begashaw, Bayu; Tessema, Fasil; Gesesew, Hailay Abrha

    2016-01-01

    Background Rural and urban populations have disparate socio-demographic and economic characteristics, which have an influence on equity and their health seeking behavior. We examined and compared the health care seeking behavior for perceived morbidity between urban and rural households in Southwest Ethiopia. Methods Analytic cross-sectional study was conducted among urban and rural households living in Esera district of Southwest Ethiopia. A random sample of 388 head of households (126 urban and 262 rural) were selected. A pretested and structured questionnaire was used for data collection with face-to-face interview. In addition to descriptive methods, binary logistic regression was used to identify factors associated with health seeking behavior at p value of less than 0.05. Results Of the sample household heads, 377 (97.2%) (119 urban and 258 rural) were successfully interviewed. Among these, 58.4% (95% CI, 53.3–63.3%) of the households sought care from modern health care that was lower among rural (48.1%) than urban (80.7%) households. The prevalence of self-treatment was 35.3% in urban and 46.1% in rural households. Among the factors considered for modern health care utilization, higher monthly income (AOR, 5.6; 95% CI, 2.04–15.4), perceived severity of disease (AOR, 2.5; 95% CI, 1.1–5.8), acute duration of disease (AOR, 8.9; 95% CI, 2.4–33.3) and short distance from health facilities (AOR, 3; 95% CI, 1.2–8.4) among rural and being married (AOR, 11.3; 95% CI, 1.2–110.2) and perceived severity of disease (AOR, 6.6; 95% CI, 1.1–10.9) among urban households showed statistically significant association. Conclusions The general health seeking behavior of households on perceived morbidity was satisfactory but lower in rural compared to urban households. Self-medication was also widely practiced in the study area. The findings signal the need to work more on accessibility and promotion of healthcare seeking behavior especially among rural households

  16. Health Care Seeking Behavior in Southwest Ethiopia.

    PubMed

    Begashaw, Bayu; Tessema, Fasil; Gesesew, Hailay Abrha

    2016-01-01

    Rural and urban populations have disparate socio-demographic and economic characteristics, which have an influence on equity and their health seeking behavior. We examined and compared the health care seeking behavior for perceived morbidity between urban and rural households in Southwest Ethiopia. Analytic cross-sectional study was conducted among urban and rural households living in Esera district of Southwest Ethiopia. A random sample of 388 head of households (126 urban and 262 rural) were selected. A pretested and structured questionnaire was used for data collection with face-to-face interview. In addition to descriptive methods, binary logistic regression was used to identify factors associated with health seeking behavior at p value of less than 0.05. Of the sample household heads, 377 (97.2%) (119 urban and 258 rural) were successfully interviewed. Among these, 58.4% (95% CI, 53.3-63.3%) of the households sought care from modern health care that was lower among rural (48.1%) than urban (80.7%) households. The prevalence of self-treatment was 35.3% in urban and 46.1% in rural households. Among the factors considered for modern health care utilization, higher monthly income (AOR, 5.6; 95% CI, 2.04-15.4), perceived severity of disease (AOR, 2.5; 95% CI, 1.1-5.8), acute duration of disease (AOR, 8.9; 95% CI, 2.4-33.3) and short distance from health facilities (AOR, 3; 95% CI, 1.2-8.4) among rural and being married (AOR, 11.3; 95% CI, 1.2-110.2) and perceived severity of disease (AOR, 6.6; 95% CI, 1.1-10.9) among urban households showed statistically significant association. The general health seeking behavior of households on perceived morbidity was satisfactory but lower in rural compared to urban households. Self-medication was also widely practiced in the study area. The findings signal the need to work more on accessibility and promotion of healthcare seeking behavior especially among rural households.

  17. 26 CFR 25.2503-6 - Exclusion for certain qualified transfer for tuition or medical expenses.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... medical care that are reimbursed by the donee's insurance. Thus, if payment for a medical expense is reimbursed by the donee's insurance company, the donor's payment for that expense, to the extent of the... without regard to the relationship between the donor and the donee. (b) Qualified transfers—(1) Definition...

  18. 46 CFR 12.619 - Requirements to qualify for an STCW endorsement as medical first-aid provider.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... medical first-aid provider. 12.619 Section 12.619 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY... Endorsements § 12.619 Requirements to qualify for an STCW endorsement as medical first-aid provider. (a) To qualify for an STCW endorsement as medical first-aid provider, an applicant must— (1) Provide evidence...

  19. Symptoms of sexually transmitted infections and care-seeking behaviors of male clients of female sex workers in Bangladesh.

    PubMed

    Ahmed, Anisuddin; Reichenbach, Laura J; Alam, Nazmul

    2012-12-01

    In Bangladesh, male clients (MCs) of female sex workers (FSWs) represent diverse occupational categories from different socioeconomic strata, and they are considered a bridging group to transmit sexually transmitted infections (STIs) to their spousal and nonspousal female partners. This study aimed to better understand sexual behaviors, STI symptoms, and care-seeking behaviors among MCs of FSWs in Bangladesh. A cross-sectional study was conducted among MCs from November 2005 to July 2006 in 3 types of sex trade settings in Bangladesh. Of 1565 MCs included in this study, 531 were from brothels, 515 from hotels, and 519 from street-based settings. Among the MCs, 32.2% reported having had STI symptoms within the last 1 year before the interview and 81.5% sought care for those symptoms. Among those who reported symptoms, 44.5% received treatment from pharmacies, 37.4% received treatment from qualified medical professionals, 8.6%, received treatment from nongovernment organization clinics, and 7.8% went to herbal providers. Male clients who had only 1 to 4 years of schooling were 2.4 times more likely to have STI symptoms (adjusted odds ratio [OR], 2.4; 95% confidence interval [CI], 1.5-3.8) compared with the MCs having 10 or more years of schooling. The MCs who had sex with more than 3 nonmarital sexual partners in the last month were 2 times more likely to have STI symptoms (adjusted OR, 2.0; 95% CI, 1.4-2.8). The MCs who used condoms consistently in their non-marital sexual contacts were significantly less likely (adjusted OR, 0.4; 95% CI, 0.3-0.6) to have STI symptoms. Reported risk behaviors, STI symptoms and care-seeking behavior suggest that MCs are a potential risk group for transmission of HIV and STIs. The study findings underscore the need to target HIV/STI prevention intervention for MCs, which are predominantly geared toward FSWs.

  20. Access to health services and care-seeking behaviors after the 2007 Ica earthquake in Peru.

    PubMed

    Daniels, Amy; Chapin, Erica; Aspilcueta, Daniel; Doocy, Shannon

    2009-06-01

    To assess care-seeking behaviors, perceptions of quality, and access to health services among populations affected by the 2007 Peruvian earthquake. A stratified cluster survey design was used to allow for comparison between urban, periurban, and rural populations of the 4 provinces most affected by the earthquake. Forty-two clusters of 16 households (n = 672) were interviewed approximately 6 months after the earthquake. Of all of the respondents, 38% reported that a household member sought medical care within 2 weeks after the earthquake. Earthquake-related injury, presence of a chronic medical condition, and residence in temporary housing were significantly associated with care seeking in adjusted models. Individuals experiencing earthquake-related injuries and those with chronic medical conditions, respectively, were 7.1 times (95% confidence interval [CI] 3.7-13.7) and 1.9 times (95% CI 1.3-2.9) more likely to seek medical care; temporary housing residents were 1.7 times (95% CI 1.0-2.8) more likely to seek care than those residing in permanent housing. Earthquake-related injury and chronic medical conditions were associated with care seeking in the first 2 weeks after the 2007 Ica earthquake. Households living in temporary housing were more likely to seek medical care than those residing in permanent structures, suggesting that displaced people are more likely to need medical attention.

  1. Does the organizational structure of health care systems influence care-seeking decisions? A qualitative analysis of Danish cancer patients' reflections on care-seeking

    PubMed Central

    Andersen, Rikke Sand; Vedsted, Peter; Olesen, Frede; Bro, Flemming; Søndergaard, Jens

    2011-01-01

    Objective The absence of a more significant improvement in cancer survival in countries such as the UK and Denmark may be partly rooted in delayed care-seeking among cancer patients. Past research on patient delay has mainly focused on patient characteristics (e.g. sociodemographic and psychological factors and symptom recognition) as causes of delayed care-seeking, while few studies have examined how the organizational structure of health care systems may influence patients’ reflections on seeking care. The aim of this study was to explore this relationship. Design The analysis presented is based on semi-structured interviews with 30 cancer patients and their families. Results The article raises two hypotheses on the relationship between structural elements of a health care system and people's reflections on seeking health care: (1) Gatekeeping introduces an asymmetrical relationship between the patient and the GP which potentially results in self-restricting care-seeking, (2) Continuity in the doctor–patient relationship may negatively influence patient reflections on access to health care, as the focus shifts from the medical issues of the consultation to reflections on how to properly interact with the GP and the system in which she/he is situated. Conclusion It is concluded that these hypotheses form a sound basis for further primary care research on how the organizational structure of health care systems influences patient reflections on access to medical care. PMID:21861597

  2. Singly-qualified medical senior house officer in oral and maxillofacial surgery: perspectives from a unit.

    PubMed

    Solanki, Kohmal; Bhatti, Nabeel; Bridle, Christopher

    2016-06-01

    Despite constituting a minority of senior house officers (SHO) in oral and maxillofacial surgery (OMFS), the number of singly-qualified medical trainees is growing. We describe the experience of a singly qualified medical trainee in OMFS and the unique benefits and opportunities for potential trainees and the department. Overall, the advantages of synergistic training outweigh any deficiencies in knowledge, and in our experience, having both medical and dental trainees in our unit has maximised training opportunities and provided a more holistic approach to patient care. Increased exposure to conditions in the head and neck also benefits trainees who wish to pursue careers in other specialties such as ear, nose, and throat (ENT), neurosurgery, ophthalmology, and plastic surgery. Copyright © 2016 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

  3. Determinants of health care seeking for childhood illnesses in Nairobi slums.

    PubMed

    Taffa, Negussie; Chepngeno, G

    2005-03-01

    The practice of appropriate health seeking has a great potential to reduce the occurrence of severe and life-threatening child illnesses. We assessed the influence of socio-demographic, economic and disease-related factors in health care seeking for child illnesses among slum dwellers of Nairobi, Kenya. A survey round of the Nairobi Urban Demographic Surveillance System (NUDSS) generated information on 2-week child morbidity, illness symptoms, perceived illness severity and use of modern health services. During this round of data collection, interviewers visited a total of 15,174 households, where 3015 children younger than 5 years lived. Of the 999 (33.1%) children who were reported to have been sick, medical care of some sort was sought for 604 (60.5%). Lack of finances (49.6%) and a perception that the illness was not serious (28.1%) were the main reasons given for failure to seek health care outside the home. Health care seeking was most common for sick children in the youngest age group (0-11 months). Caretakers sought medical care more frequently for diarrhoea symptoms than for coughing and even more so when the diarrhoea was associated with fever. Perception of illness severity was strongly associated with health care seeking. Household income was significantly associated with health care seeking up to certain threshold levels, above which its effects stabilized. Improving caretaker skills to recognize danger signs in child illnesses may enhance health-seeking behaviour. Integrated Management of Child Illnesses (IMCI) programmes must be accessible free of charge to the urban poor in order to increase health care seeking and bring about improvements in child survival.

  4. Health care seeking behavior of Korean women with lymphedema.

    PubMed

    Cho, Myoung Ok

    2004-06-01

    The present biocultural study aimed to describe the health care use patterns of women with lymphedema. Data came from interviews and participant observations with eight key informants between February 2000 and February 2002. Analyzing the process of seeking health care, this paper explored how Korean women with lymphedema make use of all the available resources in the three sectors of the health care system: professional, folk and popular health. In these three sectors of the health care system, informants showed different patterns of behavior. In the professional health care sector, they behave based on scientific Western medicine and holistic herbal medical frameworks. Informants want scientific technological treatment from a Westernized doctor and perfect humanistic and holistic treatment from a herbal doctor. In the folk sector, informants' behavior is ruled by a pragmatic and supernatural framework. Informants seek religious healers who have strong spirituality and non-religious healers who have experience and skills. Informants complied with these healer's remedies based on efficacy and empirical healing evidence. In the popular sector of the health care system, informants behave based on their concept of illness and rules of daily life. They believe lymphedema comes from poor blood circulation and they want to be regarded as members of society, not as patients with lymphedema. Therefore, informants practised popular remedies that they believed were good for promoting blood circulation and keeping their social network active. This description about health care seeking behaviors being embedded in Korean socio-medical culture can serve to understand patients with other chronic health problems. With these results, we can put a bridge over the river of cultural conflict between health professionals and patients.

  5. Career destinations, job satisfaction and views of the UK medical qualifiers of 1977

    PubMed Central

    Taylor, Kathryn; Lambert, Trevor; Goldacre, Michael

    2008-01-01

    Summary Objective To study the career destinations, job satisfaction and views of UK-trained senior doctors. Design Postal questionnaire. Setting All doctors who qualified from all UK medical schools in 1977; and Department of Health employment data. Main outcome measures Career destinations of medical qualifiers from 1977. Results 72% responded to the questionnaire. Using all available evidence, including that on non-responders, 76% of the cohort, comprising 77% of the men and 74% of the women, were working in the NHS 27 years after qualification. Approximately 18% were in medical jobs either overseas or outside the NHS. Of respondents in the NHS, 89% of men and 51% of women had full-time contracts. NHS doctors rated their job satisfaction highly, with a median score of 19.5 on a scale from 5 (very low satisfaction) to 25 (very high satisfaction). Satisfaction with time off for leisure was much lower, with a median score of 4.6 on a scale from 1 (low) to 10 (high). Of those in the NHS, 67% agreed that they worked longer hours than they thought they should; and 40% agreed that their working conditions were satisfactory. Conclusions 27 years after qualification, the percentage of women who were working in the NHS was similar to that of men. Although these senior doctors had high levels of satisfaction with the content of their jobs, they were not so satisfied with their working hours and working conditions. Our results can be used as benchmarks, against which the career pathways and satisfaction levels of more recently qualified doctors can be compared. PMID:18387910

  6. Health-care-seeking behaviour among university students in Lebanon.

    PubMed

    El Kahi, H A; Abi Rizk, G Y; Hlais, S A; Adib, S M

    2012-06-01

    This cross-sectional study assessed the health-care-seeking behaviour, barriers to accessing care and associated factors among a sample of 543 Lebanese students at Saint-Joseph University. Data were collected on health-care-seeking behaviour for health issues in the previous 12 months using an anonymous questionnaire. Health-care-seeking behaviour was categorized as: formal (professional help sought); informal relational (help sought from friends/family); informal personal (self-help). The health issues examined were: physical, psychological, social and relational, sexual, drug, alcohol and smoking. When facing health-related issues, the students tended to seek informal health care. Formal health-care-seeking behaviour was almost non-existent for psychological issues (3.3%), relational and social issues (1.8%), and issues related to substance use (5.1%). The barriers to seeking formal health care fell into 2 categories: accessibility and relational. To encourage young people to access formal health care, specific health services should be provided for them where they are assured of confidentiality and understanding.

  7. "No me ponían mucha importancia": care-seeking experiences of undocumented Mexican immigrant women with chronic illness.

    PubMed

    Chandler, Juliet T; Malone, Ruth E; Thompson, Lisa M; Rehm, Roberta S

    2012-01-01

    This interpretive phenomenological study explored the health care-seeking experiences of undocumented Mexican immigrant women. Interviews and observations were conducted with 26 uninsured Mexican immigrant women with a chronic illness residing in California. Participant narratives revealed that their health care seeking experiences were often characterized by a lack of recognition of their human plight and devaluation of their personhood. Both structural and social barriers to care exist for immigrant women. Modifying current policies to allow undocumented immigrants more options to access care could help reduce stigma, reduce suffering, and encourage clinicians to recognize their humanity and their legitimate medical needs.

  8. Delays in recognition of and care-seeking response to prolonged labor in Bangladesh.

    PubMed

    Head, Sara K; Yount, Kathryn M; Sibley, Lynn M

    2011-04-01

    Maternal death, in which prolonged labor is the third leading cause, accounts for 20% of deaths among women in Bangladesh. This study describes the process of recognition and response to symptoms during potential prolonged labor among 17 women in three sites in Bangladesh. In October-December 2008, integrated illness history interviews were conducted with women and confirmed and/or supplemented by family and/or birth attendants present during labor. Interviews elicited participants' recognition of symptoms and care-seeking reactions and recorded responses in time-by-event matrices. Interviews were conducted in Bangla, recorded, transcribed, and translated into English. The most frequent and usually first action was to seek care from untrained attendants at home, then from professional attendants outside the home. Care-seeking outside the home occurred a median of 19 h after perceived labor onset. Delays in care-seeking arose for reasons related to: (1) confusion over the onset of labor, (2) power processes inhibiting women's disclosure of labor symptoms, (3) the practice of "waiting for delivery," and (4) preferences for home delivery. Strategies to encourage lay recognition of and response to prolonged labor should consider women's misinterpretation and non-disclosure of labor pain, health beliefs surrounding the labor process, and fears of medical intervention.

  9. Platelet function abnormalities in qualified whole-blood donors: effects of medication and recent food intake.

    PubMed

    Paglieroni, T G; Janatpour, K; Gosselin, R; Crocker, V; Dwyre, D M; MacKenzie, M R; Holland, P V; Larkin, E C

    2004-01-01

    Platelet function abnormalities have been reported in blood donors who have not consumed aspirin. Our objective was to identify factors other than aspirin that may contribute to impaired platelet function in qualified volunteer blood donors. Blood samples were obtained from 24 donors following routine blood donation. Donors completed a study questionnaire that included questions about recent food consumption, medication and medical history. Platelet activation was measured using monoclonal antibodies and flow cytometry. CD62P expression and PAC-1 binding on platelets were used as indicators of platelet activation. Platelet function was measured on a platelet function analyser (PFA-100) using both collagen/epinephrine (cEPI) and collagen/ADP (cADP) cartridges. Fifty-four per cent of donors (13 of 24) had normal platelet function. Thirty-eight per cent (nine of 24) had prolonged cEPI closure times, of whom four (17%) had no cEPI closure (> 300 seconds). No closure was associated with aspirin use (two donors) or chocolate consumption (two donors) before donation. Two donors (8%) had either a shortened cEPI or cADP closure time. Platelet dysfunction in qualified blood donors is underestimated. Platelet function screening can identify donors with diet-related platelet dysfunction or with poor recollection of aspirin use.

  10. Care-seeking patterns for fatal malaria in Tanzania

    PubMed Central

    de Savigny, Don; Mayombana, Charles; Mwageni, Eleuther; Masanja, Honorati; Minhaj, Abdulatif; Mkilindi, Yahya; Mbuya, Conrad; Kasale, Harun; Reid, Graham

    2004-01-01

    Background Once malaria occurs, deaths can be prevented by prompt treatment with relatively affordable and efficacious drugs. Yet this goal is elusive in Africa. The paradox of a continuing but easily preventable cause of high mortality raises important questions for policy makers concerning care-seeking and access to health systems. Although patterns of care-seeking during uncomplicated malaria episodes are well known, studies in cases of fatal malaria are rare. Care-seeking behaviours may differ between these groups. Methods This study documents care-seeking events in 320 children less than five years of age with fatal malaria seen between 1999 and 2001 during over 240,000 person-years of follow-up in a stable perennial malaria transmission setting in southern Tanzania. Accounts of care-seeking recorded in verbal autopsy histories were analysed to determine providers attended and the sequence of choices made as the patients' condition deteriorated. Results As first resort to care, 78.7% of malaria-attributable deaths used modern biomedical care in the form of antimalarial pharmaceuticals from shops or government or non-governmental heath facilities, 9.4% used initial traditional care at home or from traditional practitioners and 11.9% sought no care of any kind. There were no differences in patterns of choice by sex of the child, sex of the head of the household, socioeconomic status of the household or presence or absence of convulsions. In malaria deaths of all ages who sought care more than once, modern care was included in the first or second resort to care in 90.0% and 99.4% with and without convulsions respectively. Conclusions In this study of fatal malaria in southern Tanzania, biomedical care is the preferred choice of an overwhelming majority of suspected malaria cases, even those complicated by convulsions. Traditional care is no longer a significant delaying factor. To reduce mortality further will require greater emphasis on recognizing danger signs

  11. 26 CFR 1.401-14 - Inclusion of medical benefits for retired employees in qualified pension or annuity plans.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 26 Internal Revenue 5 2011-04-01 2011-04-01 false Inclusion of medical benefits for retired employees in qualified pension or annuity plans. 1.401-14 Section 1.401-14 Internal Revenue INTERNAL REVENUE..., Profit-Sharing, Stock Bonus Plans, Etc. § 1.401-14 Inclusion of medical benefits for retired employees in...

  12. Care-seeking behaviour among individuals with TB symptoms in Jogjakarta Province, Indonesia: a community-based study.

    PubMed

    Ahmad, Riris A; Richardus, Jan H; de Vlas, Sake J

    2013-03-01

    Care-seeking behaviour of individuals with TB symptoms is a critical factor in early detection and treatment. Thorough understanding of determinants of the care-seeking process helps TB programme managers to improve TB case finding. The aim of this study was to assess determinants of care-seeking behaviour among patients with suspected TB at the population level. A cross-sectional survey was conducted among adults with cough for >2 weeks. Data on sociodemographics, onset of TB symptoms, TB knowledge, health facility visited and duration of each visit were collected. Of the 746 respondents interviewed, approximately 10% had not yet sought care. Of those who sought care, less than one-half presented directly to medical healthcare providers. Being female and having multiple symptoms were associated with care-seeking action. The duration of patient delay (i.e. time between onset of symptoms and visiting a health provider) was relatively short, which may be due to the availability of an extended network of healthcare providers in Jogjakarta Province. Being male, a student or self-employed were associated with longer delay in presentation. Patient delay was relatively short. Efforts need to be focused on encouraging individuals with suspected TB to seek appropriate services through health education and quality improvement of health providers.

  13. Career destinations, views and future plans of the UK medical qualifiers of 1988

    PubMed Central

    Taylor, Kathryn; Lambert, Trevor; Goldacre, Michael

    2010-01-01

    Summary Objectives To report the career destinations, views and future plans of a cohort of senior doctors who qualified in the 1980s. Methods Postal questionnaire survey of all doctors who qualified from all UK medical schools in 1988. Results The response rate was 69%. We estimated that 81% of the total cohort was working in the NHS, 16 years after qualification; and that at least 94% of graduates who, when students, were from UK homes, were working in medicine. Of NHS doctors, 30% worked part-time. NHS doctors rated their job satisfaction highly (median score 19.9, scale 5–25) but were less satisfied with the amount of leisure time available to them (median score 5.4, scale 1–10). NHS doctors were very positive about their careers, but were less positive about working hours and some other aspects of the NHS. Women were more positive than men about working conditions; general practitioners were more positive than hospital doctors. Twenty-five percent reported unmet needs for further training or career-related advice, particularly about career development. Twenty-nine percent intended to reduce their hours in future, while 6%, mainly part-time women, planned to increase their hours. Overall, 10% of NHS doctors planned to do more service work in future and 24% planned to do less; among part-time women, 18% planned to do more and only 14% less. Conclusions These NHS doctors, now in their 40s, had a high level of satisfaction with their jobs and their careers but were less satisfied with some other aspects of their working environment. A substantial percentage had expectations about future career development and change. PMID:20056666

  14. Prevalence and care-seeking for chronic diseases among Syrian refugees in Jordan.

    PubMed

    Doocy, Shannon; Lyles, Emily; Roberton, Timothy; Akhu-Zaheya, Laila; Oweis, Arwa; Burnham, Gilbert

    2015-10-31

    There are currently more people displaced by conflict than at any time since World War II. The profile of displaced populations has evolved with displacement increasingly occurring in urban and middle-income settings. Consequently, an epidemiological shift away from communicable diseases that have historically characterized refugee populations has occurred. The high prevalence of non-communicable diseases (NCDs) poses a challenge to in terms of provision of appropriate secondary and tertiary services, continuity of care, access to medications, and costs. In light of the increasing burden of NCDs faced by refugees, we undertook this study to characterize the prevalence of NCDs and better understand issues related to care-seeking for NCDs among Syrian refugees in non-camp settings in Jordan. A cross-sectional survey of 1550 refugees was conducted using a multi-stage cluster design with probability proportional to size sampling to obtain a nationally representative sample of Syrian refugees outside of camps. To obtain information on chronic conditions, respondents were asked a series of questions about hypertension, cardiovascular disease, diabetes, chronic respiratory disease, and arthritis. Differences by care-seeking for these conditions were examined using chi-square and t-test methods and characteristics of interest were included in the adjusted logistic regression model. Among adults, hypertension prevalence was the highest (9.7%, CI: 8.8-10.6), followed by arthritis (6.8%, CI: 5.9-7.6), diabetes (5.3%, CI: 4.6-6.0), chronic respiratory diseases (3.1%, CI: 2.4-3.8), and cardiovascular disease (3.7%, CI: 3.2, 4.3). Of the 1363 NCD cases, 84.7% (CI: 81.6-87.3) received care in Jordan; of the five NCDs assessed, arthritis cases had the lowest rates of care seeking at 65%, (CI:0-88, p = 0.005). Individuals from households in which the head completed post-secondary and primary education, respectively, had 89% (CI: 22-98) and 88% (CI: 13-98) lower odds of seeking care

  15. Predicting performance on the Medical Council of Canada Qualifying Exam Part II.

    PubMed

    Woloschuk, Wayne; McLaughlin, Kevin; Wright, Bruce

    2013-01-01

    Being able to predict which residents will likely be unsuccessful on high-stakes exams would allow residency programs to provide early intervention. To determine whether measures of clinical performance in clerkship (in-training evaluation reports) and first year of residency (program director ratings) predict pass-fail performance on the Medical Council of Canada Qualifying Exam Part II (MCCQE Part II). Residency program directors assessed the performance of our medical school graduates (Classes 2004-2007) at the end of the 1st postgraduate year. We subsequently collected clerkship in-training evaluation reports for these graduates. Using a neutral third party and unique codes, an anonymous dataset containing clerkship, residency, and MCCQE Part II performance scores was created for our use. Data were analyzed using descriptive statistics, correlations, receiver operating characteristics, and the Youdin index. Regression was also performed to further study the relationship among the variables. Complete data were available for 78.6% of the graduates. Of these participants, 94% passed the licensing exam on their first attempt. Receiver operating characteristics revealed that the area under the curve for clerkship in-training evaluation reports was 0.67 (p<.05) and 0.66 (p<.05) for residency program directors assessments. Corresponding Youdin indices for in-training evaluation reports and residency program director assessments were 0.30 and 0.23, respectively. Although clerkship in-training evaluation reports and residency program director ratings are significant predictors of pass-fail performance on the MCCQE Part II, the effectiveness of each one to predict pass-fail performance was relatively small. Reasons for these findings are discussed.

  16. Perceptions and care seeking behavior of obstetric complication in Thailand.

    PubMed

    Sharma, S K; Vong-Ek, P

    2012-01-01

    Importance of maternal health has been recognized over the last decade, however information about the perception of illness and healthcare behavior of obstetric complication is lacking. This study assesses women ' s knowledge, perception, and experience of obstetric complication and care-seeking behavior and explores the factors associated with the morbidity and the constraints hindering them from seeking timely care. Twenty one in-depth interviews on the perceptions, experience and care seeking behavior related to pregnancy and delivery of Women at Kanchanaburi Demographic Surveillance site of Thailand were conducted. A structured guideline was first prepared in English and translated into Thai language. An interpreter was hired to interview women at the Thai-Myanmar border to translate Thai into local language. A moderator note-taker, and interpreter were present throughout the interview period and tape recorded the conversation. In-depth interview revealed that even though quality maternal health care was accessible to most of the women, obstetric complication was prevalent and they were not seeking appropriate care specifically in highland. Too early and too late marriage, frequent child bearing, poverty, hard work, poor nutrition and traditional practices were the reasons for complications. Poor transportation, lack of health insurance, inadequate training of health personnel, poor health facilities and the perception that the complications are normal for pregnant women were the main reasons for not seeking appropriate care. Perceived reasons for complications among women living in Kanchanaburi, Thailand were early marriage, frequent childbearing, hard work, poor nutrition and traditional practices. The constraints hindering them from seeking care for the complications were perceived to be the lack of access to health personnel, health facilities, and proper transportation. These issues seemed to be related to poverty.

  17. Comparing patient care seeking pathways in three models of hospital and TB programme collaboration in China

    PubMed Central

    2013-01-01

    Background Public hospitals in China play an important role in tuberculosis (TB) control. Three models of hospital and TB control exist in China. The dispensary model is the most common one in which a TB dispensary provides both clinical and public health care. The specialist model is similar to the former except that a specialist TB hospital is located in the same area. The specialist hospital should treat only complicated TB cases but it also treats simple cases in practice. The integrated model is a new development to integrate TB service in public hospitals. Patients were diagnosed, treated and followed up in this public hospital in this model while the TB dispensary provides public health service as case reporting and mass education. This study aims to compare patient care seeking pathways under the three models, and to provide policy recommendation for the TB control system reform in China. Methods Six sites, two in each model, were selected across four provinces, with 293 newly treated uncomplicated TB patients being randomly selected. Results The majority (68%) of TB patients were diagnosed in hospitals. Patients in the integrated model presented the simplest care seeking pathways, with the least number of providers visited (2.2), shortest treatment delays (2 days) and the least medical expenditure (2729RMB/401USD). On the contrary, patients in the specialist model had the highest number of provider visits (4), longest treatment delays (23 days) and the highest medical expenditure (11626RMB/1710USD). Logistic regression suggested that patients who were hospitalised tended to have longer treatment delays and higher medical expenditure. Conclusion Specialist hospital treating uncomplicated cases not using the standard regimens posed a threat to TB control. The integrated model has shortened patient treatment pathways, and reduced patient costs; therefore, it could be considered as the direction for future reform of China’s TB control system. PMID

  18. Care-seeking at patent and proprietary medicine vendors in Nigeria.

    PubMed

    Prach, Lisa M; Treleaven, Emily; Isiguzo, Chinwoke; Liu, Jenny

    2015-06-12

    To achieve health development goals, policymakers are increasingly focused on improving primary care in low- and middle-income countries, and private sector drug retailers offer one channel through which basic services may be delivered. In Nigeria, patent and proprietary medicine vendors (PPMVs) serve as a main source of medications, but little is known about their clientele or how care is sought at PPMVs for common illnesses. We explore differences in care-seeking at PPMV shops based on the most commonly reported symptoms. In Kogi and Kwara states, Nigeria, 250 PPMV shop workers and 2,359 customers purchasing drugs were surveyed, and each worker-customer interaction was observed. Multivariate regression analysis was used to assess the association of commonly reported symptoms with care-seeking behavior prior to attending the shop and while interacting with the provider at the shop. Most customers sought care for headache (30.5 %), fever (22.9 %), cough/cold (18.1 %), or diarrhea (8.4 %). Customers with fever were more likely to report being diagnosed by a formally trained person, to have discussed the illness with and be examined by the shop worker, and have more difficulty paying. In contrast, customers with headache symptoms were less likely to experience these outcomes and spent less money purchasing drugs. Those reporting cough or cold symptoms were less likely to have been diagnosed by a formally trained person, waited longer before visiting the PPMV shop, and were more likely to discuss the illness with the shop worker, but were less likely to be examined or to recommend the purchased drug themselves. If a sick child was brought to the shop, a discussion of the illness and an exam were more likely and more money was spent on drugs. Because care-seeking behaviors vary by symptoms and the sick person's age, PPMVs should be trained to treat common illnesses for which customers are unlikely to seek a formal medical consultation. Interventions aimed at improving

  19. Stressors and social support perceptions predict illness attitudes and care-seeking intentions: re-examining the sick role.

    PubMed

    Miczo, Nathan

    2004-01-01

    Parsons' (1951) sick role concept has had a profound impact on the study of sickness as a social phenomenon. The sick role might be better conceived as a set of illness attitudes and care-seeking intentions rather than a set of social norms. This investigation purports (a) to explore the relationships among illness attitudes, (b) to examine the ability of illness attitudes to predict medical care-seeking intentions, and (c) to investigate differences in the sick role as a function of stressors and social support perceptions. Participants (N = 148) completed a survey questionnaire assessing daily hassles, life events, perceived social support, dependence, self-criticism, and the sick role. Results of a factor analysis on the sick role measures revealed four attitudinal (Release, Consideration, Burden, and Deviance) and two behavioral (Denial and Consult) factors. The attitudinal factors were moderately intercorrelated, with some ability to predict care-seeking intentions. Regression analyses revealed that stressors and support perceptions did exhibit some ability to predict the sick role. Results are discussed in terms of their implications for health communication research.

  20. Health care seeking behavior and patient delay in tuberculosis diagnosis.

    PubMed

    Almeida, Carlos Podalirio Borges de; Skupien, Erika Cavalheiro; Silva, Denise Rossato

    2015-02-01

    Delays in diagnosis of TB cases are major impeding factors in the control of TB. The objectives of this study were to describe the health care seeking behavior of TB patients, assessing patient delay and the number of health care facilities visited before the start of TB treatment. A cross-sectional study was carried out with adult patients with pulmonary TB presenting to two TB facilities to start treatment. We found a median patient delay of 20 days. The factors associated negatively with patient delay in multivariate analysis were weight loss, and have sought treatment because of the first symptom. We also demonstrated that 44.8% of patients incorrectly reported the mode of transmission of TB. In addition, the local of first attendance was an emergency room of public hospitals in 37.3% of patients. We demonstrated that the median patient delay in TB diagnosis in two TB services in a region with a high prevalence of TB was 20 days, and the protective factors associated with this delay in multivariate analysis were weight loss, and have sought treatment because of the first symptom.

  1. Family socio-demographic factors and maternal obstetric factors influencing appropriate health-care seeking behaviours for newborn jaundice in Sagamu, Nigeria.

    PubMed

    Ogunlesi, Tinuade A; Ogunlesi, Funmilayo B

    2012-04-01

    Poor care-seeking behaviour of families may be responsible for the high prevalence of complications of newborn jaundice in the developing world. To examine the influence of family socio-demographic characteristics and maternal obstetric factors on health care-seeking behaviours for newborn jaundice and the inter-relationship between this behavior and severity of newborn jaundice. Mothers whose babies were referred to a Nigerian tertiary hospital with jaundice were studied in a cross-sectional survey for appropriate health-care seeking behaviours as well as the need for exchange transfusion and the occurrence of kernicterus in their babies. Out of 182 mother-baby pairs, 127 (69.8%) mothers recognized jaundice in their infants, 34.1% delayed care for ≥48 h, 40.6% sought medical care in orthodox health facilities while 20.9% did not seek care outside the home. In all, 61.5% mothers administered various medications to jaundiced babies. Appropriate health care-seeking behaviours were recorded among 28.6% mothers. Low maternal education had a significant relationship with delayed health care-seeking and the use of home remedies for newborn jaundice. A significantly higher proportion of babies who had home remedies had delayed care. Delayed care for ≥48 h was also significantly associated with high Total Serum Bilirubin on admission, higher requirement for exchange transfusion and higher occurrence of kernicterus. Intensive health education of families may help improve their health care-seeking behaviours for neonatal jaundice.

  2. ADHD and the Role of Medication: Knowledge and Perceptions of Qualified and Student Teachers

    ERIC Educational Resources Information Center

    Akram, Gazala; Thomson, A. H.; Boyter, A. C.; McLarty, Marion

    2009-01-01

    Attention-deficit hyperactivity disorder (ADHD) is thought to affect 3-5% of school-aged children. A sound knowledge of both the disorder and its treatment would appear to be useful for school teachers. This study compared the knowledge and attitudes of Scottish qualified and student teachers towards ADHD and its pharmacological treatment. Data…

  3. ADHD and the Role of Medication: Knowledge and Perceptions of Qualified and Student Teachers

    ERIC Educational Resources Information Center

    Akram, Gazala; Thomson, A. H.; Boyter, A. C.; McLarty, Marion

    2009-01-01

    Attention-deficit hyperactivity disorder (ADHD) is thought to affect 3-5% of school-aged children. A sound knowledge of both the disorder and its treatment would appear to be useful for school teachers. This study compared the knowledge and attitudes of Scottish qualified and student teachers towards ADHD and its pharmacological treatment. Data…

  4. The Determinants of Health Care Seeking Behaviour of Adolescents Attending STD Clinics in South Africa.

    ERIC Educational Resources Information Center

    Meyer-Weitz, Anna; Reddy, Priscilla; Van Den Borne, H. W.; Kok, Gerjo; Pietersen, P.

    2000-01-01

    Investigates the determinants of delay behavior in health care seeking in a sample of 292 adolescent patients with STD symptoms. Early health care seeking was determined by perceived seriousness of STDs, an absence of self treatment prior to seeking care, and positive attitudes regarding personal autonomy in condom use behavior. (Contains 17…

  5. Caretakers' perspectives of paediatric TB and implications for care-seeking behaviours in Southern Mozambique.

    PubMed

    Mindu, Carolina; López-Varela, Elisa; Alonso-Menendez, Yara; Mausse, Yolanda; Augusto, Orvalho Joaquim; Gondo, Kizito; Múñoz, Jose; Sacarlal, Jahit; García-Basteiro, Alberto L; Alonso, Pedro L; Munguambe, Khátia

    2017-01-01

    Tuberculosis (TB) remains an important public health concern, especially in poorly resourced settings. TB diagnosis is challenging, particularly for children, who are the most vulnerable to its' impacts. Lack of knowledge and awareness of the disease compromises prompt diagnosis and treatment compliance. To gain insights regarding caretakers' knowledge of the aetiology and prevention of paediatric TB in southern Mozambique, to describe their care-seeking behaviours and to assess the acceptability of diagnostic procedures. A total of 35 caretakers were interviewed, all of which had children with TB compatible symptoms. Eleven were caretakers of children diagnosed with TB at the health facility, 11 of children for whom TB was excluded as a diagnosis at the health facility and 13 of children with TB compatible symptoms identified in the community. The first two groups took part in a TB incidence study, while the third group did not. All underwent the same semi-structured interviews, the results of which were analysed and compared using content analysis. Even when confronted with signs suggestive of TB, most caretakers never suspected it or misinterpreted the signs, even among caretakers with TB and TB contacts. There was limited knowledge of TB, except among those undergoing treatment. The transgression of social norms was often presented as an explanation for TB in parallel to medically sound causes. The use of traditional care for prevention is widespread, but it varied for treatment purposes. TB diagnostic procedures were considered painful but were unanimously tolerated. Misconceptions of paediatric TB, associated complex care-seeking itineraries and negative feelings of the diagnostic procedures may result in delays, low adherence and lost to follow-up, which needs to be addressed by adequately framed health promotion approaches.

  6. Parasitic skin diseases: health care-seeking in a slum in north-east Brazil.

    PubMed

    Heukelbach, Jörg; van Haeff, Evelien; Rump, Babette; Wilcke, Thomas; Moura, Rômulo César Sabóia; Feldmeier, Hermann

    2003-04-01

    Ectoparasitic diseases are endemic in many poor communities in north-east Brazil, and heavy infestation is frequent. We conducted two studies to assess disease perception and health care seeking behaviour in relation to parasitic skin diseases and to determine their public health importance. The first study comprised a representative cross-sectional survey of the population of a slum in north-east Brazil. Inhabitants were examined for the presence of scabies, tungiasis, pediculosis and cutaneous larva migrans (CLM). The second study assessed health care seeking behaviour related to these ectoparasitic diseases of patients attending a Primary Health Care Centre (PHCC) adjacent to the slum. Point prevalence rates in the community were: head lice 43.3% (95% CI: 40.5-46.3), tungiasis 33.6% (95% CI: 30.9-36.4), scabies 8.8% (95% CI: 7.3-10.6) and CLM 3.1% (95% CI: 2.2-4.3). Point prevalence rates of patients attending the PHCC were: head lice 38.2% (95% CI: 32.6-44.1), tungiasis 19.1% (95% CI: 14.7-24.1), scabies 18.8% (95% CI: 14.4-23.7) and CLM 2.1% (95% CI: 0.8-4.5). Only 28 of 54 patients with scabies, three of 55 patients with tungiasis, four of six patients with CLM and zero of 110 patients with head lice sought medical assistance. The physicians of the PHCC only diagnosed a parasitic skin disease when it was pointed out by the patient himself. In all cases patients were correctly informed about the ectoparasites they carried. The results show that tungiasis and pediculosis, and to a lesser extent scabies and CLM, are hyperendemic but neglected by both population and physicians, and that prevalence rates of tungiasis and scabies at the PHCC do not reflect the true prevalence of these diseases in the community.

  7. Health care-seeking behaviour of HIV-infected mothers and male partners in Nairobi, Kenya.

    PubMed

    Drake, Alison L; Wilson, Suzanne K; Kinuthia, John; Roxby, Alison C; Matemo, Daniel; Farquhar, Carey; Rao, Deepa

    2015-01-01

    Health care-seeking behaviours of HIV-infected mothers in sub-Saharan Africa are poorly characterised and typically focus on individual health conditions rather than overall health. We conducted a qualitative study to understand how HIV-infected mothers, their male partners and their HIV-exposed infants seek medical services. We performed 32 in-depth interviews (17 female, 15 male) and four focus group discussions among HIV-infected post-partum women and their male partners in Nairobi, Kenya. We used a grounded theory approach to explore the paths followed for health-related concerns. Female participants reported that willingness to be tested for HIV influences whether women sought antenatal care and the type of facility they preferred for childbirth. The need for medical care outside regular clinic hours and securing safe transportation at night were also significant barriers to seeking care. Most men sought services from traditional healers and chemists before HIV diagnosis, and at governmental facilities afterwards. Both men and women sent infants to traditional healers for non-medical conditions such as bewitching and massage but rarely for medical conditions. Strategies to reduce HIV-related stigma and fears in antenatal and maternity settings, increase access to care after-hours and improve linkage to HIV care for men early in their infection are needed.

  8. Assesssing herbal medical practitioners in professional qualifying examination in Ghana, a model.

    PubMed

    Adusi-Poku, Yaw; Okine, Laud K-N; Hlortsi-Akakpo, F K; Fleischer, Theophilus C; Mensah, M L K; Arhin, Peter; Agyemfra, George; Dabra, Togbega; Mensah, E N

    2009-10-15

    About 70% of Ghanaians depend on Alternative health practice for their primary health care needs. Hence, there is the need to streamline and regulate these practices. Graduates from the Faculty of Pharmacy and Pharmaceutical Sciences, Kwame Nkrumah University of Science and Technology (K.N.U.S.T), Kumasi-Ghana were assessed by the Professional Qualifying Examination Board of the Traditional Medicine Practice Council (TMPC), Ghana, after two years of internship training. A model of assessment took into consideration, the scope of the university training, internship and the primary health care needs of the society.

  9. Factors affecting the threshold for seeking care: the Panic Attack Care-Seeking Threshold (PACT) Study.

    PubMed

    Realini, J P; Katerndahl, D A

    1993-01-01

    This study was conducted to explore the phenomenon of seeking medical care for panic attacks and to identify factors associated with seeking care. A community sample of adults was screened using the Structured Clinical Interview of the Diagnostic and Statistical Manual of Mental Disorders, 3rd edition. Subjects who had experienced panic attacks participated in a structured interview concerning their health care access and utilization, panic characteristics, comorbidity, illness attitudes and perceptions, and family characteristics. Forty-one percent of the subjects had not sought medical care for their panic attacks. Having to get someone to drive (RR [relative risk] = 1.8; P = 0.0026), inability to work because of panic (RR = 1.6; P = 0.0054), and a high treatment experience score on the Illness Attitude Scales (RR = 1.5; P = 0.034) independently predicted seeking care. Seeking support was also significantly associated with seeking care (t = -4.05; P = 0.0001). Care seekers tended to have more severe symptoms, stronger symptom perceptions, and more bodily preoccupation and to abuse drugs more frequently. Seeking care was not influenced by sex, race or ethnicity, stress, psychiatric comorbidity, family function, social support, or access to health care. Nearly one-half of persons with panic attacks do not seek care for their attacks. Those who seek care differ from those who do not in ways that have important implications for the understanding of this illness.

  10. The relationship between physical activity and care-seeking behavior among employed adults.

    PubMed

    Katz, Abigail Sherman; Pronk, Nicolaas Petrus

    2014-02-01

    Physical activity is regarded an important health behavior. Routine doctor visits, dentist visits, and willingness to seek phone advice from a nurse are considered important care-seeking behaviors (ie, behaviors that reflect the way in which people seek and access health care delivery resources available to them). Employers promote physical activity as well as care-seeking behavior to protect and promote health, optimize productivity, and manage health care costs. The purpose of this study was to investigate the association between physical activity and 3 care-seeking behaviors among a sample of 5500 employed adults. Data were obtained from employee health assessments. Logistic regression was used to test the relationship between physical activity and care-seeking behavior. Physical activity was positively associated with all 3 measures of care-seeking behavior: doctor visits (P < .001), dentist visits (P < .001), and willingness to seek phone advice from a nurse (P < .05). For individuals reporting chronic conditions, physical activity was negatively associated with doctor visits for the condition (P < .05) and positively associated with self-perceived health (P < .001). Physical activity is associated with important care-seeking behaviors for employees with and without chronic conditions.

  11. Barriers and facilitators to health care seeking behaviours in pregnancy in rural communities of southern Mozambique.

    PubMed

    Munguambe, Khátia; Boene, Helena; Vidler, Marianne; Bique, Cassimo; Sawchuck, Diane; Firoz, Tabassum; Makanga, Prestige Tatenda; Qureshi, Rahat; Macete, Eusébio; Menéndez, Clara; von Dadelszen, Peter; Sevene, Esperança

    2016-06-08

    . Women do seek antenatal care at health facilities, despite the presence of other health care providers in the community. There are important factors that prevent timely care-seeking for obstetric emergencies and delivery. Unfamiliarity with warning signs, especially among partners, discouragement from revealing pregnancy early in gestation, complex and untimely decision-making processes, fear of mistreatment by health-care providers, lack of transport and financial constraints were the most commonly cited barriers. Women of reproductive age would benefit from community saving schemes for transport and medication, which in turn would improve their birth preparedness and emergency readiness; in addition, pregnancy follow-up should include key family members, and community-based health care providers should encourage prompt referrals to health facilities, when appropriate. NCT01911494.

  12. The career aspirations of women doctors who qualified in 1974 and 1977 from a United Kingdom medical school.

    PubMed

    Rhodes, P J

    1989-03-01

    The career aspirations of doctors who qualified from a UK medical school were examined in relation to firmness of career choice and marital and family circumstances 1 year and 7 years after qualification. Although there was greater certainty of career choice amongst all doctors, the women were consistently less likely to be certain than the men. The men were more likely than the women to be married (and more likely to have children). The main differences in patterns of career choice were the greater popularity of medicine and surgery among the men and of general practice and community medicine among the women. The most plausible explanation for these differences is the different marital and family pressures experienced by men and women.

  13. How social representations of sexually transmitted infections influence experiences of genito-urinary symptoms and care-seeking in Britain: mixed methods study protocol.

    PubMed

    Mapp, Fiona; Hickson, Ford; Mercer, Catherine H; Wellings, Kaye

    2016-07-11

    Social understandings of sexually transmitted infections and associated symptoms and care-seeking behaviour continue to lag behind advancements in biomedical diagnostics and treatment, perpetuating the burden of disease. There is a lack of research linking perceptions, experiences and care-seeking for sexual health issues, especially research conducted outside of medical settings. We aim to explore lay perceptions of STIs and how these influence experiences of genito-urinary symptoms and associated care-seeking behaviour, in women and men in Britain. This study adopts a participant-selection variant of the explanatory sequential mixed methods design to incorporate quantitative and qualitative strands. We use data from Britain's third National Survey of Sexual Attitudes and Lifestyles (n = 15,162) to analyse national patterns of symptom experience and care-seeking, and to identify a purposive qualitative sample. Semi-structured interviews (n = 27) following up with survey participants include a novel flash card activity providing qualitative data about infection perceptions, symptom experiences and decisions about healthcare. Quantitative and qualitative data are analysed separately using complex survey analyses and principles of Interpretative Phenomenological Analysis respectively. Data are then integrated in a subsequent phase of analysis using matrices to compare, contrast and identify silences from each method. This is an ongoing mixed methods study collecting, analysing and synthesising linked data from a national survey and follow-up semi-structured interviews. It adds explanatory potential to existing national survey data and is likely to inform future surveys about sexual health. Given the current uncertainty around service provision in Britain, this study provides timely data about symptom experiences and care-seeking behaviour which may inform future commissioning of sexual healthcare.

  14. Widespread pain - do pain intensity and care-seeking influence sickness absence? - A population-based cohort study.

    PubMed

    Mose, Søren; Christiansen, David Høyrup; Jensen, Jens Christian; Andersen, Johan Hviid

    2016-05-04

    Both musculoskeletal pain-intensity in relation to a specific location (e.g. lower back or shoulder) and pain in multiple body regions have been shown to be associated with impaired function and sickness absence, but the impact of pain intensity on the association between widespread pain and sickness absence has not been studied. Additionally it is unknown whether care-seeking in general practice due to musculoskeletal disorders has a positive or negative impact on future absenteeism. The purpose of this study was to examine the influence of pain intensity on the association between number of musculoskeletal pain sites and sickness absence, and to analyze the impact on absenteeism from care-seeking in general practice due to musculoskeletal disorders. 3745 Danish adults registered with eight General Practitioners (GPs) in one primary medical center reported location and intensity of experienced musculoskeletal pain in seven different body regions in February 2008. Outcome was duration of sickness absence based on register data divided into long-term (>52 weeks during follow-up) and sickness absence of shorter duration (12-52 weeks during follow-up) over a period of 4 years. Data on pain-intensity were analyzed at three different cut-off levels for each body region: i) > 1 (any pain), ii) > 2 (bothersome pain), iii) > 3 (very bothersome pain). Analyses were stratified and compared between participants without GP contact and participants with GP contact due to musculoskeletal disorders. Musculoskeletal pain in more than two body regions was strongly associated with long-term sickness absence in an exposure-response pattern. Different cut-off levels of pain intensity and adjustment for age, sex, educational level and work environmental factors did not alter the results. Similar findings were observed for sickness absence of shorter duration, although the association was weaker. Care-seeking in general practice due to musculoskeletal disorders did not overall

  15. FOREIGN MEDICAL SCHOOL GRADUATES—Problems of Qualifying as Competent to Practice

    PubMed Central

    Stein, Justin J.

    1955-01-01

    It is financially and practically impossible to investigate thoroughly all the medical schools in the world and to keep the records current. There is at present no acceptable method for screening the graduates. The official policy of the American Medical Association regarding licensing to practice medicine in the United States is that it is a state right and that it is entirely under the jurisdiction of the governments of the individual states. Hospitals in this country have a great responsibility to the public and to their attending physicians not to engage incompetent physicians and not to exploit the physicians they engage. It is the obligation of all medical licensing boards to constantly help in elevating and improving the standards of medical care. The foreign - trained physicians who have received medical education and training comparable to that given in this country will always be welcome. The exchange of students and faculty members between schools in friendly foreign countries and the United States should be encouraged. The number of foreign physicians serving as interns and residents in this country is steadily increasing. PMID:14390005

  16. Health care seeking among detained undocumented migrants: a cross-sectional study

    PubMed Central

    2011-01-01

    Background As in many European countries, access to care is decreased for undocumented migrants in the Netherlands due to legislation. Studies on the health of undocumented migrants in Europe are scarce and focus on care-seeking migrants. Not much is known on those who do not seek care. Methods This cross-sectional study includes both respondents who did and did not seek care, namely undocumented migrants who have been incarcerated in a detention centre while awaiting expulsion to their country of origin. A consecutive sample of all new arrivals was studied. Data were collected through structured interviews and reviews of medical records. Results Among the 224 male migrants who arrived at the detention centre between May and July 2008, 173 persons were interviewed. 122 respondents met inclusion criteria. Only half of the undocumented migrants in this study knew how to get access to medical care in the Netherlands if in need. Forty-six percent of respondents reported to have sought medical help during their stay in the Netherlands while having no health insurance (n = 57). Care was sought most frequently for injuries and dental problems. About 25% of these care seekers reported to have been denied care by a health care provider. Asian migrants were significantly less likely to seek care when compared to other ethnic groups, independent from age, chronic health problems and length of stay in the Netherlands. Conclusion The study underlines the need for a better education of undocumented patients and providers concerning the opportunities for health care in the Netherlands. Moreover, there is a need to further clarify the reasons for the denial of care to undocumented patients, as well as the barriers to health care as perceived by undocumented migrants. PMID:21443761

  17. Newly qualified doctors' views on the significance and accessibility of career advice during medical training in Saudi Arabia.

    PubMed

    Mehmood, Syed Imran; Norcini, John J; Borleffs, Jan C C

    2013-01-01

    Career advice is an important instrument to help students with the proper specialty selection. The study aims (1) to explore the views of newly graduated doctors in Saudi Arabia about their experience with the current status of career support system during medical training and (2) to identify cross-cultural similarities and differences. A cross-sectional design study was conducted using a questionnaire to elicit the responses of participants from newly qualified doctors concerning the availability and significance of career advice. SPSS (version 11.0; Chicago, IL) was used to analyze the data and statistical tests, such as chi-square and unpaired t tests, were used to analyze the observations. A response rate of 94.7% was obtained. Among this group, 102 were males and 78 were females. Only 53% did receive career advice. The majority of men felt that career advice during medical studies was inadequate, while women were less negative (69% versus 32%; p = 0.0001). Furthermore, men were more disappointed about the possibilities for career advice after graduating than women (34% versus 13%, p = 0.0001). The results show that only half of newly graduated doctors had received any career advice during medical training. As the health care system cannot afford the potential waste of time and resources for doctors, career guidance should begin in undergraduate training so that the process of thinking about their future career starts longtime before they make their career choice.

  18. Health Care Seeking Behavior for Common Childhood Illnesses in Jeldu District, Oromia Regional State, Ethiopia.

    PubMed

    Kolola, Tufa; Gezahegn, Takele; Addisie, Mesfin

    2016-01-01

    Even though health care seeking interventions potentially reduce child mortality from easily treatable diseases, significant numbers of children die without ever reaching a health facility or due to delays in seeking care in Ethiopia. This study aimed to assess health care seeking behavior for common childhood illnesses and associated factors. A community-based cross-sectional study was conducted in Jeldu District from January to February 2011. A systematic sampling method was used for sample selection. Data were collected from 422 caregivers with under-five children who experienced diseases within six weeks before the survey. Interviewer administered structured and pre-tested questionnaire which were used to collect data. Data entry and cleaning were carried out using Epi Info version 3.5.1 and analyzed using SPSS version 16. Descriptive analysis was done to determine the magnitude of health care seeking behavior. Multivariate logistic regression analyses were performed to identify associated factors. A total of 422 caregivers of under-five children were participated in the study giving an overall response rate of 97.5%. Three hundred fifteen (74.6%) children sought care from health facilities for all conditions. However, only 55.4% of them were taken to health facilities as first source treatment during their illness and prompt care was also very low (13.7%). Marital status of the caregivers (AOR = 2.84; 95%CI: 1.62-4.98), number of symptoms experienced by the child (AOR = 2.04; 95%CI: 1.24-3.36) and perceived severity of the illness (AOR = 3.20; 95%CI: 1.96-5.22) were predictors of health care seeking behavior. Health care seeking behavior for childhood illnesses was delayed and decision to seek care from health facilities was influenced by worsening of the illnesses. Thus, community level promotion of prompt health care seeking is essential to enhance the health care seeking behavior for child hood illnesses in the locality.

  19. Catastrophic care-seeking costs as an indicator for lung health

    PubMed Central

    2015-01-01

    Costs incurred during care-seeking for chronic respiratory disease are a major problem with severe consequences for socio-economic status and health outcomes. Most of the published evidence to date relates to tuberculosis (TB) and there is a lack of information for the major non-communicable chronic respiratory diseases: asthma and chronic obstructive pulmonary disease (COPD). International policy is recognising the need to address this problem and measure progress towards eliminating catastrophic care-seeking costs (see the post-2015 TB strategy). Current tools for measuring, defining, and understanding the full consequences of catastrophic care-seeking costs are inadequate. We propose two areas of work which are urgently needed to prepare health systems and countries for the burden of chronic lung disease that will fall on poor populations in the coming 10-20 years: a) Rapid scale up of the number and scope of studies of patient costs associated with chronic non-communicable respiratory disease. b) Work towards deeper understanding and effective measurement of catastrophic care-seeking costs. This will produce a range of indicators, such as dissaving, which can more effectively inform health policy decision-making for lung health. These will also be useful for other health problems. We argue that reduction in care-seeking costs will be a key monitoring indicator for improvements in lung health in particular, and health in general, in the coming 10 to 20 years. PMID:28281702

  20. Catastrophic care-seeking costs as an indicator for lung health.

    PubMed

    Squire, S B; Thomson, Rachael; Namakhoma, Ireen; El Sony, Asma; Kritski, Afranio; Madan, Jason

    2015-01-01

    Costs incurred during care-seeking for chronic respiratory disease are a major problem with severe consequences for socio-economic status and health outcomes. Most of the published evidence to date relates to tuberculosis (TB) and there is a lack of information for the major non-communicable chronic respiratory diseases: asthma and chronic obstructive pulmonary disease (COPD). International policy is recognising the need to address this problem and measure progress towards eliminating catastrophic care-seeking costs (see the post-2015 TB strategy). Current tools for measuring, defining, and understanding the full consequences of catastrophic care-seeking costs are inadequate. We propose two areas of work which are urgently needed to prepare health systems and countries for the burden of chronic lung disease that will fall on poor populations in the coming 10-20 years: a) Rapid scale up of the number and scope of studies of patient costs associated with chronic non-communicable respiratory disease. b) Work towards deeper understanding and effective measurement of catastrophic care-seeking costs. This will produce a range of indicators, such as dissaving, which can more effectively inform health policy decision-making for lung health. These will also be useful for other health problems. We argue that reduction in care-seeking costs will be a key monitoring indicator for improvements in lung health in particular, and health in general, in the coming 10 to 20 years.

  1. Care seeking in Sri Lanka: one possible explanation for low childhood mortality.

    PubMed

    Amarasiri de Silva, M W; Wijekoon, A; Hornik, R; Martines, J

    2001-11-01

    This paper examines care-seeking practices of mother caretakers with children less than five years of age in a rural district of Sri Lanka. The study was carried out from June to September 1998, documenting care-seeking practices of mother caretakers in a population of 2248 children in 60 villages. Of the five targeted diseases in the IMCI programme (Integrated Management of Childhood Illnesses) that were the focus of the study, acute respiratory infections (82.0%) and diarrhoea (14.8%) were predominant. Although malnutrition was highly prevalent it was not recognised by mother caretakers as an illness. Findings show that in 65.0% of illness episodes in children the mother caretakers sought outside care and treatment. Caretakers sought treatment from both private and public sectors with the majority seeking care in the private sector. Care seeking of mother caretakers was driven by symptomology. Young children with higher perceived severity and high-risk symptoms were brought to provider care more frequently, although a large percentage of episodes with low-risk symptoms were also brought for outside care. Care seeking was similar across socio-economic groups. The study points out that high care seeking of mother caretakers in Sri Lanka, particularly for illnesses with acute high-risk symptoms and signs, is a plausible explanation for the low level of childhood mortality despite the prevalence of a high rate of malnutrition.

  2. Characteristics and Medication Use of Psoriasis Patients Who May or May Not Qualify for Randomized Controlled Trials.

    PubMed

    Malatestinic, William; Nordstrom, Beth; Wu, Jashin J; Goldblum, Orin; Solotkin, Kathleen; Lin, Chen-Yen; Kistler, Kristin; Fraeman, Kathy; Johnston, Joseph; Hawley, Lcdr Lesley; Sicignano, Nicholas; Araujo, Andre

    2017-03-01

    Clinical trials impose exclusion criteria that may limit the generalizability of results. To (a) determine the percentage of real-world patients who would qualify for psoriasis randomized controlled trials; (b) ascertain differences between moderate-to-severe psoriasis patients who would be eligible, ineligible, or potentially eligible for clinical trials; and (c) compare their biologic treatment patterns. Moderate-to-severe psoriasis patients were identified from the U.S. Department of Defense health care database from January 1, 2008, to October 31, 2013. Eligibility classification for psoriasis trials was based on common trial exclusion criteria involving medical conditions and recent treatment history. Patient characteristics and treatment patterns of 4 biologics (adalimumab, etanercept, infliximab, and ustekinumab) were compared between groups. Adherence was measured by medication possession ratio and persistence as continuous time on drug with ≤ 90-day gap between supply times. Among 16,284 qualifying psoriasis patients, 4,677 (28.7%) were medically ineligible, and 8,466 (52.0%) had ineligibility-related treatments that could be stopped prior to trial entry; the latter patients were considered potentially eligible for psoriasis trials. Common reasons for medical ineligibility included malignancies and hematologic disorders; treatment ineligibilities included use of topical corticosteroids and phototherapy. Medically ineligible patients were older and had more comorbidities, while potentially eligible patients were younger and healthier than trial-eligible patients. Most treatment patterns were similar across groups, except that, compared with the trial-eligible group, medically ineligible patients had greater adherence to infliximab and potentially trial-eligible patients had greater adherence and persistence to adalimumab. This large real-world study found that patients who may be ineligible for psoriasis trials differ in important respects (e

  3. Health care seeking behavior of parents with acute flaccid paralysis child

    PubMed Central

    Tegegne, Ayesheshem Ademe; Mersha, Amare Mengistu

    2017-01-01

    Introduction Despite the tremendous increase in the number of modern health institutions, traditional medical practices still remain alternative places of health care service delivery and important sites for disease notification in the disease surveillance system. The objectives of this study are to describe the patterns and factors associated with health care seeking behavior of parents and care takers with acute flaccid paralysis child and see how the traditional practice affect the surveillance system. Methods A cross-sectional descriptive study was conducted to assess the health seeking behavior of parents with an acute flaccid paralysis child. Data were collected throughout the country as a routine surveillance program. Results Of 1299 families analyzed, 907(69.3%) of families with AFP child first went to health institutions to seek medical care, while. 398 (30.7%) of parents took their child first to other traditional sites, including holy water sites (11.8%), traditional healers (9.1%) and prayer places (5.4%). Over half of the parents with AFP child reported practicing home measures before first seeking health service from modern health institutions. Home measures (OR, 0.1202, 95% CI 0.0804-0.1797), decision by relatives (OR, 0.5595, 95% CI 0.3665-0.8540) and More than 10km distance from health facility (OR, 0.5962, 95% CI, 0.4117-0.8634) were significantly associated to first seeking health service from health institutions (p<0.05). Conclusion Program strategies must certainly be developed to expand and capture all traditional sites in the surveillance network, and intensify sensitization and active surveillance visit in these areas. PMID:28983391

  4. Health care seeking behavior of parents with acute flaccid paralysis child.

    PubMed

    Tegegne, Ayesheshem Ademe; Mersha, Amare Mengistu

    2017-01-01

    Despite the tremendous increase in the number of modern health institutions, traditional medical practices still remain alternative places of health care service delivery and important sites for disease notification in the disease surveillance system. The objectives of this study are to describe the patterns and factors associated with health care seeking behavior of parents and care takers with acute flaccid paralysis child and see how the traditional practice affect the surveillance system. A cross-sectional descriptive study was conducted to assess the health seeking behavior of parents with an acute flaccid paralysis child. Data were collected throughout the country as a routine surveillance program. Of 1299 families analyzed, 907(69.3%) of families with AFP child first went to health institutions to seek medical care, while. 398 (30.7%) of parents took their child first to other traditional sites, including holy water sites (11.8%), traditional healers (9.1%) and prayer places (5.4%). Over half of the parents with AFP child reported practicing home measures before first seeking health service from modern health institutions. Home measures (OR, 0.1202, 95% CI 0.0804-0.1797), decision by relatives (OR, 0.5595, 95% CI 0.3665-0.8540) and More than 10km distance from health facility (OR, 0.5962, 95% CI, 0.4117-0.8634) were significantly associated to first seeking health service from health institutions (p<0.05). Program strategies must certainly be developed to expand and capture all traditional sites in the surveillance network, and intensify sensitization and active surveillance visit in these areas.

  5. Care-seeking behavior for upper respiratory infections.

    PubMed

    Solberg, L I; Braun, B L; Fowles, J B; Kind, E A; Anderson, R S; Healey, M L

    2000-10-01

    Many recent efforts to reduce unnecessary medical services have targeted care of upper respiratory infections (URIs). We tested whether patients who seek care very early in their illness differ from those who seek care later and whether they might require a different approach to care. We surveyed by telephone 257 adult patients and 249 parents of child patients who called or visited one of 3 primary care clinics within 10 days (adults) or 14 days (parents) of the onset of uncomplicated URI symptoms. Those who contacted the clinic within the first 2 days of illness were compared with those who made contact later. Although 28% of adults and 41% of parents contacted their clinic within the first 2 days of symptom onset, we found very few differences in the characteristics of the caller or patient between those who called early and later. The illnesses of those who called early were not more severe, and they did not have different beliefs, histories, approaches to medical care, or needs. The only clinician-relevant difference was that adult patients calling in the first 2 days had a greater desire to rule out complications (84.7% vs 64.1% calling in 3-5 days and 70.6% calling after 5 days of illness, P < or = .05). Those who seek medical care very early for a URI do not appear to be different in clinically important ways. If we are going to reduce overuse of medical care and antibiotics for URIs, clinical trials of more effective and efficient strategies are needed to encourage home care and self-management.

  6. Women's autonomy and reproductive health care seeking behavior in Ethiopia.

    PubMed

    Wado, Yohannes Dibaba

    2017-07-31

    This paper investigated the potential importance of women's autonomy in reproductive healthcare-seeking behavior of women in Ethiopia. Data from the 2011 Ethiopian Demographic and Health survey (DHS), that involved a total of 16,515 women, were analyzed. A weighted sub-sample of married women and women who had had a live birth were included in analyses on family planning and antenatal care. Women's autonomy was measured by participation in decision-making, attitudes toward wife beating and whether getting permission to seek medical care was a big problem. Nearly 54% of women participated in all major household decisions, and 69% said getting permission to go for medical care was not a large problem. Women's participation in domestic decision-making was significantly positively associated with use of family planning (adjusted odds ratio [aOR]: 1.37, 95% confidence interval [CI]: 1.17-1.62) and antenatal care (aOR: 1.36, 95% CI: 1.13-1.64) after adjusting for the effects of socio-demographic variables. Moreover, greater women's education, paid employment, exposure to media and better household economic status were related to both use of family planning and antenatal care. Improving women's autonomy will help to attain both gender equality and improved use of health services.

  7. Moving beyond quality control in diagnostic radiology and the role of the clinically qualified medical physicist.

    PubMed

    Delis, H; Christaki, K; Healy, B; Loreti, G; Poli, G L; Toroi, P; Meghzifene, A

    2017-09-01

    Quality control (QC), according to ISO definitions, represents the most basic level of quality. It is considered to be the snapshot of the performance or the characteristics of a product or service, in order to verify that it complies with the requirements. Although it is usually believed that "the role of medical physicists in Diagnostic Radiology is QC", this, not only limits the contribution of medical physicists, but is also no longer adequate to meet the needs of Diagnostic Radiology in terms of Quality. In order to assure quality practices more organized activities and efforts are required in the modern era of diagnostic radiology. The complete system of QC is just one element of a comprehensive quality assurance (QA) program that aims at ensuring that the requirements of quality of a product or service will consistently be fulfilled. A comprehensive Quality system, starts even before the procurement of any equipment, as the need analysis and the development of specifications are important components under the QA framework. Further expanding this framework of QA, a comprehensive Quality Management System can provide additional benefits to a Diagnostic Radiology service. Harmonized policies and procedures and elements such as mission statement or job descriptions can provide clarity and consistency in the services provided, enhancing the outcome and representing a solid platform for quality improvement. The International Atomic Energy Agency (IAEA) promotes this comprehensive quality approach in diagnostic imaging and especially supports the field of comprehensive clinical audits as a tool for quality improvement. Copyright © 2017 Associazione Italiana di Fisica Medica. Published by Elsevier Ltd. All rights reserved.

  8. An educational multimedia campaign has differential effects on public stroke knowledge and care-seeking behavior.

    PubMed

    Marx, Juergen J; Nedelmann, Max; Haertle, Birgit; Dieterich, Marianne; Eicke, Bernd M

    2008-03-01

    To study the differential educational effects of a multimodal educational program on public stroke knowledge, we performed computer-assisted telephone surveys among a random sample of 500 members of the general public, before and immediately after an intense three-month educational campaign. The intervention comprised of poster advertisements, flyers, mail circular, slogans, stroke interest stories etc. in local newspapers, on television and radio, and public events. The main outcome measures were stroke knowledge, the intended behavior in acute stroke and the educational media remembered after the intervention. General knowledge of the nature of stroke (65.7% correct answers before versus 84.9 % after the campaign, p < 0.01) and the awareness of being at risk of stroke (32.7 % vs. 41.9%, p < 0.01) increased due to the campaign, especially in respondents of lower educational background. There was no significant effect on the number of patients who would seek emergency medical care after the intervention (81 % vs. 82 %) and hardly any effect on detailed knowledge of stroke warning signs or different risk factors. Mass media like newspapers, radio and television were most frequently reported as the main information source remembered (66.6 %). Our data indicate that educational programs do have differential effects on public stroke knowledge and individual stroke risk,which does not necessarily lead to a change in care-seeking behavior. Repeated information using short-tailored slogans and cues to action led to a gain in general stroke knowledge, especially in high-risk populations of lower educational background. Large educational campaigns seem unsuitable, however, for mediation of detailed information on stroke.

  9. Health-care seeking behaviour for tuberculosis symptoms in Croatia.

    PubMed

    Jurcev-Savicevic, Anamarija; Kardum, Goran

    2012-08-01

    Early detection and treatment of tuberculosis (TB) patients have been key principles of TB control. Therefore, it is important to understand the causes of delay and to estimate their magnitude in order to plan interventions that yield the maximum benefit. A total of 240 subjects aged ≥ 15 year with pulmonary TB were interviewed. Patient delay was defined as the period (in days) from the appearance of any symptoms to the first visit to a medical provider. The median patient delay was 38 days. When using the median as a cut-off to define long patient delay, being an ex-smoker (P = 0.036), current smoker (P = 0.030), coughing (P = 0.021) and losing weight (P = 0.050) were found to be significant. Having high level of education (P = 0.014) was associated with short delay. Being an ex-smoker (P = 0.050, adjusted odds ratio (aOR) = 1.940, 95% CI 1.001-3.759), current smoker (P = 0.029, aOR = 2.077, 95% CI 1.076-4.012) and having a cough (P = 0.022, aOR = 2.032, 95% CI 1.108-3.727), were significant in multivariate logistic regression, while having high level of education remained associated with short delay (P = 0.016, aOR = 0.286, 95% CI 0.103-0.791). The most common reasons for delay were supposed influenza or symptoms improving over time (34.5%) and underestimated symptoms (32.9%). People with smoking habits and health-seeking behaviour that may favour advanced disease and prolonged infectiousness as well as people with the lowest level of education contributed to TB delay. To reduced patient delay, efforts should be made to increase TB knowledge, which has to be adjusted to the less-educated segments of the population.

  10. Renal sympathetic denervation in patients with treatment-resistant hypertension after witnessed intake of medication before qualifying ambulatory blood pressure.

    PubMed

    Fadl Elmula, Fadl Elmula Mohamed; Hoffmann, Pavel; Fossum, Eigil; Brekke, Magne; Gjønnæss, Eyvind; Hjørnholm, Ulla; Kjær, Vibeke N; Rostrup, Morten; Kjeldsen, Sverre E; Os, Ingrid; Stenehjem, Aud-E; Høieggen, Aud

    2013-09-01

    It is unknown whether the decline in blood pressure (BP) after renal denervation (RDN) is caused by denervation itself or concomitantly improved drug adherence. We aimed to investigate the BP lowering effect of RDN in true treatment-resistant hypertension by excluding patients with poor drug adherence. Patients with resistant hypertension (n=18) were referred for a thorough clinical and laboratory work-up. Treatment-resistant hypertension was defined as office systolic BP>140 mm Hg, despite maximally tolerated doses of ≥ 3 antihypertensive drugs, including a diuretic. In addition, ambulatory daytime systolic BP>135 mm Hg was required after witnessed intake of antihypertensive drugs to qualify. RDN (n=6) was performed with Symplicity Catheter System. The mean office and ambulatory BPs remained unchanged at 1, 3, and 6 months in the 6 patients, whereas there was no known change in antihypertensive medication. Two patients, however, had a fall in both office and ambulatory BPs. Our findings question whether BP falls in response to RDN in patients with true treatment-resistant hypertension. Additional research must aim to verify potential BP lowering effect and identify a priori responders to RDN before this invasive method can routinely be applied to patients with drug-resistant hypertension. Clinical Trial Registration- URL: http://www.clinicaltrials.gov. Unique identifier: NCT01673516.

  11. Care-seeking decisions for worsening symptoms in heart failure: a qualitative metasynthesis.

    PubMed

    Ivynian, S E; DiGiacomo, M; Newton, P J

    2015-11-01

    Over 50 % of heart failure (HF) patients delay seeking help for worsening symptoms until these reach acute levels and require emergency hospitalisation. This metasynthesis aimed to identify and explore factors influencing timely care-seeking in patients with HF. Electronic databases searched were MEDLINE, Embase, and CINAHL. Studies were included if they were peer-reviewed journal articles, written in English, and reported perspectives of HF patients following qualitative data collection and analysis. Forty articles underwent analysis following the approach of Thomas and Harden. Leventhal's self-regulatory model (SRM) was used to organise the literature. Much of the literature fits within the SRM; however, this model did not account for all factors that influence patients' care-seeking for worsening symptoms. Factors not accounted for included patients' appraisals of previous care-seeking experiences, perceived system and provider barriers to accessing care, and the influence of external appraisals. When added to factors already represented in the model, such as misattribution of symptoms, not identifying with HF diagnosis, cognitive status, lack of understanding information provided, adaptation to symptoms, and emotional responses, a more comprehensive account of patients' decision-making was revealed. This metasynthesis identified factors, as yet unaccounted for, in a prominent model, and has suggested a more comprehensive framework for addressing care-seeking in HF patients. This information can be used to tailor education, communication, and service initiatives to improve HF patients' responses to worsening symptoms and target those most at risk of delay.

  12. Awareness of treatment history in family and friends, and mental health care seeking propensity.

    PubMed

    Thériault, François L; Colman, Ian

    2017-04-01

    Many adults suffering from mental disorders never receive the care they need. The role of family and friends in overcoming mental health treatment barriers is poorly understood. We investigated the association between awareness of lifetime mental health treatment history in one's family or friends, and likelihood of having recently received mental health care for oneself. Using Canadian Community Health Survey 2012-Mental Health data, we defined care seekers as individuals who talked about mental health issues to at least one health professional in the past 12 months. Seekers were matched to non-seekers based on estimated care seeking propensity, and 1933 matched pairs were created. Reported awareness of lifetime treatment history in family and friends was compared between seekers and non-seekers. There were no differences in the distribution of any confounder of interest between seekers and non-seekers. 73% of seekers were aware of treatment history in family or friends, compared to only 56% of non-seekers (RR 1.3; 95% CI 1.2, 1.3). Awareness of treatment history in family members had nearly identical associations with care seeking as awareness of treatment history in friends. We have found a social clustering of mental health care seeking behavior; individuals who were aware of lifetime treatment history in family or friends were more likely to have recently sought care for themselves. These novel results are consistent with a social learning model of care seeking behavior, and could inform efforts to bridge the current mental health treatment gap.

  13. Health Care Seeking Behavior for Common Childhood Illnesses in Jeldu District, Oromia Regional State, Ethiopia

    PubMed Central

    Kolola, Tufa; Gezahegn, Takele; Addisie, Mesfin

    2016-01-01

    Background Even though health care seeking interventions potentially reduce child mortality from easily treatable diseases, significant numbers of children die without ever reaching a health facility or due to delays in seeking care in Ethiopia. This study aimed to assess health care seeking behavior for common childhood illnesses and associated factors. Methods A community-based cross-sectional study was conducted in Jeldu District from January to February 2011. A systematic sampling method was used for sample selection. Data were collected from 422 caregivers with under-five children who experienced diseases within six weeks before the survey. Interviewer administered structured and pre-tested questionnaire which were used to collect data. Data entry and cleaning were carried out using Epi Info version 3.5.1 and analyzed using SPSS version 16. Descriptive analysis was done to determine the magnitude of health care seeking behavior. Multivariate logistic regression analyses were performed to identify associated factors. Results A total of 422 caregivers of under-five children were participated in the study giving an overall response rate of 97.5%. Three hundred fifteen (74.6%) children sought care from health facilities for all conditions. However, only 55.4% of them were taken to health facilities as first source treatment during their illness and prompt care was also very low (13.7%). Marital status of the caregivers (AOR = 2.84; 95%CI: 1.62–4.98), number of symptoms experienced by the child (AOR = 2.04; 95%CI: 1.24–3.36) and perceived severity of the illness (AOR = 3.20; 95%CI: 1.96–5.22) were predictors of health care seeking behavior. Conclusion Health care seeking behavior for childhood illnesses was delayed and decision to seek care from health facilities was influenced by worsening of the illnesses. Thus, community level promotion of prompt health care seeking is essential to enhance the health care seeking behavior for child hood illnesses in the

  14. The Recognition of and Care Seeking Behaviour for Childhood Illness in Developing Countries: A Systematic Review

    PubMed Central

    Geldsetzer, Pascal; Williams, Thomas Christie; Kirolos, Amir; Mitchell, Sarah; Ratcliffe, Louise Alison; Kohli-Lynch, Maya Kate; Bischoff, Esther Jill Laura; Cameron, Sophie; Campbell, Harry

    2014-01-01

    Background Pneumonia, diarrhoea, and malaria are among the leading causes of death in children. These deaths are largely preventable if appropriate care is sought early. This review aimed to determine the percentage of caregivers in low- and middle-income countries (LMICs) with a child less than 5 years who were able to recognise illness in their child and subsequently sought care from different types of healthcare providers. Methods and Findings We conducted a systematic literature review of studies that reported recognition of, and/or care seeking for episodes of diarrhoea, pneumonia or malaria in LMICs. The review is registered with PROSPERO (registration number: CRD42011001654). Ninety-one studies met the inclusion criteria. Eighteen studies reported data on caregiver recognition of disease and seventy-seven studies on care seeking. The median sensitivity of recognition of diarrhoea, malaria and pneumonia was low (36.0%, 37.4%, and 45.8%, respectively). A median of 73.0% of caregivers sought care outside the home. Care seeking from community health workers (median: 5.4% for diarrhoea, 4.2% for pneumonia, and 1.3% for malaria) and the use of oral rehydration therapy (median: 34%) was low. Conclusions Given the importance of this topic to child survival programmes there are few published studies. Recognition of diarrhoea, malaria and pneumonia by caregivers is generally poor and represents a key factor to address in attempts to improve health care utilisation. In addition, considering that oral rehydration therapy has been widely recommended for over forty years, its use remains disappointingly low. Similarly, the reported levels of care seeking from community health workers in the included studies are low even though global action plans to address these illnesses promote community case management. Giving greater priority to research on care seeking could provide crucial evidence to inform child mortality programmes. PMID:24718483

  15. Social differentiation and embodied dispositions: a qualitative study of maternal care-seeking behaviour for near-miss morbidity in Bolivia

    PubMed Central

    Rööst, Mattias; Jonsson, Cecilia; Liljestrand, Jerker; Essén, Birgitta

    2009-01-01

    Background Use of maternal health care in low-income countries has been associated with several socioeconomic and demographic factors, although contextual analyses of the latter have been few. A previous study showed that 75% of women with severe obstetric morbidity (near-miss) identified at hospitals in La Paz, Bolivia were in critical conditions upon arrival, underscoring the significance of pre-hospital barriers also in this setting with free and accessible maternal health care. The present study explores how health care-seeking behaviour for near-miss morbidity is conditioned in La Paz, Bolivia. Methods Thematic interviews with 30 women with a near-miss event upon arrival at hospital. Near-miss was defined based on clinical and management criteria. Modified analytic induction was applied in the analysis that was further influenced by theoretical views that care-seeking behaviour is formed by predisposing characteristics, enabling factors, and perceived need, as well as by socially shaped habitual behaviours. Results The self-perception of being fundamentally separated from "others", meaning those who utilise health care, was typical for women who customarily delivered at home and who delayed seeking medical assistance for obstetric emergencies. Other explanations given by these women were distrust of authority, mistreatment by staff, such as not being kept informed about their condition or the course of their treatment, all of which reinforced their dissociation from the health-care system. Conclusion The findings illustrate health care-seeking behaviour as a practise that is substantially conditioned by social differentiation. Social marginalization and the role health institutions play in shaping care-seeking behaviour have been de-emphasised by focusing solely on endogenous cultural factors in Bolivia. PMID:19640286

  16. Effect of an intervention to increase statin use in medicare members who qualified for a medication therapy management program.

    PubMed

    Stockl, Karen M; Tjioe, Daniel; Gong, Sherry; Stroup, Jenni; Harada, Ann S M; Lew, Heidi C

    2008-01-01

    adjusting for age, gender, geography, and chronic disease score. To determine the implications of this intervention for routine practice, outcome measures included estimates of (1) the number of patient interventions necessary to prevent 1 major CV event and (2) the coronary event costs avoided by the intervention. The number of interventions necessary to prevent 1 major CV event was estimated by (1) calculating the number of members requiring interventions in order for 1 member to initiate statin therapy, based on the present study's findings, and then (2) calculating the number of statin initiations necessary to avoid a major CV event, based on clinical trial estimates of the effect of statin treatment on CV event rates. During the 4-month period following the intervention, 12.1% (n = 138) of the intervention members started a statin medication compared with 7.3% (n =51) of comparison members (P = 0.001). After covariate adjustment, the odds of initiating a statin medication were 65% higher (adjusted odds ratio [OR] = 1.65; 95% confidence interval [CI] = 1.15-2.36; P = 0.006) in the intervention than in the comparison group. The estimated number of members requiring interventions to prevent 1 major CV event was 220. The estimated coronary event cost avoidance is dollars 12,323 per 220 members who received the intervention, after subtraction of program administrative costs and the cost of statin drug therapy. A statin initiation intervention aimed at prescribers for MA-PD and PDP members with diabetes or CAD who qualified for MTMP services was successful in increasing statin use among this group of members at high risk for CV events.

  17. Association Between Patient-Centered Medical Home Capabilities and Outcomes for Medicare Beneficiaries Seeking Care from Federally Qualified Health Centers.

    PubMed

    Timbie, Justin W; Hussey, Peter S; Setodji, Claude M; Kress, Amii; Malsberger, Rosalie; Lavelle, Tara A; Friedberg, Mark W; Wensky, Suzanne G; Giuriceo, Katherine D; Kahn, Katherine L

    2017-05-26

    Patient-centered medical home (PCMH) models of primary care have the potential to expand access, improve population health, and lower costs. Federally qualified health centers (FQHCs) were early adopters of PCMH models. We measured PCMH capabilities in a diverse nationwide sample of FQHCs and assessed the relationship between PCMH capabilities and Medicare beneficiary outcomes. Cross-sectional, propensity score-weighted, multivariable regression analysis. A convenience sample of 804 FQHC sites that applied to a nationwide FQHC PCMH initiative and 231,163 Medicare fee-for-service beneficiaries who received a plurality of their primary care services from these sites. PCMH capabilities were self-reported using the National Committee for Quality Assurance's (NCQA's) 2011 application for PCMH recognition. Measures of utilization, continuity of care, quality, and Medicare expenditures were derived from Medicare claims covering a 1-year period ending October 2011. Nearly 88% of sites were classified as having PCMH capabilities equivalent to NCQA Level 1, 2, or 3 PCMH recognition. These more advanced sites were associated with 228 additional FQHC visits per 1000 Medicare beneficiaries (95% CI: 176, 278), compared with less advanced sites; 0.02 points higher practice-level continuity of care (95% CI: 0.01, 0.03); and a greater likelihood of administering two of four recommended diabetes tests. However, more advanced sites were also associated with 181 additional visits to specialists per 1000 beneficiaries (95% CI: 124, 232) and 64 additional visits to emergency departments (95% CI: 35, 89)-but with no differences in inpatient utilization. More advanced sites had higher Part B expenditures ($111 per beneficiary [95% CI: $61, $158]) and total Medicare expenditures of $353 [95% CI: $65, $614]). Implementation of PCMH models in FQHCs may be associated with improved primary care for Medicare beneficiaries. Expanded access to care, in combination with slower development of key

  18. Becoming a patient-centered medical home: a 9-year transition for a network of Federally Qualified Health Centers.

    PubMed

    Calman, Neil S; Hauser, Diane; Weiss, Linda; Waltermaurer, Eve; Molina-Ortiz, Elizabeth; Chantarat, Tongtan; Bozack, Anne

    2013-01-01

    The patient-centered medical home (PCMH) model has great potential for optimizing the care of chronically ill patients, yet there is much to be learned about various implementations of this model and their impact on patient care processes and outcomes. We examined changes in patterns of health care use in a network of Federally Qualified Health Centers throughout a 9-year period of practice transformation that included recognition of all centers by the National Committee for Quality Assurance (NCQA) as Level 3 PCMH practices. We analyzed deidentified data from electronic health records for the period 2003 to 2011 to identify patterns of service use for all 4,595 patients with diabetes. We also examined a subsample of 545 patients who were in care throughout the study period to track improvement in glycated hemoglobin levels as a clinical measure over time. Through the transition to a PCMH, the mean number of encounters with outreach, diabetes educators, and psychosocial services increased for all diabetic patients; virtually all patients had visits with a primary care clinician, but the mean number of visits decreased slightly. Among patients in the subsample, mean annual levels of glycated hemoglobin decreased steadily during the 9-year study period, mainly driven by a reduction in patients having baseline levels exceeding 9%. This retrospective study conducted in a real-world setting using electronic health record data demonstrates a shift in resource use by diabetic patients from the primary care clinician to other members of the care team. The findings suggest that PCMH implementation has the potential to alter processes of care and improve outcomes of care, especially among those with higher disease burden.

  19. Factors Affecting Initial Intimate Partner Violence-Specific Health Care Seeking in the Tokyo Metropolitan Area, Japan.

    PubMed

    Kamimura, Akiko; Bybee, Deborah; Yoshihama, Mieko

    2014-09-01

    This study examined the factors affecting a women's initial intimate partner violence (IPV)-specific health care seeking event which refers to the first health care seeking as a result of IPV in a lifetime. Data were collected using the Life History Calendar method in the Tokyo metropolitan area from 101 women who had experienced IPV. Discrete-time survival analysis was used to assess the time to initial IPV-specific health care seeking. IPV-related injury was the most significant factor associated with increased likelihood of seeking IPV-specific health care seeking for the first time. In the presence of a strong effect of formal help seeking, physical and sexual IPV were no longer significantly related to initial IPV-specific health care seeking. The results suggest some victims of IPV may not seek health care unless they get injured. The timing of receiving health care would be important to ensure the health and safety of victims.

  20. Sex differences in morbidity and care-seeking during the neonatal period in rural southern Nepal.

    PubMed

    Rosenstock, Summer; Katz, Joanne; Mullany, Luke C; Khatry, Subarna K; LeClerq, Steven C; Darmstadt, Gary L; Tielsch, James M

    2015-08-08

    South Asian studies, including those from Nepal, have documented increased risk of neonatal mortality among girls, despite their early biologic survival advantage. We examined sex differences in neonatal morbidity and care-seeking behavior to determine whether such differences could help explain previously observed excess late neonatal mortality among girls in Nepal. A secondary analysis of data from a trial of chlorhexidine use among neonates in rural Nepal was conducted. The objective was to examine sex differences in neonatal morbidity and care-seeking behavior for ill newborns. Girls were used as the reference group. Referral for care was higher during the early neonatal period (ENP: 0-7 days old) (50.7%) than the late neonatal period (LNP: 8-28 days old) (31.3%), but was comparable by sex. There were some significant differences in reasons for referral by sex. Boys were significantly more often referred for convulsions/stiffness, having yellow body/eyes, severe skin infection, and having at least two of the following: difficulty breathing, difficulty feeding, fever, or vomiting during the ENP. Girls were more often referred for hypothermia. During the LNP, boys were significantly more often referred for having yellow body/eyes, persistent watery stool, and severe skin infection. There were no referral types in the LNP for which girls were more often referred. Less than half of those referred at any point were taken for care (47.0%) and referred boys were more often taken than girls (Neonatal Period OR: 1.77, 95% CI: 1.64 - 1.91). Family composition differentially impacted the relationship between care-seeking and sex. The greatest differences were in families with only prior living girls (Pahadi - ENP OR: 1.78, 95% CI: 1.29 - 2.45 and LNP OR: 1.51, 95% CI: 1.03 - 2.21; Madeshi - ENP OR: 2.86, 95% CI: 2.28 - 3.59 and LNP OR: 2.45, 95% CI: 1.84 - 3.26). Care-seeking was inadequate for both sexes, but ill boys were consistently more often taken for care than

  1. The influence of gender and other patient characteristics on health care-seeking behaviour: a QUALICOPC study.

    PubMed

    Thompson, Ashley E; Anisimowicz, Yvonne; Miedema, Baukje; Hogg, William; Wodchis, Walter P; Aubrey-Bassler, Kris

    2016-03-31

    Canadians' health care-seeking behaviour for physical and mental health issues was examined using the international Quality and Cost of Primary Care (QUALICOPC) survey that was conducted in 2013 in Canada. This study used the cross-sectional Patient Experiences Survey collected from 7260 patients in 759 practices across 10 Canadian provinces as part of the QUALICOPC study. A Responsive Care Scale (RCS) was constructed to reflect the degree of health care-seeking behaviour across 11 health conditions. Using several patient characteristics as independent variables, four multiple regression analyses were conducted. Patients' self-reports indicated that there were gender differences in health care-seeking behaviour, with women reporting they visited their primary care provider to a greater extent than did men for both physical and mental health concerns. Overall, patients were less likely to seek care for mental health concerns in comparison to physical health concerns. For both women and men, the results of the regressions indicated that age, illness prevention, trust in physicians and chronic conditions were important factors when explaining health care-seeking behaviours for mental health concerns. This study confirms the gender differences in health care-seeking behaviour advances previous research by exploring in detail the variables predicting differences in health care-seeking behaviour for men and women. The variables were better predictors of health care-seeking behaviour in response to mental health concerns than physical health concerns, likely reflecting greater variation among those seeking mental health care. This study has implications for those working to improve barriers to health care access by identifying those more likely to engage in health care-seeking behaviours and the variables predicting health care-seeking. Consequently, those who are not accessing primary care can be targeted and policies can be developed and put in place to promote their

  2. Obstetric complications: the health care seeking behaviour & cost pressure generated from it in rural Bangladesh.

    PubMed

    Khan, A K M R A

    2002-07-01

    The study was done throughout 2001 to find out the health care-seeking behavior & cost analysis generated from obstetric complications in rural Bangladesh. Total 350 women in postnatal period who had obstetric complications were interviewed from the study area of 150 km apart in the rural section of Bangladesh namely Dewangonj & Trishal Upazila. Majority of the respondents belonged to the age group 17-35 years & all the mothers had obstetric complications. Major obstetric complications were haemorrhage, prolonged labour, premature rupture of membrane, eclampsia, septic abortion, obstructed labour, prolonged labour etc. 74% had history of home delivery out of which 26% were reported to the hospital. Majority of them (74%) was reluctant to take the health utilization system. The major problem was financial burden, which seems to divert the major changing of health care seeking behavior.

  3. Applying behavior change theory to technology promoting veteran mental health care seeking.

    PubMed

    Whealin, Julia M; Kuhn, Eric; Pietrzak, Robert H

    2014-11-01

    Despite the availability of effective mental health interventions, the vast majority of veterans with a mental disorder underutilize psychological services. Contemporary research has revealed that several factors such as low education, stigma, stoicism, lack of knowledge, and negative beliefs about mental health services are associated with veterans' underutilization of services. In this article, the authors provide an overview of factors that affect symptomatic veterans' decisions about whether to seek mental health services. Second, they describe the theory of planned behavior (Ajzen & Fishbein, 1980), a useful model for understanding mental health care seeking that can inform the development of technology-based interventions designed to increase veterans' willingness to seek psychological services. Third, the authors describe the development of Considering Professional Help, a personalized web-based tool developed by the Department of Veterans Affairs, which has been designed to promote mental health care seeking in veterans with mental health problems. (PsycINFO Database Record (c) 2014 APA, all rights reserved).

  4. Attitudes Toward Alzheimer's Care-Seeking Among Korean Americans: Effects of Knowledge, Stigma, and Subjective Norm.

    PubMed

    Casado, Banghwa Lee; Hong, Michin; Lee, Sang E

    2017-03-10

    Early detection of Alzheimer's disease (AD) ensures that affected individuals and their caregivers can make appropriate plans for health care needs, yet many ethnic minorities delay seeking care for AD until the disease has progressed. This study examined attitudes toward care-seeking for AD among Korean Americans (KAs) and identified factors affecting their attitudes. A cross-sectional survey was used to collect data from 234 KA adults. We conducted hierarchical regression analyses to examine the effects of sociocultural background (age, gender, education, cultural orientation), AD knowledge and exposure to AD, and beliefs about AD (stigma of pity, shame, and public avoidance) and AD care (subjective norm) on KAs' attitudes toward seeking AD care from primary care physicians (PCPs) and AD specialists. We also tested whether knowledge of AD moderated the impact of beliefs about AD and AD care on KAs' attitudes toward seeking AD care. For both PCPs and AD specialists, the subjective norm had the strongest effect on KAs' attitudes toward care seeking (β = 0.557 for PCPs, β = 0.360 for specialists). Effects of stigma beliefs disappeared in the presence of the subjective norm. AD knowledge moderated the impact of the subjective norm on the attitudes toward both PCPs (β = -1.653) and specialists (β = -1.742). The significance of the subjective norm in KAs' attitudes toward AD care-seeking underscores the importance of public education, and our study suggests that increasing AD knowledge could facilitate a change in public attitudes toward seeking AD care.

  5. Health Care Seeking Behavior of Persons with Acute Chagas Disease in Rural Argentina: A Qualitative View

    PubMed Central

    Dinardi, Graciela; Canevari, Cecilia; Torabi, Nahal

    2016-01-01

    Chagas disease (CD) is a tropical parasitic disease largely underdiagnosed and mostly asymptomatic affecting marginalized rural populations. Argentina regularly reports acute cases of CD, mostly young individuals under 14 years old. There is a void of knowledge of health care seeking behavior in subjects experiencing a CD acute condition. Early treatment of the acute case is crucial to limit subsequent development of disease. The article explores how the health outcome of persons with acute CD may be conditioned by their health care seeking behavior. The study, with a qualitative approach, was carried out in rural areas of Santiago del Estero Province, a high risk endemic region for vector transmission of CD. Narratives of 25 in-depth interviews carried out in 2005 and 2006 are analyzed identifying patterns of health care seeking behavior followed by acute cases. Through the retrospective recall of paths for diagnoses, weaknesses of disease information, knowledge at the household level, and underperformance at the provincial health care system level are detected. The misdiagnoses were a major factor in delaying a health care response. The study results expose lost opportunities for the health care system to effectively record CD acute cases. PMID:27829843

  6. Health Care Seeking Behavior of Persons with Acute Chagas Disease in Rural Argentina: A Qualitative View.

    PubMed

    Llovet, Ignacio; Dinardi, Graciela; Canevari, Cecilia; Torabi, Nahal

    2016-01-01

    Chagas disease (CD) is a tropical parasitic disease largely underdiagnosed and mostly asymptomatic affecting marginalized rural populations. Argentina regularly reports acute cases of CD, mostly young individuals under 14 years old. There is a void of knowledge of health care seeking behavior in subjects experiencing a CD acute condition. Early treatment of the acute case is crucial to limit subsequent development of disease. The article explores how the health outcome of persons with acute CD may be conditioned by their health care seeking behavior. The study, with a qualitative approach, was carried out in rural areas of Santiago del Estero Province, a high risk endemic region for vector transmission of CD. Narratives of 25 in-depth interviews carried out in 2005 and 2006 are analyzed identifying patterns of health care seeking behavior followed by acute cases. Through the retrospective recall of paths for diagnoses, weaknesses of disease information, knowledge at the household level, and underperformance at the provincial health care system level are detected. The misdiagnoses were a major factor in delaying a health care response. The study results expose lost opportunities for the health care system to effectively record CD acute cases.

  7. Determinants of Care Seeking for Children With Pneumonia and Diarrhea in Guatemala: Implications for Intervention Strategies

    PubMed Central

    Pope, Daniel; Arana, Byron; Shiels, Christopher; Romero, Carolina; Klein, Robert; Stanistreet, Debbi

    2014-01-01

    Objectives. We identified barriers to care seeking for pneumonia and diarrhea among rural Guatemalan children. Methods. A population-based survey was conducted twice from 2008 to 2009 among 1605 households with children younger than 5 years. A 14-day calendar recorded episodes of carer-reported pneumonia (n = 364) and diarrhea (n = 481), and formal (health services, public, private) and informal (neighbors, traditional, local shops, pharmacies) care seeking. Results. Formal care was sought for nearly half of severe pneumonias but only for 27% within 2 days of onset, with 31% and 18%, respectively, for severe diarrhea. In multivariable analysis, factors independently associated with formal care seeking were knowing the Community Emergency Plan, mother’s perception of illness severity, recognition of World Health Organization danger signs, distance from the health center, and having someone to care for family in an emergency. Conclusions. Proximal factors associated with recognizing need for care were important in determining formal care, and were strongly linked to social determinants. In addition to specific action by the health system with an enhanced community health worker role, a systems approach can help ensure barriers are addressed among poorer and more remote homes. PMID:24524510

  8. Association between beliefs and care-seeking behavior for low back pain.

    PubMed

    Mannion, Anne F; Wieser, Simon; Elfering, Achim

    2013-05-20

    Cross sectional population-based survey. To investigate the relationship between low back pain (LBP) beliefs and care seeking in LBP. Not all people experiencing LBP seek care for their problem. Consistent predictors of care-seeking behavior seem to be female sex and high perceived disability; the role of beliefs about LBP has not been investigated sufficiently. A questionnaire booklet was mailed to a random sample of 2860 individuals otherwise participating in an epidemiological study of musculoskeletal health. It contained the Back Beliefs Questionnaire (BBQ), the Fear-Avoidance Beliefs Questionnaire (FABQ; physical activity and work scales), and questions about sociodemographics, LBP characteristics, and LBP-related care seeking in the last month ("yes" = visit to specialist, general practitioner, physiotherapist, or other health care practitioner; "no" = none of these). Logistic regression was used to identify whether beliefs made a significant contribution to care-seeking behavior, beyond known predictors conceptualized in the behavioral model of health services use. A total of 2507 of 2860 (88%) individuals completed the questionnaire; 1071 (43%) reported current LBP, 301 (28%) of which had sought care. In univariate analyses the following were all significantly related to care seeking (all P < 0.01): female sex; increasing age; not working full time; lower income; greater LBP frequency, LBP intensity, and limitations in activities of daily living; worse general health; higher FABQ-Physical Activity, FABQ-Work, and Back Beliefs Questionnaire scores. In multiple regression, female sex (odds ratio [OR], 1.731; 95% confidence interval [CI], 1.174-2.551; P = 0.006), LBP frequency (OR, 1.492; 95% CI, 1.249-1.783; P < 0.0001), limitations in activities of daily living (OR, 1.010; 95% CI, 1.001-1.020; P = 0.037), and high FABQ-Work Scores (OR, 1.025; 95% CI, 1.005-1.044, P = 0.012) contributed significantly to the final model. That the odds of seeking care are

  9. Health and Oral Health Care Needs and Health Care-Seeking Behavior Among Homeless Injection Drug Users in San Francisco

    PubMed Central

    Wenger, Lynn; Lorvick, Jennifer; Shiboski, Caroline; Kral, Alex H.

    2010-01-01

    Few existing studies have examined health and oral health needs and treatment-seeking behavior among the homeless and injection drug users (IDUs). This paper describes the prevalence and correlates of health and oral health care needs and treatment-seeking behaviors in homeless IDUs recruited in San Francisco, California, from 2003 to 2005 (N = 340). We examined sociodemographic characteristics, drug use patterns, HIV status via oral fluid testing, physical health using the Short Form 12 Physical Component Score, self-reported needs for physical and oral health care, and the self-reported frequency of seeking medical and oral health care. The sample had a lower health status as compared to the general population and reported a frequent need for physical and oral health care. In bivariate analysis, being in methadone treatment was associated with care-seeking behavior. In addition, being enrolled in Medi-Cal, California’s state Medicaid program, was associated with greater odds of seeking physical and oral health care. Methamphetamine use was not associated with higher odds of needing oral health care as compared to people who reported using other illicit drugs. Homeless IDUs in San Francisco have a large burden of unmet health and oral health needs. Recent cuts in Medi-Cal’s adult dental coverage may result in a greater burden of oral health care which will need to be provided by emergency departments and neighborhood dental clinics. PMID:20945108

  10. Care Seeking Patterns of STIs-Associated Symptoms in Iran: Findings of a Population-Based Survey

    PubMed Central

    Nasirian, Maryam; Karamouzian, Mohammad; Kamali, Kianoush; Nabipour, Amir Reza; Maghsoodi, Ahmad; Nikaeen, Roja; Razzaghi, Ali Reza; Mirzazadeh, Ali; Baneshi, Mohammad Reza; Haghdoost, Ali Akbar

    2016-01-01

    Background: Understanding the prevalence of symptoms associated with sexually transmitted infections (STIs) and how care is sought for those symptoms are important components of STIs control and prevention. People’s preference between public and private service providers is another important part of developing a well-functioning STIs surveillance system. Methods: This cross-sectional survey was carried out in spring 2011, using a nonrandom quota sample of 1190 participants (52% female) in 4 densely-populated cities of Tehran, Kerman, Shiraz, and Babol. Two predictive logistic regression models were constructed to assess the association between the socio-demographic determinants (independent variables) and the dependent variables of history of STIs-associated symptom and seeking care. Results: Around 57% (677 out of 1190; men: 29.70% and women: 81.80%) had experienced at least one STIs-associated symptom during the previous year. History of experiencing STIs-associated symptoms among men, was negatively significantly associated with older age (adjusted odds ratio [AOR] = 0.34, CI 95%: 0.17-0.67). Women who were married, in older ages, and had higher educations were more likely to report a recent (past year) STIs symptom, however all were statistically insignificant in both bivariate and multivariable models. Among those who have had STIs-associated symptoms in the last year, 31.15% did nothing to improve their symptoms, 8.03% attempted self-treatment by over-the-counter (OTC) medications or traditional remedies, and 60.93% sought care in health facilities. In both bivariate and multivariable analyses, care seeking among men was insignificantly associated with any of the collected demographic variables. Care seeking among women was positively significantly associated with being married (AOR = 2.48, 95% CI: 1.60-3.84). Conclusion: The reported prevalence of STIs-associated symptoms among our participants is concerning. A considerable number of participants had

  11. Care seeking in tuberculosis: results from a countrywide cluster randomised survey in Bangladesh

    PubMed Central

    Hossain, Shahed; Zaman, K; Quaiyum, Abdul; Banu, Sayera; Husain, Ashaque; Islam, Akramul; Borgdorff, Martien; van Leth, Frank

    2014-01-01

    Objectives To explore systematically the care seeking trajectories of tuberculosis (TB) cases up to four subsequent places of care and to assess the type of services provided at each place. Methods TB cases detected actively during the 2007–2009 national TB prevalence survey and passively under the routine programme in the same period were interviewed by administering a standardised questionnaire. Care seeking and services provided up to four subsequent points were explored. Care seeking was further explored by categorising the providers into formal, informal and ‘self-care’ groups. Results A total of 273 TB cases were included in this study, of which 33 (12%) were detected during the survey and 240 (88%) from the TB registers. Out of the 118 passively detected cases who first sought care from an informal provider, 52 (44.1%) remained in the informal sector at the second point of care. Similarly, out of the 52, 17 (32.7%) and out of the 17, 5 (29.4%) remained in the informal sector at the third and fourth subsequent points of care, respectively. All the 33 actively detected cases had ‘self-care’ at the first point, and 27 (81.8%) remained with ’self-care’ up to the fourth point of care. Prescribing drugs (59–99%) was the major type of care provided by the formal and informal care providers at each point and was limited to the non-existent practice of investigation or referrals. Conclusions Free TB services are still underutilised by TB cases and informal caregivers remained the major care providers for such cases in Bangladesh. In order to improve case detection, it is necessary that the National Tuberculosis Programme immediately takes effective initiatives to engage all types of care providers, particularly informal providers who are the first point of care for the majority of the TB suspects. PMID:24871537

  12. Care-Seeking Pattern for Diarrhea among Children under 36 Months Old in Rural Western China

    PubMed Central

    Gao, Wenlong; Dang, Shaonong; Yan, Hong; Wang, Duolao

    2012-01-01

    Objective To explore the caretakers' care-seeking pattern and its determinants among children under 36 months old with diarrhea in rural western China. Methods The data of 14112 households was collected in 45 counties of 10 provinces of western China from June to August 2005. A generalized estimated equation (GEE) linear model was used to identify the determinants of the care-seeking. Results Village-level and township-level care were sought for childhood diarrhea by 67.02% of the caretakers. GEE model analysis shows that compared with the caretakers of the children delivered at county-level or above hospitals, those of the children delivered at home seldom sought a higher level care (−0.23, 95%CI: −0.45,−0.01, p = 0.040); that the age of the children was negatively associated with seeking a higher level care (12 vs 36 months: 0.35, 95%CI: 0.16,0.55, p<0.001; 24 vs 36 months: 0.26, 95%CI: 0.08,0.44, p = 0.004); that the more danger signs of diarrhea the caretakers recognized, the higher level care they sought for their children with diarrhea (0.04, 95%CI: 0.00,0.07, p = 0.037); that the children with breastfeeding were given a higher level care than those without (0.15, 95%CI: 0.01,0.28, p = 0.035); that the mothers with a higher education sought the higher level care than those with only primary education (0.29, 95%CI: 0.03,0.56, p = 0.032); and that the farther the villages where these caretakers lived were from their townships, the lower level care for their children with diarrhea they sought (−0.09, 95%CI: −0.18,−0.01, p = 0.039). Conclusion Village-level and township-level care were sought for childhood diarrhea by most of the caretakers. Birth settings, the distance from village to township, maternal education, caretakers' awareness of the danger signs of diarrhea, breastfeeding status and age of children affected the care-seeking. These findings may have some implications for the improvement of health care services and

  13. Neonatal deaths in rural southern Tanzania: care-seeking and causes of death.

    PubMed

    Mrisho, Mwifadhi; Schellenberg, David; Manzi, Fatuma; Tanner, Marcel; Mshinda, Hassan; Shirima, Kizito; Msambichaka, Beverly; Abdulla, Salim; Schellenberg, Joanna Armstrong

    2012-01-01

    Introduction. We report cause of death and care-seeking prior to death in neonates based on interviews with relatives using a Verbal Autopsy questionnaire. Materials and Methods. We identified neonatal deaths between 2004 and 2007 through a large household survey in 2007 in five rural districts of southern Tanzania. Results. Of the 300 reported deaths that were sampled, the Verbal Autopsy (VA) interview suggested that 11 were 28 days or older at death and 65 were stillbirths. Data was missing for 5 of the reported deaths. Of the remaining 219 confirmed neonatal deaths, the most common causes were prematurity (33%), birth asphyxia (22%) and infections (10%). Amongst the deaths, 41% (90/219) were on the first day and a further 20% (43/219) on day 2 and 3. The quantitative results matched the qualitative findings. The majority of births were at home and attended by unskilled assistants. Conclusion. Caregivers of neonates born in health facility were more likely to seek care for problems than caregivers of neonates born at home. Efforts to increase awareness of the importance of early care-seeking for a premature or sick neonate are likely to be important for improving neonatal health.

  14. Knowledge, Attitudes and Eye Care Seeking Practices Regarding Trachoma in Central Division of Kajiado County, Kenya

    PubMed Central

    Ng’etich, Arthur S.; Owino, Claudio; Juma, Ahmad; Khisa, Kevin N.

    2015-01-01

    Trachoma is responsible for the visual impairment of about two million people worldwide, out of which a majority are irreversibly blind. The study aimed to assess the level of knowledge, attitudes and eye care seeking practices of the community regarding the available trachoma eye care services. Community members aged eighteen and over participated. Descriptive cross-sectional study design was adapted. Data analysis was performed using Stata. The level of awareness of trachoma disease in the study area was high (95%). About three quarters (71%) of the respondents were knowledgeable of the available trachoma eye care services. A majority had a positive attitude towards the available services and expressed need for the services. Public health facilities were mostly preferred. The study concluded that the community was knowledgeable of the available trachoma eye care services and had a positive attitude towards the services. Concerned stakeholders should reinforce the positive attitudes through community based educational programs and improve eye care seeking practices through community participation in education and outreach services. PMID:28299140

  15. Gender difference in knowledge of tuberculosis and associated health-care seeking behaviors: a cross-sectional study in a rural area of China.

    PubMed

    Wang, Jianming; Fei, Yang; Shen, Hongbing; Xu, Biao

    2008-10-08

    Tuberculosis (TB) detection under the national TB control program in China follows passive case-finding guidelines, which could be influenced by the accessibility of health service and patient's health-care seeking behaviors. One intriguing topic is the correlation between men and women's knowledge on TB and their health-care seeking behaviors. Two cross-sectional studies were separately carried out in Yangzhong County, a rural area of China. One study, by using systematic sampling method, including 1,200 subjects, was conducted to investigate the TB knowledge among general population. Another study in the same source population screened 33,549 people aged 15 years or over among 20 stratified cluster-sampled villages for identifying prolonged cough patients at households and individual interviews were then carried out. Gender difference in the knowledge of TB and health-care seeking behaviors was analyzed particularly. Among general population, only 16.0% (men 17.1% vs. women 15.0%) knew the prolonged cough with the duration of 3 weeks or longer was a symptom for suspicious TB. Fewer women than men knew the local appointed health facility for TB diagnosis and treatment as well as the current free TB service policy. Moreover, women were less likely to learn information about TB and share it with others on their own initiatives. On the contrary, after the onset of the prolonged cough, women (79.2%) were more likely to seek health-care than men (58.6%) did. However, a large part of women preferred to visit the lower level non-hospital health facilities at first such as village clinics and drugstores. TB and DOTS program were not well known by rural Chinese. Gender issues should be considered to reduce diagnostic delay of TB and improve both men and women's access to qualified health facility for TB care. Strengthening awareness of TB and improving the accessibility of health-care service is essential in TB control strategy, especially under the current vertical TB

  16. Predictive value of grade point average (GPA), Medical College Admission Test (MCAT), internal examinations (Block) and National Board of Medical Examiners (NBME) scores on Medical Council of Canada qualifying examination part I (MCCQE-1) scores.

    PubMed

    Roy, Banibrata; Ripstein, Ira; Perry, Kyle; Cohen, Barry

    2016-01-01

    To determine whether the pre-medical Grade Point Average (GPA), Medical College Admission Test (MCAT), Internal examinations (Block) and National Board of Medical Examiners (NBME) scores are correlated with and predict the Medical Council of Canada Qualifying Examination Part I (MCCQE-1) scores. Data from 392 admitted students in the graduating classes of 2010-2013 at University of Manitoba (UofM), College of Medicine was considered. Pearson's correlation to assess the strength of the relationship, multiple linear regression to estimate MCCQE-1 score and stepwise linear regression to investigate the amount of variance were employed. Complete data from 367 (94%) students were studied. The MCCQE-1 had a moderate-to-large positive correlation with NBME scores and Block scores but a low correlation with GPA and MCAT scores. The multiple linear regression model gives a good estimate of the MCCQE-1 (R2 =0.604). Stepwise regression analysis demonstrated that 59.2% of the variation in the MCCQE-1 was accounted for by the NBME, but only 1.9% by the Block exams, and negligible variation came from the GPA and the MCAT. Amongst all the examinations used at UofM, the NBME is most closely correlated with MCCQE-1.

  17. Predictive value of grade point average (GPA), Medical College Admission Test (MCAT), internal examinations (Block) and National Board of Medical Examiners (NBME) scores on Medical Council of Canada qualifying examination part I (MCCQE-1) scores

    PubMed Central

    Roy, Banibrata; Ripstein, Ira; Perry, Kyle; Cohen, Barry

    2016-01-01

    Background To determine whether the pre-medical Grade Point Average (GPA), Medical College Admission Test (MCAT), Internal examinations (Block) and National Board of Medical Examiners (NBME) scores are correlated with and predict the Medical Council of Canada Qualifying Examination Part I (MCCQE-1) scores. Methods Data from 392 admitted students in the graduating classes of 2010–2013 at University of Manitoba (UofM), College of Medicine was considered. Pearson’s correlation to assess the strength of the relationship, multiple linear regression to estimate MCCQE-1 score and stepwise linear regression to investigate the amount of variance were employed. Results Complete data from 367 (94%) students were studied. The MCCQE-1 had a moderate-to-large positive correlation with NBME scores and Block scores but a low correlation with GPA and MCAT scores. The multiple linear regression model gives a good estimate of the MCCQE-1 (R2 =0.604). Stepwise regression analysis demonstrated that 59.2% of the variation in the MCCQE-1 was accounted for by the NBME, but only 1.9% by the Block exams, and negligible variation came from the GPA and the MCAT. Conclusions Amongst all the examinations used at UofM, the NBME is most closely correlated with MCCQE-1. PMID:27103953

  18. ‘Complex’ but coping: experience of symptoms of tuberculosis and health care seeking behaviours - a qualitative interview study of urban risk groups, London, UK

    PubMed Central

    2014-01-01

    Background Tuberculosis awareness, grounded in social cognition models of health care seeking behaviour, relies on the ability of individuals to recognise symptoms, assess their risk and access health care (passive case finding). There is scant published research into the health actions of ‘hard-to-reach’ groups with tuberculosis, who represent approximately 17% of the London TB caseload. This study aimed to analyse patients’ knowledge of tuberculosis, their experiences of symptoms and their health care seeking behaviours. Methods Qualitative interviews were conducted with 17 participants, predominantly homeless and attending a major tuberculosis centre in London, UK. Most had complex medical and social needs including drug and alcohol use or immigration problems affecting entitlement to social welfare. Analytical frameworks aimed to reflect the role of broader social structures in shaping individual health actions. Results Although participants demonstrated some knowledge of tuberculosis their awareness of personal risk was low. Symptoms commonly associated with tuberculosis were either not recognised or were attributed to other causes for which participants would not ordinarily seek health care. Many accessed health care by chance and, for some, for health concerns other than tuberculosis. Conclusions Health education, based on increasing awareness of symptoms, may play a limited role in tuberculosis care for populations with complex health and social needs. The findings support the intensification of outreach initiatives to identify groups at risk of tuberculosis and the development of structured care pathways which support people into prompt diagnosis and treatment. PMID:24943308

  19. 'Complex' but coping: experience of symptoms of tuberculosis and health care seeking behaviours--a qualitative interview study of urban risk groups, London, UK.

    PubMed

    Craig, Gillian M; Joly, Louise M; Zumla, Alimuddin

    2014-06-18

    Tuberculosis awareness, grounded in social cognition models of health care seeking behaviour, relies on the ability of individuals to recognise symptoms, assess their risk and access health care (passive case finding). There is scant published research into the health actions of 'hard-to-reach' groups with tuberculosis, who represent approximately 17% of the London TB caseload. This study aimed to analyse patients' knowledge of tuberculosis, their experiences of symptoms and their health care seeking behaviours. Qualitative interviews were conducted with 17 participants, predominantly homeless and attending a major tuberculosis centre in London, UK. Most had complex medical and social needs including drug and alcohol use or immigration problems affecting entitlement to social welfare. Analytical frameworks aimed to reflect the role of broader social structures in shaping individual health actions. Although participants demonstrated some knowledge of tuberculosis their awareness of personal risk was low. Symptoms commonly associated with tuberculosis were either not recognised or were attributed to other causes for which participants would not ordinarily seek health care. Many accessed health care by chance and, for some, for health concerns other than tuberculosis. Health education, based on increasing awareness of symptoms, may play a limited role in tuberculosis care for populations with complex health and social needs. The findings support the intensification of outreach initiatives to identify groups at risk of tuberculosis and the development of structured care pathways which support people into prompt diagnosis and treatment.

  20. Patterns and determinants of care seeking for obstetric complications in rural northwest Bangladesh: analysis from a prospective cohort study.

    PubMed

    Sikder, Shegufta S; Labrique, Alain B; Craig, Ian M; Wakil, Mohammad Abdul; Shamim, Abu Ahmed; Ali, Hasmot; Mehra, Sucheta; Wu, Lee; Shaikh, Saijuddin; West, Keith P; Christian, Parul

    2015-04-18

    In communities with low rates of institutional delivery, little data exist on care-seeking behavior for potentially life-threatening obstetric complications. In this analysis, we sought to describe care-seeking patterns for self-reported complications and near misses in rural Bangladesh and to identify factors associated with care seeking for these conditions. Utilizing data from a community-randomized controlled trial enrolling 42,214 pregnant women between 2007 and 2011, we used multivariable multinomial logistic regression to explore the association of demographic and socioeconomic factors, perceived need, and service availability with care seeking for obstetric complications or near misses. We also used multivariable multinomial logistic regression to analyze the factors associated with care seeking by type of obstetric complication (eclampsia, sepsis, hemorrhage, and obstructed labor). Out of 9,576 women with data on care seeking for obstetric complications, 77% sought any care, with 29% (n = 2,150) visiting at least one formal provider and 70% (n = 5,149) visiting informal providers only. The proportion of women seeking at least one formal provider was highest among women reporting eclampsia (57%), followed by hemorrhage (28%), obstructed labor (22%), and sepsis (17%) (p < 0.001). In multivariable analyses, socioeconomic factors such as living in a household from the highest wealth quartile (Relative Risk Ratio of 1.49; 95% CI of [1.33-1.73]), women's literacy (RRR of 1.21; 95% CI of [1.05-1.42]), and women's employment (RRR of 1.10; 95% CI of [1.01-1.18]) were significantly associated with care seeking from formal providers. Service factors including living less than 10 kilometers from a health facility (RRR of 1.16; 95% CI of [1.05-1.28]) and facility availability of comprehensive obstetric services (RRR of 1.25; 95% CI of 1.04-1.36) were also significantly associated with seeking care from formal providers. While the majority of women reporting obstetric

  1. The effect of wealth status on care seeking and health expenditures in Afghanistan.

    PubMed

    Steinhardt, Laura C; Waters, Hugh; Rao, Krishna Dipankar; Naeem, Ahmad Jan; Hansen, Peter; Peters, David H

    2009-01-01

    This paper analyses the effect of wealth status on care-seeking patterns and health expenditures in Afghanistan, based on a national household survey conducted within public health facility catchment areas. We found high rates of reported care-seeking, with more than 90% of those ill seeking care. Sick individuals from all wealth quintiles had high rates of care-seeking, although those in the wealthiest quintile were more likely to seek care than those from the poorest (odds ratio 2.2; 95% CI 1.6, 3.0). The nearest clinic providing the government's Basic Package of Health Services (BPHS) was the most commonly sought first provider (53% overall), especially for relatively poor households (62% in poorest vs. 42% in least poor quintile, P < 0.0001). Sick individuals from wealthier quintiles used hospitals and for-profit private providers more than those in poorer quintiles. Multivariate analysis showed that wealth quintile was the strongest predictor of seeking care, and of going first to private providers. More than 90% of those seeking care paid money out-of-pocket. Mean (median) expenditures among those paying for care in the previous month were 873 Afghanis (200 Afghanis), equivalent to US$17.5 (US$4). Expenditures were lowest at BPHS clinics and highest at private providers. Financing care through borrowing money or selling assets/land ('any distress' financing) was reported in nearly 30% of cases and was almost twice as high among households in the poorest versus the least poor quintile (P < 0.0001). Financing care through selling assets/land ('severe distress' financing) was less common (10% overall) and did not differ by wealth status. These findings indicate that BPHS facilities are being used by the poor who live close to them, but further research is needed to assess utilization among populations in more remote areas. The high out-of-pocket health expenditures, particularly for private sector services, highlight the need to develop financial protection

  2. Rethinking How to Promote Maternity Care-Seeking: Factors Associated With Institutional Delivery in Guinea

    PubMed Central

    Brazier, Ellen; Fiorentino, Renée; Barry, Saidou; Kasse, Yaya; Millimono, Sita

    2014-01-01

    This article presents findings from a study on women's delivery care-seeking in two regions of Guinea. We explored exposure to interventions promoting birth preparedness and complication readiness among women with recent live births and stillbirths. Using multivariate regression models, we identified factors associated with women's knowledge and practices related to birth preparedness, as well as their use of health facilities during childbirth. We found that women's knowledge about preparations for any birth (normal or complicated) was positively associated with increased preparation for birth, which itself was associated with institutional delivery. Knowledge about complication readiness, obstetric risks, and danger signs was not associated with birth preparation or with institutional delivery. The study findings highlight the importance of focusing on preparation for all births—and not simply obstetric emergencies—in interventions aimed at increasing women's use of skilled maternity care. PMID:24821280

  3. Rethinking how to promote maternity care-seeking: factors associated with institutional delivery in Guinea.

    PubMed

    Brazier, Ellen; Fiorentino, Renée; Barry, Saidou; Kasse, Yaya; Millimono, Sita

    2014-01-01

    This article presents findings from a study on women's delivery care-seeking in two regions of Guinea. We explored exposure to interventions promoting birth preparedness and complication readiness among women with recent live births and stillbirths. Using multivariate regression models, we identified factors associated with women's knowledge and practices related to birth preparedness, as well as their use of health facilities during childbirth. We found that women's knowledge about preparations for any birth (normal or complicated) was positively associated with increased preparation for birth, which itself was associated with institutional delivery. Knowledge about complication readiness, obstetric risks, and danger signs was not associated with birth preparation or with institutional delivery. The study findings highlight the importance of focusing on preparation for all births--and not simply obstetric emergencies--in interventions aimed at increasing women's use of skilled maternity care.

  4. Perceptions of Child Body Size and Health Care Seeking for Undernourished Children in Southern Malawi.

    PubMed

    Flax, Valerie L; Thakwalakwa, Chrissie; Ashorn, Ulla

    2016-12-01

    Child undernutrition affects millions of children globally, but little is known about the ability of adults to detect different types of child undernutrition in low-income countries. We used focused ethnographic methods to understand how Malawian parents and grandparents describe the characteristics they use to identify good and poor child growth, their actual or preferred patterns of health seeking for undernourished children, and the perceived importance of child undernutrition symptoms in relation to other childhood illnesses. Malawians value adiposity rather than stature in assessing child growth. Symptoms of malnutrition, including wasting and edema, were considered the least severe childhood illness symptoms. Parents delayed health care seeking when a child was ill. When they sought care, it was for symptoms such as diarrhea or fever, and they did not recognize malnutrition as the underlying cause. These findings can be used to tailor strategies for preventing and treating growth faltering in Malawian children.

  5. The effect of maternal education on gender bias in care-seeking for common childhood illnesses.

    PubMed

    Bhan, Gautam; Bhandari, Nita; Taneja, Sunita; Mazumder, Sarmila; Bahl, Rajiv

    2005-02-01

    This paper assessed gender bias within hospitalisation rates to ascertain whether differential care-seeking practices significantly contribute to excess female mortality. It then examined the impact of socio-economic factors, particularly maternal education and economic status, on gender bias. The results find both the clear and significant impact of gender on hospitalisation rates, as well as the simultaneous inability of rising education and economic status to alleviate this bias. A secondary analysis was conducted within a uniquely large and ongoing randomised control trial that sought to measure the impact of Zinc supplementation on hospitalisations and deaths in low-income communities in New Delhi, India. During the course of the study, 85,633 children were enrolled and monitored over one year of follow-up. Of the 430 deaths that occurred, 230 were female (0.57% of total females), while 200 were male (0.43% of all males). Despite this higher mortality amongst females (p<0.02), girls were hospitalised far less frequently than boys. Of the 4418 children who were hospitalised at least once, 2854 (64.6%) were males and only 1564 (35.4%) were females, indicating a significantly lower rate of care-seeking for females (p<0.00). Curiously, our results show that gender bias is highest amongst highly educated mothers, and decreases steadily for children of mothers with a middle school education, a primary school education, and is lowest amongst mothers with no formal education. Put differently, female children of mothers with no formal education were significantly more likely to be hospitalised than children of mothers with several years of formal education, even after adjusting for all other factors. Economic status was not found to affect the association of gender and hospitalisation, though overall odds of hospitalisation rose with increasing economic status. Paternal education was found not to be significantly related to hospitalisation.

  6. Physician Office vs Retail Clinic: Patient Preferences in Care Seeking for Minor Illnesses

    PubMed Central

    Ahmed, Arif; Fincham, Jack E.

    2010-01-01

    PURPOSE Retail clinics are a relatively new phenomenon in the United States, offering cheaper and convenient alternatives to physician offices for minor illness and wellness care. The objective of this study was to investigate the effects of cost of care and appointment wait time on care-seeking decisions at retail clinics or physician offices. METHODS As part of a statewide random-digit-dial survey of households, adult residents of Georgia were interviewed to conduct a discrete choice experiment with 2 levels each of 4 attributes: price ($59; $75), appointment wait time (same day; 1 day or longer), care setting–clinician combination (nurse practitioner in retail clinic; physician in private office), and acute illness (urinary tract infection [UTI]; influenza). The respondents indicated whether they would seek care under each of the 16 resulting choice scenarios. A cooperation rate of 33.1% yielded 493 completed telephone interviews. RESULTS The respondents preferred to seek care for both conditions; were less likely to seek care for UTI (β =−0.149; P = .008); preferred to seek care from a physician (β =1.067; P <.001) and receive same day care (β =−2.789; P<.001). All else equal, cost savings of $31.42 would be required for them to seek care at a retail clinic and $82.12 to wait 1 day or more. CONCLUSIONS Time and cost savings offered by retail clinics are attractive to patients, and they are likely to seek care there given sufficient cost savings. Appointment wait time is the most important factor in care-seeking decisions and should be considered carefully in setting appointment policies in primary care practices. PMID:20212298

  7. Predictors of Health Care Seeking Behavior During Pregnancy, Delivery, and the Postnatal Period in Rural Tanzania.

    PubMed

    Larsen, Anna; Exavery, Amon; Phillips, James F; Tani, Kassimu; Kanté, Almamy M

    2016-08-01

    Objectives Four antenatal visits, delivery in a health facility, and three postnatal visits are the World Health Organization recommendations for women to optimize maternal health outcomes. This study examines maternal compliance with the full recommended maternal health visits in rural Tanzania with the goal of illuminating interventions to reduce inequalities in maternal health. Methods Analysis included 907 women who had given birth within two years preceding a survey of women of reproductive age. Multinomial logistic regression was used to assess the influence of maternal, household, and community-level characteristics on four alternative classes defining relative compliance with optimal configuration of maternal health care seeking behavior. Results Parity, wealth index, timeliness of ANC initiation, nearest health facility type, religion, and district of residence were significant predictors of maternal health care seeking when adjusted for other factors. Multiparous women compared to primiparous were less likely to seek care at the high level [RRR 0.16, 95 % confidence interval (CI) 0.06-0.46], at the mid-level (RRR 0.22, 95 % CI 0.09-0.58), and the mid-low level (RRR 0.27, 95 % CI 0.09-0.80). Women in the highest wealth index compared to those in the poorest group were almost three times more likely to seek the highest two levels of care versus the lowest level (high RRR 2.92, 95 % CI 1.27-6.71, mid-level RRR 2.71, 95 % 1.31-5.62). Conclusion Results suggest that efforts to improve the overall impact of services on the continuum of care in rural Tanzania would derive particular benefit from strategies that improve maternal health coverage among multiparous and low socioeconomic status women.

  8. Factors influencing eye-care seeking behaviour of parents for their children in Nigeria.

    PubMed

    Ebeigbe, Jennifer A

    2016-12-18

    The eye-care seeking behaviour of parents for their children has a role to play in increasing or reducing the prevalence of childhood blindness. In Nigeria, little or no work has been done in this area. Hence, this study was carried out with a view to assisting eye-care professionals plan better program regimens and also to help them identify various elements that either facilitate or hinder eye-care seeking behaviour of parents for their school age children. This was a qualitative narrative study. Data were collected using in-depth interviews (IDIs) and focus group discussions (FGDs). Thirty-five parents and 10 eye-care practitioners were selected by random sampling and homogenous sampling methods, respectively. Parents were selected, based on those who sought care and those who did not seek care for their children after a school screening exercise. Collected data were analysed qualitatively by transcribing the voice recordings of interview sessions into textual data and themes were raised. Four FGDs and 13 IDIs were conducted. Parents were more likely to seek care for manifest conditions than for conditions they could not perceive. A family history of ocular disease and repetitiveness of complaints facilitated parents to seek eye care for their children. The cost of eye-care services was a major barrier. Logistics such as fixing a doctor's appointment, getting time off work and long waiting periods at the clinic were also reported as barriers. Fear of treatment options and family interferences were also mentioned. Parents have some concerns and challenges in seeking eye care for their children. This study recommends that more work be done through planned awareness programs to educate parents and help them overcome the concerns and barriers that hinder them from seeking eye care for their children. © 2016 Optometry Australia.

  9. Postpartum haemorrhage and eclampsia: differences in knowledge and care-seeking behaviour in two districts of Bangladesh.

    PubMed

    Kalim, Nahid; Anwar, Iqbal; Khan, Jasmin; Blum, Lauren S; Moran, Allisyn C; Botlero, Roslin; Koblinsky, Marge

    2009-04-01

    In high- and low-performing districts of Bangladesh, the study explored the demand-side of maternal healthcare by looking at differences in perceived knowledge and care-seeking behaviours of women in relation to postpartum haemorrhage or eclampsia. Haemorrhage and eclampsia are two major causes of maternal mortality in Bangladesh. The study was conducted during July 2006-December 2007. Both postpartum bleeding and eclampsia were recognized by women of different age-groups as severe and life-threatening obstetric complications. However, a gap existed between perception and actual care-seeking behaviours which could contribute to the high rate of maternal deaths associated with these conditions. There were differences in care-seeking practices among women in the two different areas of Bangladesh, which may reflect sociocultural differences, disparities in economic and educational opportunities, and a discrimination in the availability of care.

  10. Care-seeking practices in South Asia: using formative research to design program interventions to save newborn lives.

    PubMed

    Syed, U; Khadka, N; Khan, A; Wall, S

    2008-12-01

    The purpose of this paper is to summarize the formative research findings of newborn care practices in poor and rural districts of Bangladesh, Nepal, and Pakistan and to explain how these findings were used to design behavior change communication elements of newborn care programs. In-depth interviews and focus group discussions regarding newborn care practices were conducted with mothers, mothers-in-law, delivery attendants, health care providers, husbands/fathers, male and female community leaders, religious leaders and elderly influential persons between 2002-2003 in three countries supported by Save the Children's Saving Newborn Lives program. Key findings from each country are summarized according to time periods and care-seeking practices: antenatal care, birth and emergency preparedness/care-seeking, postnatal care and care-seeking for newborn illness. All country reports indicated cultural and religious barriers to seeking care as well as limited societal knowledge about the importance of care-seeking and recognition of maternal and newborn danger signs. Routine care-seeking, especially during the postnatal period, was universally low. When families did seek care, they preferred remedies from traditional healers rather than skilled health workers because of cultural and religious beliefs, poor access to health facilities, and financial barriers. Findings from the country reports were used to design behavior change communication strategies that addressed the underlying reasons why newborn care practices were sub-optimal. Cultural and religious barriers, though strong, were not insurmountable in implementing effective behavior change communication strategies. Formative research from South Asian countries has proved crucial to program approaches to improve care-seeking for maternal and newborn care, increasing availability and access of key services, and expanding family and community knowledge and demand for these services.

  11. The social mentality theory of self-compassion and self-reassurance: The interactive effect of care-seeking and caregiving.

    PubMed

    Hermanto, Nicola; Zuroff, David Charles

    2016-01-01

    The aim of this study was to test social mentality theory, which views self-compassion/reassurance as a form of intrapersonal relating in which the interpersonal mentalities of care-seeking and caregiving are activated. Self-report measures of motivations, cognitions, and behaviors related to seeking and receiving care from others were administered to 195 students. Self-compassion/reassurance was predicted by the interaction of care-seeking and caregiving, with the positive effect of care-seeking intensified at high caregiving. As hypothesized, the combination of high care-seeking and high caregiving predicted the highest level of self-compassion/reassurance. The lowest level of self-compassion/reassurance was predicted by the combination of low care-seeking and high caregiving consistent with the concept of compulsive caregiving. Findings suggest that fostering a kinder way of relating to oneself may be achieved through more effective care-seeking and caregiving with others.

  12. Best-fit model of exploratory and confirmatory factor analysis of the 2010 Medical Council of Canada Qualifying Examination Part I clinical decision-making cases.

    PubMed

    Champlain, André F De

    2015-01-01

    This study aims to assess the fit of a number of exploratory and confirmatory factor analysis models to the 2010 Medical Council of Canada Qualifying Examination Part I (MCCQE1) clinical decision-making (CDM) cases. The outcomes of this study have important implications for a range of domains, including scoring and test development. The examinees included all first-time Canadian medical graduates and international medical graduates who took the MCCQE1 in spring or fall 2010. The fit of one- to five-factor exploratory models was assessed for the item response matrix of the 2010 CDM cases. Five confirmatory factor analytic models were also examined with the same CDM response matrix. The structural equation modeling software program Mplus was used for all analyses. Out of the five exploratory factor analytic models that were evaluated, a three-factor model provided the best fit. Factor 1 loaded on three medicine cases, two obstetrics and gynecology cases, and two orthopedic surgery cases. Factor 2 corresponded to pediatrics, and the third factor loaded on psychiatry cases. Among the five confirmatory factor analysis models examined in this study, three- and four-factor lifespan period models and the five-factor discipline models provided the best fit. The results suggest that knowledge of broad disciplinary domains best account for performance on CDM cases. In test development, particular effort should be placed on developing CDM cases according to broad discipline and patient age domains; CDM testlets should be assembled largely using the criteria of discipline and age.

  13. 26 CFR 1.401-14 - Inclusion of medical benefits for retired employees in qualified pension or annuity plans.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... retirement portion of the plan as well as the portion providing the medical benefits described in section 401... contain provisions for determining the amount which will be paid. Such benefits, when added to any life... such plan. For purposes of this section, life insurance protection includes any benefit paid under...

  14. Impact of children's migration on health and health care-seeking behavior of elderly left behind

    PubMed Central

    2011-01-01

    Background Many countries are facing the burden of accelerated population aging and a lack of institutional support to meet the needs of older individuals. In developing countries, adult children are primarily responsible for the care of their elderly parents. However, out-migration of adult children is common in these countries. This study aims to explore the impact of migration on the health of the elderly left behind and their health care-seeking behavior. Methods This paper uses data from a national survey of older persons in Thailand conducted in 2007. The analysis is confined to those who were aged 60 years or above and who had at least one child (biological or step/adopted) (n = 28,677). Logistic regression was used to assess the net effect of migration of adult children on the health of the elderly left behind and their health care-seeking behavior, after controlling for other socio-demographic and economic variables. Results More than two-thirds of the elderly (67%) had at least one migrant child. About three-fifths (58%) reported that they had at least one symptom of poor mental health. Almost three in five elderly (56%) rated their health as poor, and 44% had experienced at least one chronic disease. About two-thirds of the elderly (65%) got sick during the 5 years preceding the survey. An overwhelming majority of elderly (88%) who got sick during the five years preceding the survey had sought treatment for their last illness. After controlling for socio-demographic and economic variables, our study found that those elderly who had a migrant child were more likely (OR = 1.10; 95% CI 1.05-1.17) to have symptoms of poor mental health than those whose children had not migrated. However, no significant association was observed among physical health, such as experience of chronic disease, perceived poor health, and illness of the elderly left behind. Interestingly, however, out-migration of adult children was independently associated with higher utilization

  15. Impact of children's migration on health and health care-seeking behavior of elderly left behind.

    PubMed

    Adhikari, Ramesh; Jampaklay, Aree; Chamratrithirong, Aphichat

    2011-03-02

    Many countries are facing the burden of accelerated population aging and a lack of institutional support to meet the needs of older individuals. In developing countries, adult children are primarily responsible for the care of their elderly parents. However, out-migration of adult children is common in these countries. This study aims to explore the impact of migration on the health of the elderly left behind and their health care-seeking behavior. This paper uses data from a national survey of older persons in Thailand conducted in 2007. The analysis is confined to those who were aged 60 years or above and who had at least one child (biological or step/adopted) (n = 28,677). Logistic regression was used to assess the net effect of migration of adult children on the health of the elderly left behind and their health care-seeking behavior, after controlling for other socio-demographic and economic variables. More than two-thirds of the elderly (67%) had at least one migrant child. About three-fifths (58%) reported that they had at least one symptom of poor mental health. Almost three in five elderly (56%) rated their health as poor, and 44% had experienced at least one chronic disease. About two-thirds of the elderly (65%) got sick during the 5 years preceding the survey. An overwhelming majority of elderly (88%) who got sick during the five years preceding the survey had sought treatment for their last illness.After controlling for socio-demographic and economic variables, our study found that those elderly who had a migrant child were more likely (OR = 1.10; 95% CI 1.05-1.17) to have symptoms of poor mental health than those whose children had not migrated. However, no significant association was observed among physical health, such as experience of chronic disease, perceived poor health, and illness of the elderly left behind. Interestingly, however, out-migration of adult children was independently associated with higher utilization of health services. The

  16. Care-Seeking for Diarrhoea in Southern Malawi: Attitudes, Practices and Implications for Diarrhoea Control

    PubMed Central

    Masangwi, Salule; Ferguson, Neil; Grimason, Anthony; Morse, Tracy; Kazembe, Lawrence

    2016-01-01

    This paper examined care-seeking behaviour and its associated risk factors when a family member had diarrhoea. Data was obtained from a survey conducted in Chikwawa, a district in Southern Malawi. Chikwawa is faced with a number of environmental and socioeconomic problems and currently diarrhoea morbidity in the district is estimated at 24.4%, statistically higher than the national average of 17%. Using hierarchically built data from a survey of 1403 households nested within 33 communities, a series of two level binary logistic regression models with Bayesian estimation were used to determine predictors of care-seeking behaviour. The results show that 68% of mothers used oral rehydration solutions (ORS) the last time a child in their family had diarrhoea. However, when asked on the action they take when a member of their household has diarrhoea two thirds of the mothers said they visit a health facility. Most respondents (73%) mentioned distance and transport costs as the main obstacles to accessing their nearest health facility and the same proportion of respondents mentioned prolonged waiting time and absence of health workers as the main obstacles encountered at the health facilities. The main predictor variables when a member of the family had diarrhoea were maternal age, distance to the nearest health facility, school level, and relative wealth, household diarrhoea endemicity, and household size while the main predictor variables when a child had diarrhoea were existence of a village health committee (VHC), distance to the nearest health facility, and maternal age. Most households use ORS for the treatment of diarrhoea and village health committees and health surveillance assistants (HSAs) are important factors in this choice of treatment. Health education messages on the use and efficacy of ORS to ensure proper and prescribed handling are important. There is need for a comprehensive concept addressing several dimensions of management and proper coordination

  17. Care-Seeking for Diarrhoea in Southern Malawi: Attitudes, Practices and Implications for Diarrhoea Control.

    PubMed

    Masangwi, Salule; Ferguson, Neil; Grimason, Anthony; Morse, Tracy; Kazembe, Lawrence

    2016-11-15

    This paper examined care-seeking behaviour and its associated risk factors when a family member had diarrhoea. Data was obtained from a survey conducted in Chikwawa, a district in Southern Malawi. Chikwawa is faced with a number of environmental and socioeconomic problems and currently diarrhoea morbidity in the district is estimated at 24.4%, statistically higher than the national average of 17%. Using hierarchically built data from a survey of 1403 households nested within 33 communities, a series of two level binary logistic regression models with Bayesian estimation were used to determine predictors of care-seeking behaviour. The results show that 68% of mothers used oral rehydration solutions (ORS) the last time a child in their family had diarrhoea. However, when asked on the action they take when a member of their household has diarrhoea two thirds of the mothers said they visit a health facility. Most respondents (73%) mentioned distance and transport costs as the main obstacles to accessing their nearest health facility and the same proportion of respondents mentioned prolonged waiting time and absence of health workers as the main obstacles encountered at the health facilities. The main predictor variables when a member of the family had diarrhoea were maternal age, distance to the nearest health facility, school level, and relative wealth, household diarrhoea endemicity, and household size while the main predictor variables when a child had diarrhoea were existence of a village health committee (VHC), distance to the nearest health facility, and maternal age. Most households use ORS for the treatment of diarrhoea and village health committees and health surveillance assistants (HSAs) are important factors in this choice of treatment. Health education messages on the use and efficacy of ORS to ensure proper and prescribed handling are important. There is need for a comprehensive concept addressing several dimensions of management and proper coordination

  18. Health care seeking practices of caregivers of children under 5 with diarrhea in two informal settlements in Nairobi, Kenya.

    PubMed

    Mukiira, Carol; Ibisomi, Latifat

    2015-06-01

    In Kenya, as in other developing countries, diarrhea is among the leading causes of child mortality. Despite being easy to prevent and treat, care seeking for major child illnesses including diarrhea remains poor in the country. Mortality due to diarrhea is even worse in informal settlements that are characterized by poor sanitary conditions and largely unregulated health care system among other issues. The study aims to examine the health care seeking practices of caregivers of children under 5 with diarrhea in two informal settlements in Nairobi, Kenya. The article used data from a maternal and child health (MCH) prospective study conducted between 2006 and 2010. Results show that more than half (55%) of the caregivers sought inappropriate health care in the treatment of diarrhea of their child. Of the 55%, about 35% sought no care at all. Use of oral rehydration solution and zinc supplements, which are widely recommended for management of diarrhea, was very low. The critical predictors of health care seeking identified in the study are duration of illness, informal settlement of residence, and the child's age. The study showed that appropriate health care seeking practices for childhood diarrhea remain a great challenge among the urban poor in Kenya.

  19. Dental pain and care-seeking in 11-14-yr-old adolescents in a low-income country.

    PubMed

    Pau, Allan; Khan, Sami S; Babar, Muneer G; Croucher, Ray

    2008-10-01

    The purpose of this article was to document the 1-month dental pain prevalence in 11-14-yr-old subjects attending Grade Six of middle schools in Peshawar, Pakistan, and to explore the effect of dental pain and the impact on daily living on dental care-seeking. A self-completed questionnaire survey of all 13 middle schools in University Town, Peshawar, Pakistan, was carried out in April 2007. Questionnaire items on dental pain were adapted from the dental pain screening questionnaire (DePaQ) and items on the impact on daily living were adapted from the child-oral impact on daily performance (OIDP-Child) questionnaire. Regression analysis was carried out to determine the relative usefulness of predictors for care-seeking. The prevalence of dental pain was estimated to be 30.4%, and care-seeking in those reporting pain was estimated to be 64%. Care-seeking was associated with 'pain felt in one tooth', 'painful tooth felt loose', 'difficulties sleeping', and 'difficulties playing', which accounted for 35% of the explained variance. The findings substantiate dental pain as an important dental public health concern in Pakistan and support the hypothesis that assessment of dental pain characteristics can add to the accuracy of dental need estimation.

  20. Transaction costs of access to health care: Implications of the care-seeking pathways of tuberculosis patients for health system governance in Nigeria

    PubMed Central

    Abimbola, Seye; Ukwaja, Kingsley N.; Onyedum, Cajetan C.; Negin, Joel; Jan, Stephen; Martiniuk, Alexandra L.C.

    2015-01-01

    Health care costs incurred prior to the appropriate patient–provider transaction (i.e., transaction costs of access to health care) are potential barriers to accessing health care in low- and middle-income countries. This paper explores these transaction costs and their implications for health system governance through a cross-sectional survey of adult patients who received their first diagnosis of pulmonary tuberculosis (TB) at the three designated secondary health centres for TB care in Ebonyi State, Nigeria. The patients provided information on their care-seeking pathways and the associated costs prior to reaching the appropriate provider. Of the 452 patients, 84% first consulted an inappropriate provider. Only 33% of inappropriate consultations were with qualified providers (QP); the rest were with informal providers such as pharmacy providers (PPs; 57%) and traditional providers (TP; 10%). Notably, 62% of total transaction costs were incurred during the first visit to an inappropriate provider and the mean transaction costs incurred was highest with QPs (US$30.20) compared with PPs (US$14.40) and TPs (US$15.70). These suggest that interventions for reducing transaction costs should include effective decentralisation to integrate TB care with services at the primary health care level, community engagement to address information asymmetry, enforcing regulations to keep informal providers within legal limits and facilitating referral linkages among formal and informal providers to increase early contact with appropriate providers. PMID:25652349

  1. Transaction costs of access to health care: Implications of the care-seeking pathways of tuberculosis patients for health system governance in Nigeria.

    PubMed

    Abimbola, Seye; Ukwaja, Kingsley N; Onyedum, Cajetan C; Negin, Joel; Jan, Stephen; Martiniuk, Alexandra L C

    2015-10-01

    Health care costs incurred prior to the appropriate patient-provider transaction (i.e., transaction costs of access to health care) are potential barriers to accessing health care in low- and middle-income countries. This paper explores these transaction costs and their implications for health system governance through a cross-sectional survey of adult patients who received their first diagnosis of pulmonary tuberculosis (TB) at the three designated secondary health centres for TB care in Ebonyi State, Nigeria. The patients provided information on their care-seeking pathways and the associated costs prior to reaching the appropriate provider. Of the 452 patients, 84% first consulted an inappropriate provider. Only 33% of inappropriate consultations were with qualified providers (QP); the rest were with informal providers such as pharmacy providers (PPs; 57%) and traditional providers (TP; 10%). Notably, 62% of total transaction costs were incurred during the first visit to an inappropriate provider and the mean transaction costs incurred was highest with QPs (US$30.20) compared with PPs (US$14.40) and TPs (US$15.70). These suggest that interventions for reducing transaction costs should include effective decentralisation to integrate TB care with services at the primary health care level, community engagement to address information asymmetry, enforcing regulations to keep informal providers within legal limits and facilitating referral linkages among formal and informal providers to increase early contact with appropriate providers.

  2. Care Seeking Behaviour for Children with Suspected Pneumonia in Countries in Sub-Saharan Africa with High Pneumonia Mortality

    PubMed Central

    Noordam, Aaltje Camielle; Carvajal-Velez, Liliana; Sharkey, Alyssa B.; Young, Mark; Cals, Jochen W. L.

    2015-01-01

    Pneumonia is the leading cause of childhood mortality in sub-Saharan Africa (SSA). Because effective antibiotic treatment exists, timely recognition of pneumonia and subsequent care seeking for treatment can prevent deaths. For six high pneumonia mortality countries in SSA we examined if children with suspected pneumonia were taken for care, and if so, from which type of care providers, using national survey data of 76530 children. We also assessed factors independently associated with care seeking from health providers, also known as ‘appropriate’ providers. We report important differences in care seeking patterns across these countries. In Tanzania 85% of children with suspected pneumonia were taken for care, whereas this was only 30% in Ethiopia. Most of the children living in these six countries were taken to a primary health care facility; 86, 68 and 59% in Ethiopia, Tanzania and Burkina Faso respectively. In Uganda, hospital care was sought for 60% of children. 16–18% of children were taken to a private pharmacy in Democratic Republic of Congo (DRC), Tanzania and Nigeria. In Tanzania, children from the richest households were 9.5 times (CI 2.3–39.3) more likely to be brought for care than children from the poorest households, after controlling for the child’s age, sex, caregiver’s education and urban-rural residence. The influence of the age of a child, when controlling for sex, urban-rural residence, education and wealth, shows that the youngest children (<2 years) were more likely to be brought to a care provider in Nigeria, Ethiopia and DRC. Urban-rural residence was not significantly associated with care seeking, after controlling for the age and sex of the child, caregivers education and wealth. The study suggests that it is crucial to understand country-specific care seeking patterns for children with suspected pneumonia and related determinants using available data prior to planning programmatic responses. PMID:25706531

  3. Care seeking behaviour for children with suspected pneumonia in countries in sub-Saharan Africa with high pneumonia mortality.

    PubMed

    Noordam, Aaltje Camielle; Carvajal-Velez, Liliana; Sharkey, Alyssa B; Young, Mark; Cals, Jochen W L

    2015-01-01

    Pneumonia is the leading cause of childhood mortality in sub-Saharan Africa (SSA). Because effective antibiotic treatment exists, timely recognition of pneumonia and subsequent care seeking for treatment can prevent deaths. For six high pneumonia mortality countries in SSA we examined if children with suspected pneumonia were taken for care, and if so, from which type of care providers, using national survey data of 76530 children. We also assessed factors independently associated with care seeking from health providers, also known as 'appropriate' providers. We report important differences in care seeking patterns across these countries. In Tanzania 85% of children with suspected pneumonia were taken for care, whereas this was only 30% in Ethiopia. Most of the children living in these six countries were taken to a primary health care facility; 86, 68 and 59% in Ethiopia, Tanzania and Burkina Faso respectively. In Uganda, hospital care was sought for 60% of children. 16-18% of children were taken to a private pharmacy in Democratic Republic of Congo (DRC), Tanzania and Nigeria. In Tanzania, children from the richest households were 9.5 times (CI 2.3-39.3) more likely to be brought for care than children from the poorest households, after controlling for the child's age, sex, caregiver's education and urban-rural residence. The influence of the age of a child, when controlling for sex, urban-rural residence, education and wealth, shows that the youngest children (<2 years) were more likely to be brought to a care provider in Nigeria, Ethiopia and DRC. Urban-rural residence was not significantly associated with care seeking, after controlling for the age and sex of the child, caregivers education and wealth. The study suggests that it is crucial to understand country-specific care seeking patterns for children with suspected pneumonia and related determinants using available data prior to planning programmatic responses.

  4. Pathways of care-seeking during fatal infant illnesses in under-resourced South African settings

    PubMed Central

    Sharkey, Alyssa B; Chopra, Mickey; Jackson, Debra; Winch, Peter J; Minkovitz, Cynthia S

    2011-01-01

    Summary The purpose of this study was to examine care-seeking during fatal infant illnesses in under-resourced South African settings to inform potential strategies for reducing infant mortality. We interviewed 22 caregivers of deceased infants in a rural community and 28 in an urban township. We also interviewed seven local leaders and 12 health providers to ascertain opinions about factors contributing to infant death. Despite the availability of free public health services in these settings, many caregivers utilised multiple sources of care including allopathic, indigenous and home treatments. Urban caregivers reported up to eight points of care while rural caregivers reported up to four points of care. The specific pathways taken and combinations of care varied, but many caregivers used other types of care shortly after presenting at public services, indicating dissatisfaction with the care they received. Many infants died despite caregivers’ considerable efforts, pointing to critical deficiencies in the system of care serving these families. Initiatives that aim to improve assessment, management and referral practices by both allopathic and traditional providers (for example, through training and improved collaboration), and caregiver recognition of infant danger signs may reduce the high rate of infant death in these settings. PMID:22136954

  5. Danger Signs of Childhood Pneumonia: Caregiver Awareness and Care Seeking Behavior in a Developing Country

    PubMed Central

    Ndu, Ikenna K.; Ekwochi, Uchenna; Osuorah, Chidiebere D. I.; Onah, Kenechi S.; Obuoha, Ejike; Odetunde, Odutola I.; Nwokoye, Ikenna; Obumneme-Anyim, Nnenne I.; Okeke, Ifeyinwa B.; Amadi, Ogechukwu F.

    2015-01-01

    Background. Efforts to reduce child mortality especially in Africa must as a necessity aim to decrease mortality due to pneumonia. To achieve this, preventive strategies such as expanding vaccination coverage are key. However once a child develops pneumonia prompt treatment which is essential to survival is dependent on mothers and caregiver recognition of the symptoms and danger signs of pneumonia. Methods. This community based cross-sectional study enrolled four hundred and sixty-six caregivers in Enugu state. It aimed to determine knowledge of caregivers about danger signs of pneumonia and the sociodemographic factors that influence knowledge and care seeking behaviour of caregivers. Results. There is poor knowledge of the aetiology and danger signs of pneumonia among caregivers. Higher maternal educational attainment and residence in semiurban area were significantly associated with knowledge of aetiology, danger signs, and vaccination of their children against pneumonia. Fast breathing and difficulty in breathing were the commonest known and experienced WHO recognized danger signs while fever was the commonest perceived danger sign among caregivers. Conclusion. Knowledge of danger signs and health seeking behaviour among caregivers is inadequate. There is need for intensified public and hospital based interventions targeted at mothers to improve their knowledge about pneumonia. PMID:26576161

  6. Care-Seeking Patterns and Direct Economic Burden of Injuries in Bangladesh.

    PubMed

    Alfonso, Natalia Y; Alonge, Olakunle; Hoque, Dewan Md Emdadul; Baset, Kamran Ul; Hyder, Adnan A; Bishai, David

    2017-04-29

    This study provides a comprehensive review of the care-seeking patterns and direct economic burden of injuries from the victims' perspective in rural Bangladesh using a 2013 household survey covering 1.17 million people. Descriptive statistics and bivariate analyses were used to derive rates and test the association between variables. An analytic model was used to estimate total injury out-of-pocket (OOP) payments and a multivariate probit regression model assessed the relationship between financial distress and injury type. Results show non-fatal injuries occur to 1 in 5 people in our sample per year. With average household size of 4.5 in Bangladesh--every household has an injury every year. Most non-fatally injured patients sought healthcare from drug sellers. Less than half of fatal injuries sought healthcare and half of those with care were hospitalized. Average OOP payments varied significantly (range: $8-$830) by injury type and outcome (fatal vs. non-fatal). Total injury OOP expenditure was $$355,795 and $5000 for non-fatal and fatal injuries, respectively, per 100,000 people. The majority of household heads with injuries reported financial distress. This study can inform injury prevention advocates on disparities in healthcare usage, OOP costs and financial distress. Reallocation of resources to the most at risk populations can accelerate reduction of preventable injuries and prevent injury related catastrophic payments and impoverishment.

  7. Health care seeking behaviour and utilisation in a multiple health insurance system: does insurance affiliation matter?

    PubMed Central

    2014-01-01

    Background Many countries striving to achieve universal health insurance coverage have done so by means of multiple health insurance funds covering different population groups. However, existence of multiple health insurance funds may also cause variation in access to health care, due to the differential revenue raising capacities and benefit packages offered by the various funds resulting in inequity and inefficiency within the health system. This paper examines how the existence of multiple health insurance funds affects health care seeking behaviour and utilisation among members of the Community Health Fund, the National Health Insurance Fund and non-members in two districts in Tanzania. Methods Using household survey data collected in 2011 with a sample of 3290 individuals, the study uses a multinomial logit model to examine the influence of predisposing, enabling and need characteristics on the probability of seeking care and choice of provider. Results Generally, health insurance is found to increase the probability of seeking care and reduce delays. However, the probability, timing of seeking care and choice of provider varies across the CHF and NHIF members. Conclusions Reducing fragmentation is necessary to provide opportunities for redistribution and to promote equity in utilisation of health services. Improvement in the delivery of services is crucial for achievement of improved access and financial protection and for increased enrolment into the CHF, which is essential for broadening redistribution and cross-subsidisation to promote equity. PMID:24645876

  8. Morbidity patterns and health care seeking behavior among older widows in India.

    PubMed

    Agrawal, Gopal; Keshri, Kunal

    2014-01-01

    In the process of health transition, India is facing rapid pace of demographic aging. Rapid increase in older adult population posed serious concerns regarding health and health care utilization for them. However, very limited research documented resultant implications of demographic aging for health and health care use in the nexus of marital status and gender. With this perspective, the present study examined patterns in morbidity prevalence and health seeking behaviour among older widows in India. Multivariate logistic regression models were estimated to examine the effects of socio-demographic conditions on morbidity prevalence among older widows and their health care seeking behavior. Data from the latest 60(th) round of National Sample Survey (NSS), 2004 was used. Overall, morbidity prevalence was 13% greater among older widows compared to older widowers. Adjusted prevalence of communicable and non-communicable diseases was found 74 and 192 per 1000 older widows respectively. At the same time, likelihood of seeking health care services for reported morbidities was substantially lower among older widows. The findings of this study are important to support policy makers and health care providers in identifying individuals 'at risk' and could be integrated into the current programs of social, economic and health security for the older persons.

  9. Health care seeking behaviour and utilisation in a multiple health insurance system: does insurance affiliation matter?

    PubMed

    Chomi, Eunice Nahyuha; Mujinja, Phares G M; Enemark, Ulrika; Hansen, Kristian; Kiwara, Angwara Dennis

    2014-03-19

    Many countries striving to achieve universal health insurance coverage have done so by means of multiple health insurance funds covering different population groups. However, existence of multiple health insurance funds may also cause variation in access to health care, due to the differential revenue raising capacities and benefit packages offered by the various funds resulting in inequity and inefficiency within the health system. This paper examines how the existence of multiple health insurance funds affects health care seeking behaviour and utilisation among members of the Community Health Fund, the National Health Insurance Fund and non-members in two districts in Tanzania. Using household survey data collected in 2011 with a sample of 3290 individuals, the study uses a multinomial logit model to examine the influence of predisposing, enabling and need characteristics on the probability of seeking care and choice of provider. Generally, health insurance is found to increase the probability of seeking care and reduce delays. However, the probability, timing of seeking care and choice of provider varies across the CHF and NHIF members. Reducing fragmentation is necessary to provide opportunities for redistribution and to promote equity in utilisation of health services. Improvement in the delivery of services is crucial for achievement of improved access and financial protection and for increased enrolment into the CHF, which is essential for broadening redistribution and cross-subsidisation to promote equity.

  10. Symptom recognition and health care seeking among immigrants and native Swedish patients with heart failure

    PubMed Central

    Hedemalm, Azar; Schaufelberger, Maria; Ekman, Inger

    2008-01-01

    Background It is not known what patient perceptions or beliefs lead to beneficial decisions or response patterns in symptom interpretation among heart failure (HF) patients, especially immigrants. The aim of this study was to explore and compare symptom recognition and health care seeking patterns among immigrants and native Swedes with HF. Methods The study used a qualitative design. Semi-structured interviews were conducted with 42 patients with HF, of whom 21 were consecutively selected immigrants and 21 were randomly selected Swedish patients. The interviews were analysed using content analysis. Results A majority of the immigrant patients sought health care for symptoms and signs, such as breathing difficulties, fatigue and swelling. Twice as many immigrants as Swedes were unaware of "what the illness experience entailed" and which symptoms indicated worsening of HF. Conclusion The symptoms that patients sought care for, were similar among immigrants and Swedes. However, when interpreting symptoms more immigrants were unaware of the connection between the symptoms/signs and their HF condition. More tailored educational interventions might improve recognition of worsening symptoms in immigrant patients with chronic heart failure. PMID:18590538

  11. Household roles and care-seeking behaviours in response to severe childhood illness in Mali.

    PubMed

    Ellis, Amy A; Doumbia, Seydou; Traoré, Sidy; Dalglish, Sarah L; Winch, Peter J

    2013-11-01

    Malaria is a major cause of under-five mortality in Mali and many other developing countries. Malaria control programmes rely on households to identify sick children and either care for them in the home or seek treatment at a health facility in the case of severe illness. This study examines the involvement of mothers and other household members in identifying and treating severely ill children through case studies of 25 rural Malian households. A wide range of intra-household responses to severe illness were observed among household members, both exemplifying and contravening stated social norms about household roles. Given their close contact with children, mothers were frequently the first to identify illness symptoms. However, decisions about care-seeking were often taken by fathers and senior members of the household. As stewards of the family resources, fathers usually paid for care and thus significantly determined when and where treatment was sought. Grandparents were frequently involved in diagnosing illnesses and directing care towards traditional healers or health facilities. Relationships between household members during the illness episode were found to vary from highly collaborative to highly conflictive, with critical effects on how quickly and from where treatment for sick children was sought. These findings have implications for the design and targeting of malaria and child survival programming in the greater West African region.

  12. How do risk preferences relate to malaria care-seeking behavior and the acceptability of a new health technology in Nigeria?

    PubMed

    Liu, Jenny; Modrek, Sepideh; Anyanti, Jennifer; Nwokolo, Ernest; De La Cruz, Anna; Schatzkin, Eric; Isiguzo, Chinwoke; Ujuju, Chinazo; Montagu, Dominic

    2014-09-05

    To reduce the burden of disease from malaria, innovative approaches are needed to engender behavior change. One unobservable, but fundamental trait-preferences for risk-may influence individuals' willingness to adopt new health technologies. We explore the association of risk preferences with malaria care-seeking behavior and the acceptability of malaria rapid diagnostic tests (RDTs) to inform RDT scale-up plans. In Oyo State, Nigeria, adult customers purchasing anti-malarial medications at selected drug shops took surveys and received an RDT as they exited. After an initial risk preference assessment via a simple lottery game choice, individuals were given their RDT result and treatment advice, and called four days later to assess treatment adherence. We used bivariable and multivariable regression analysis to assess the association of risk game choices with malaria care-seeking behaviors and RDT acceptability. Of 448 respondents, 63.2% chose the lottery game with zero variance in expected payout, 27.9% chose the game with low variance, and 8.9% chose the game with high variance. Compared to participants who chose lower variance games, individuals choosing higher variance games were older, less educated, more likely to be male, and were more likely to patronize lower quality drug shops, seek care immediately, and report complete disability due to their illness. In contrast, individuals choosing lower variance games were more likely to follow the correct treatment directions and were more likely to report an increase in their willingness to pay for an RDT compared to other risk groups, our two measures of RDT acceptability. Differences in estimated associations between risk game choices and selected care-seeking behaviors remained after controlling sociodemographic confounders. The uptake of health diagnostic information in terms of translating the RDT experience into willingness to pay for an RDT and treatment adherence to test results may vary according to risk

  13. "In a situation of rescuing life": meanings given to diabetes symptoms and care-seeking practices among adults in Southeastern Tanzania: a qualitative inquiry.

    PubMed

    Metta, Emmy; Bailey, Ajay; Kessy, Flora; Geubbels, Eveline; Hutter, Inge; Haisma, Hinke

    2015-03-07

    Diabetes mellitus is an emerging public health problem in Tanzania. For the community and the health system to respond adequately to this problem, it is important that we understand the meanings given to its symptoms, and the care-seeking practices of individuals. To explore collective views on the meanings given to diabetes symptoms, we conducted nine focus group discussions with adult diabetes patients and members of the general community. To gain a better understanding of how the meanings in the community inform the care-seeking practices of individuals, 19 in-depth interviews were conducted with diabetes patients. The data were analyzed using principles of grounded theory and applying cultural schema theory as a deductive framework. In the communities and among the patients, knowledge and awareness of diabetes are limited. Both people with diabetes and community members referred to their prevailing cultural meaning systems and schemas for infectious diseases to interpret and assign meaning to the emerging symptoms. Diabetes patients reported that they had initially used anti-malarial medicines because they believed their symptoms-like headache, fever, and tiredness-were suggestive of malaria. Schemas for body image informed the meaning given to diabetes symptoms similar to those of HIV, like severe weight loss. Confusion among members of the community about the diabetes symptoms instigated tension, causing patients to be mistrusted and stigmatized. The process of meaning-giving and the diagnosis of the diabetes symptoms was challenging for both patients and health care professionals. Diabetes patients reported being initially misdiagnosed and treated for other conditions by medical professionals. The inability to assign meaning to the symptoms and determine their etiologies informed the decision made by some patients to consult traditional healers, and to associate their symptoms with witchcraft causes. The meanings given to diabetes symptoms and the care-seeking

  14. Health care-seeking behaviours and health expenditures in adults aged 45 years and older in China, 2011-2013.

    PubMed

    Li, Jiasen; Feng, Xing Lin

    2017-05-01

    To provide an assessment of China's progress to universal health coverage (UHC) from the perspective of people-centred care. We obtained data on 28 103 participants from the China Health and Retirement Longitudinal Study (CHALRS) during 2011-2013. We used logistic regressions and generalised linear models to analyse care-seeking behaviours and medical expenditures. We found that 95.5% of the subjects were covered by social health insurance in 2013, and nearly 60% subjects in need of medical care were self-medicated. Health insurance was a strong predictor for the access to outpatient care. Use of pure and mixed self-medication increased by 15% and 32% respectively, while use of pure outpatient care fell by 10% between 2011 and 2013, after adjusting for predisposing, service needs and enabling factors. Such trends were particularly evident for the Urban Resident Basic Medical Insurance and the New Cooperative Medical Scheme, which covered more than 80%. The monthly out-of-pocket medical expenditures and the probability of encountering catastrophic health expenditures for outpatient care were four times larger than that for self-medication. Between 2011 and 2013, outpatient care medical costs rose by nearly 50%, whereas there was no such obvious trend for self-medication. People with insurance schemes offering lower cost sharing incurred consistently higher out-of-pocket outpatient payments. The monitoring of global progress to UHC should incorporate self-medication. In China, it seems that the current reform and the huge government investment have not resulted in access to affordable quality care. To achieve UHC, not only universal insurance, but system-level efforts are needed. © 2017 John Wiley & Sons Ltd.

  15. Patient-initiated e-mails to providers: associations with out-of-pocket visit costs, and impact on care-seeking and health.

    PubMed

    Reed, Mary; Graetz, Ilana; Gordon, Nancy; Fung, Vicki

    2015-12-01

    To understand when patients use secure e-mail messaging with healthcare providers across several types of questions or concerns, associations between out-of-pocket costs for in-person visits and use of secure messaging, and to examine patient-reported impacts on care-seeking behavior and overall health. Cross-sectional survey of patients in an integrated healthcare delivery system, with access to a patient portal to send secure e-mail messages to providers at no out-of-pocket cost. The study included patients with a chronic condition (N = 1041). We described patient-reported preferences for contacting providers and patient-reported impact of e-mail use on phone calls, in-person visits, and overall health. We used multivariate analyses to examine patient characteristics associated with using e-mail as a first contact method, and effects on care-seeking and health. Overall, 56% of patients sent their provider an e-mail within 1 year, and 46% reported e-mail as their first method of contact for 1 or more types of medical concerns. After adjustment, higher out-of-pocket costs for in-person visits were significantly associated with choosing e-mail as a first method of contact (P < .05). Among patients who had e-mailed their provider, 42% reported that it reduced their phone contacts, 36% reduced in-person office visits and 32% reported e-mailing improved their overall health. Patients reported using e-mail broadly to initiate conversations with their providers, and patients with higher out-of-pocket costs for in-person visits were more likely to choose e-mail as a first contact method. Use of secure e-mails reduced patients' use of other types of healthcare and resulted in improved overall health.

  16. Factors affecting eye care-seeking behavior of parents for their children.

    PubMed

    Balasubramaniam, Sudharsanam M; Kumar, Divya Senthil; Kumaran, Sheela Evangeline; Ramani, Krishna Kumar

    2013-10-01

    Most of the causes of childhood blindness are either treatable or preventable. Eye care-seeking behavior (ESB) of parents for their children plays a pivotal role in reducing this problem. This study was done because there was a sparsity of literature in this context and with a view to help eye care professionals plan better programs and to identify factors facilitating and/or hindering ESB of parents for their school-going children in an urban area. This study adopted a qualitative snapshot narrative study design. In-depth interviews and focus group discussions were conducted in areas of Chennai with parents and eye care professionals selected through stratified purposive sampling. Parents were based on those who sought care and did not seek care after a school eye screening program and on their socioeconomic status. Data were transcribed to English, familiarized, and inductive coded, and themes were formed. Redundancy was considered as end point of data collection. Two focus group discussions and 11 in-depth interviews were conducted. Squint, redness or watering of eyes, eye irritation, headache, family history of ocular diseases, severity, and repetitiveness of symptoms facilitate parents seeking eye care for their wards/children. Economic status was an important barrier reported to affect the ESB. Logistic factors like taking appointment with doctor, taking leave from work, transport, and traveling distance were noted. This study shows the facilitating factors and barriers for ESB of the Chennai urban parents for their wards. The results suggest that efforts needed to be put to overcome the barriers through planned awareness programs.

  17. Intimate partner violence and health care-seeking patterns among female users of urban adolescent clinics.

    PubMed

    Miller, Elizabeth; Decker, Michele R; Raj, Anita; Reed, Elizabeth; Marable, Danelle; Silverman, Jay G

    2010-11-01

    To assess the prevalence of intimate partner violence (IPV) and associations with health care-seeking patterns among female patients of adolescent clinics, and to examine screening for IPV and IPV disclosure patterns within these clinics. A self-administered, anonymous, computerized survey was administered to female clients ages 14-20 years (N = 448) seeking care in five urban adolescent clinics, inquiring about IPV history, reasons for seeking care, and IPV screening by and IPV disclosure to providers. Two in five (40%) female urban adolescent clinic patients had experienced IPV, with 32% reporting physical and 21% reporting sexual victimization. Among IPV survivors, 45% reported abuse in their current or most recent relationship. IPV prevalence was equally high among those visiting clinics for reproductive health concerns as among those seeking care for other reasons. IPV victimization was associated with both poor current health status (AOR 1.57, 95% CI 1.03-2.40) and having foregone care in the past year (AOR 2.59, 95% CI 1.20-5.58). Recent IPV victimization was associated only with past 12 month foregone care (AOR 2.02, 95% CI 1.18-3.46). A minority (30%) reported ever being screened for IPV in a clinical setting. IPV victimization is pervasive among female adolescent clinic attendees regardless of visit type, yet IPV screening by providers appears low. Patients reporting poor health status and foregone care are more likely to have experienced IPV. IPV screening and interventions tailored for female patients of adolescent clinics are needed.

  18. Determinants of health care seeking behaviour during pregnancy in Ogun State, Nigeria.

    PubMed

    Akeju, David O; Oladapo, Olufemi T; Vidler, Marianne; Akinmade, Adepoju A; Sawchuck, Diane; Qureshi, Rahat; Solarin, Muftaut; Adetoro, Olalekan O; von Dadelszen, Peter

    2016-06-08

    In Nigeria, women too often suffer the consequences of serious obstetric complications that may lead to death. Delay in seeking care (phase I delay) is a recognized contributor to adverse pregnancy outcomes. This qualitative study aimed to describe the health care seeking practices in pregnancy, as well as the socio-cultural factors that influence these actions. The study was conducted in Ogun State, in south-western Nigeria. Data were collected through focus group discussions with pregnant women, recently pregnant mothers, male decision-makers, opinion leaders, traditional birth attendants, health workers, and health administrators. A thematic analysis approach was used with QSR NVivo version 10. Findings show that women utilized multiple care givers during pregnancy, with a preference for traditional providers. There was a strong sense of trust in traditional medicine, particularly that provided by traditional birth attendants who are long-term residents in the community. The patriarchal c influenced health-seeking behaviour in pregnancy. Economic factors contributed to the delay in access to appropriate services. There was a consistent concern regarding the cost barrier in accessing health services. The challenges of accessing services were well recognised and these were greater when referral was to a higher level of care which in most cases attracted unaffordable costs. While the high cost of care is a deterrent to health seeking behaviour, the cost of death of a woman or a child to the family and community is immeasurable. The use of innovative mechanisms for health care financing may be beneficial for women in these communities to reduce the barrier of high cost services. To reduce maternal deaths all stakeholders must be engaged in the process including policy makers, opinion leaders, health care consumers and providers. Underlying socio-cultural factors, such as structure of patriarchy, must also be addressed to sustainably improve maternal health. NCT

  19. A community-based intervention designed to increase preventive health care seeking among adolescents: the Gonorrhea Community Action Project.

    PubMed

    VanDevanter, Nancy L; Messeri, Peter; Middlestadt, Susan E; Bleakley, Amy; Merzel, Cheryl R; Hogben, Matthew; Ledsky, Rebecca; Malotte, C Kevin; Cohall, Renee M; Gift, Thomas L; St Lawrence, Janet S

    2005-02-01

    We evaluated the effectiveness of an intervention designed to increase preventive health care seeking among adolescents. Adolescents and young adults aged 12 to 21 years, recruited from community-based organizations in 2 different communities, were randomized into either a 3-session intervention or a control condition. We estimated outcomes from 3-month follow-up data using logistic and ordinary least squares regression. Female intervention participants were significantly more likely than female control participants to have scheduled a health care appointment (odds ratio [OR]=3.04), undergone a checkup (OR=2.87), and discussed with friends or family members the importance of undergoing a checkup (OR=4.5). There were no differences between male intervention and male control participants in terms of outcomes. This theory-driven, community-based group intervention significantly increased preventive health care seeking among female adolescents. Further research is needed, however, to identify interventions that will produce successful outcomes among male adolescents.

  20. A qualitative exploration of care-seeking pathways for sick children in the rural Oromia region of Ethiopia.

    PubMed

    Shaw, Bryan; Amouzou, Agbessi; Miller, Nathan P; Bryce, Jennifer; Surkan, Pamela J

    2017-03-09

    Ethiopia has experienced rapid improvements in its healthcare infrastructure, such as through the recent scale up of integrated community case management (iCCM) delivered by community-based health extension workers (HEWs) targeting children under the age of five. Despite notable improvements in child outcomes, the use of HEWs delivering iCCM remains very low. The aim of our study was to explain this phenomenon by examining care-seeking practices and treatment for sick children in two rural districts in the Oromia Region of Ethiopia. Using qualitative methods, we explored perceptions of child illness, influences on decision-making processes occurring over the course of a child's illness and caregiver perceptions of available community-based sources of child illness care. Sixteen focus group discussions (FGDs) and 40 in-depth interviews (IDIs) were held with mothers of children under age five. For additional perspective, 16 IDIs were conducted fathers and 22 IDIs with health extension workers and community health volunteers. Caregivers often described the act of care-seeking for a sick child as a time of considerable uncertainty. In particular, mothers of sick children described the cultural, social and community-based resources available to minimize this uncertainty as well as constraints and strategies for accessing these resources in order to receive treatment for a sick child. The level of trust and familiarity were the most common dynamics noted as influencing care-seeking strategies; trust in biomedical and government providers was often low. Overall, our research highlights the multiple and dynamic influences on care-seeking for sick children in rural Ethiopia. An understanding of these influences is critical for the success of existing and future health interventions and continued improvement of child health in Ethiopia.

  1. Autonomy dimensions and care seeking for delivery in Zambia; the prevailing importance of cluster-level measurement

    PubMed Central

    Gabrysch, Sabine; McMahon, Shannon A.; Siling, Katja; Kenward, Michael G.; Campbell, Oona M. R.

    2016-01-01

    It is widely held that decisions whether or when to attend health facilities for childbirth are not only influenced by risk awareness and household wealth, but also by factors such as autonomy or a woman’s ability to act upon her own preferences. How autonomy should be constructed and measured – namely, as an individual or cluster-level variable – has been less examined. We drew on household survey data from Zambia to study the effect of several autonomy dimensions (financial, relationship, freedom of movement, health care seeking and violence) on place of delivery for 3200 births across 203 rural clusters (villages). In multilevel logistic regression, two autonomy dimensions (relationship and health care seeking) were strongly associated with facility delivery when measured at the cluster level (OR 1.27 and 1.57, respectively), though not at the individual level. This suggests that power relations and gender norms at the community level may override an individual woman’s autonomy, and cluster-level measurement may prove critical to understanding the interplay between autonomy and care seeking in this and similar contexts. PMID:26931301

  2. Psychometric evaluation of the Perceived Barriers to Health Care-seeking Decision in Chinese patients with acute coronary syndromes.

    PubMed

    Li, Polly W C; Lee, Diana T F; Yu, Doris S F

    2014-01-01

    This study aimed to develop the Chinese version of the Perceived Barriers to Health Care-seeking Decision (PBHSD-C) and evaluate its psychometric properties in Chinese patients with acute coronary syndromes (ACS). The assessment of the level of perceived barriers in the care-seeking trajectory of ACS patients is important for the understanding of its impact on pre-hospital delay in seeking care. The psychometric properties of PBHSD-C were evaluated among 114 ACS patients in the cardiac unit of two major hospitals in Hong Kong. The Content Validity Indexes were ranged from .88 to 1. The Cronbach's alpha of the PBHSD-C was .74. The intraclass correlation coefficients of all items were above .80. The convergent validity of the PBHSD-C was also supported. The PBHSD-C is reliable and valid to be used to assess the level of perceived barriers in the care-seeking of Chinese patients with ACS. Copyright © 2014 Elsevier Inc. All rights reserved.

  3. Acute childhood morbidities in rural Wardha: some epidemiological correlates and health care seeking.

    PubMed

    Deshmukh, P R; Dongre, A R; Sinha, N; Garg, B S

    2009-08-01

    In India, common morbidities among children under 3 years of age are fever, acute respiratory infections, diarrhea. Effective early management at the home level and health care-seeking behavior in case of appearance of danger signs are key strategies to prevent the occurrence of severe and life-threatening complications. To find out the prevalence of acute child morbidities, their determinants and health-seeking behavior of the mothers of these children. The cross-sectional study was carried out in Wardha district of central India. We interviewed 990 mothers of children below 3 years of age using 30-cluster sampling method. Nutritional status was defined by National Center for Health Statistics (NCHS) reference. Composite index of anthropometric failure (CIAF) was constructed. Hemoglobin concentration in each child was estimated using the 'filter paper cyanm ethemoglobin method.' Using World Health Organization guidelines, anemia was defined as hemoglobin concentration less than 110 g/L. Post-survey focus group discussions (FGDs) were undertaken to bridge gaps in information obtained from the survey. The data was analyzed by using SPSS 12.0.1 software package. Chi-square was used to test the association, while odds ratios were calculated to measure the strength of association. Multiple logistic regression analysis was applied to derive the final model. Anemia was detected in 80.3% of children, and 59.6% of children were undernourished as indicated by CIAF. The overall prevalence of acute morbidity was 59.9%. Children with mild anemia, moderate anemia and severe anemia had 1.52, 1.61 and 9.21 times higher risk of being morbid, respectively. Similarly, children with single, 2 and 3 anthropometric failures had 1.16, 1.29 and 2.27 times higher risk of being morbid, respectively. Out of 594 (60%) children with at least one of the acute morbidities, 520 (87.5%) sought health care, where majority (66.1%) received treatment from private clinics. The final model suggested

  4. Patterns and Determinants of Care-Seeking for Antepartum and Intrapartum Complications in Rural Bangladesh: Results from a Cohort Study

    PubMed Central

    Creanga, Andreea A.; Koffi, Alain K.; Mitra, Dipak K.; Mahmud, Arif; Begum, Nazma; Moin, Syed Mamun Ibne; Ram, Malathi; Quaiyum, Md Abdul; Ahmed, Saifuddin; Saha, Samir K.; Baqui, Abdullah H.

    2016-01-01

    Background The burden of maternal complications during antepartum and intrapartum periods is high and care seeking from a trained provider is low, particularly in low middle income countries of sub-Saharan Africa and South Asia. Identification of barriers to access to trained care and development of strategies to address them will contribute to improvements in maternal health. Using data from a community-based cohort of pregnant women, this study identified the prevalence of antepartum and intrapartum complications and determinants of care-seeking for these complications in rural Bangladesh. Methods The study was conducted in 24,274 pregnant women between June 2011 and December 2013 in rural Sylhet district of Bangladesh. Women were interviewed during pregnancy to collect data on demographic and socioeconomic characteristics; prior miscarriages, stillbirths, live births, and neonatal deaths; as well as data on their ability to make decision to go to health center alone. They were interviewed within the first 7 days of child birth to collect data on self-reported antepartum and intrapartum complications and care seeking for those complications. Bivariate analysis was conducted to explore association between predisposing (socio-demographic), enabling (economic), perceived need, and service related factors with care-seeking for self-reported antepartum and intrapartum complications. Multivariable multinomial logistic regression was performed to examine the association of selected factors with care-seeking for self-reported antepartum and intrapartum complications adjusting for co-variates. Results Self-reported antepartum and intrapartum complications among women were 14.8% and 20.9% respectively. Among women with any antepartum complication, 58.9% sought care and of these 46.5% received care from a trained provider. Of the women with intrapartum complications, 61.4% sought care and of them 46.5% did so from a trained provider. Care-seeking for both antepartum and

  5. Changing poor mothers' care-seeking behaviors in response to childhood illness: findings from a cross-sectional study in Granada, Nicaragua

    PubMed Central

    2010-01-01

    Background In 2008, approximately 8.8 million children under 5 years of age died worldwide. Most of these deaths occurred in developing countries, but little is known about poor mothers' care-seeking behaviors for their children. We examined poor mothers' care-seeking behaviors in response to childhood illness, and identified factors affecting their choices. We also assessed mothers' perception of the medical services and their confidence in the health care available for their children. Methods We carried out a community-based cross-sectional study with structured questionnaires. Participants were 756 mothers and their young children (0-23 months) in Nandaime municipality, Granada province, Nicaragua. We took the children's anthropometric measurements and we assessed the mothers according to their income. We divided them into 3 global absolute poverty categories (income: <1 USD/day, 1-2 USD/day, >2 USD/day), and 4 quintile. Results When a child showed symptoms of illness, most mothers (>75%) selected public health facilities as their first choice. More than half (>58%) were satisfied with the medical services, but the poorest mothers expressed more dissatisfaction (p = 0.003), when we divided the participants into 4 quintiles groups according to their income. In the poorest group, the main reasons for dissatisfaction were cost (46.6%), and distance to the facilities (25.8%). Almost half (41.3%) of mothers lacked confidence in the health care offered to their child, while most of the wealthiest mothers (75.7%) did have confidence in it (p = 0.001). The poorest mothers showed greater interest in health education than the wealthiest (86.2% vs. 77.8%) (p = 0.015). We found that poor mothers (≤2 USD/day) changed their second choice for care in a positive direction. Factors affecting the change in second choice were the child having symptoms of respiratory disease (AOR, 2.51; 95% CI, 1.28-4.90, p = 0.007), visiting health post as the first choice (AOR, 2.11; 95% CI, 1

  6. Insights into health care seeking behaviour for children in communities in KwaZulu-Natal, South Africa.

    PubMed

    Haskins, Lyn; Grant, Merridy; Phakathi, Sifiso; Wilford, Aurene; Jama, Ngcwalisa; Horwood, Christiane

    2017-05-29

    South African infant and child mortality remains high, with many deaths occurring outside the formal health services. Delayed health care seeking represents a large proportion of these deaths. To generate knowledge about the role of, and influences on, caregivers with regard to decision-making about when and where to seek care for sick children. Two communities in KwaZulu-Natal. A qualitative, exploratory design employing participatory research techniques was used to undertake focus group discussions with community members. Health care seeking for a sick child was described as a complex process influenced by multiple carers using multiple providers. Decision-making about seeking health care for a sick child was not an individual effort, but was shared with others in the household and guided by how the symptoms were perceived, either a Western illness or African illness. A sick child could either be treated at home or be taken to a variety of places including clinics, private doctors, traditional healers, faith healers and hospitals. Traditional healers were associated with the treatment of illnesses perceived to be traditional. Few participants said that they would take their child back to the original health provider if the child remained ill, but would move from one provider to another until the child's health improved. The formal health system needs to ensure that sick children are identified and managed appropriately to reduce child deaths. Knowledge and understanding of health care seeking behaviour for sick children by carers is an important aspect. Interventions need to be designed with these contextual issues in mind.

  7. Exploring Maternal Health Care-Seeking Behavior of Married Adolescent Girls in Bangladesh: A Social-Ecological Approach

    PubMed Central

    Shahabuddin, Asm; Nöstlinger, Christiana; Delvaux, Thérèse; Sarker, Malabika; Delamou, Alexandre; Bardají, Azucena; Broerse, Jacqueline E. W.; De Brouwere, Vincent

    2017-01-01

    Background The huge proportion of child marriage contributes to high rates of pregnancies among adolescent girls in Bangladesh. Despite substantial progress in reducing maternal mortality in the last two decades, the rate of adolescent pregnancy remains high. The use of skilled maternal health services is still low in Bangladesh. Several quantitative studies described the use of skilled maternal health services among adolescent girls. So far, very little qualitative evidence exists about attitudes and practices related to maternal health. To fill this gap, we aimed at exploring maternal health care-seeking behavior of adolescent girls and their experiences related to pregnancy and delivery in Bangladesh. Methods and Findings A prospective qualitative study was conducted among thirty married adolescent girls from three Upazilas (sub-districts) of Rangpur district. They were interviewed in two subsequent phases (2014 and 2015). To triangulate and validate the data collected from these married adolescent girls, key informant interviews (KIIs) and focus group discussions (FGDs) were conducted with different stakeholders. Data analysis was guided by the Social-Ecological Model (SEM) including four levels of factors (individual, interpersonal and family, community and social, and organizational and health systems level) which influenced the maternal health care-seeking behavior of adolescent girls. While adolescent girls showed little decision making-autonomy, interpersonal and family level factors played an important role in their use of skilled maternal health services. In addition, community and social factors and as well as organizational and health systems factors shaped adolescent girls’ maternal health care-seeking behavior. Conclusions In order to improve the maternal health of adolescent girls, all four levels of factors of SEM should be taken into account while developing health interventions targeting adolescent girls. PMID:28095432

  8. Exploring Maternal Health Care-Seeking Behavior of Married Adolescent Girls in Bangladesh: A Social-Ecological Approach.

    PubMed

    Shahabuddin, Asm; Nöstlinger, Christiana; Delvaux, Thérèse; Sarker, Malabika; Delamou, Alexandre; Bardají, Azucena; Broerse, Jacqueline E W; De Brouwere, Vincent

    2017-01-01

    The huge proportion of child marriage contributes to high rates of pregnancies among adolescent girls in Bangladesh. Despite substantial progress in reducing maternal mortality in the last two decades, the rate of adolescent pregnancy remains high. The use of skilled maternal health services is still low in Bangladesh. Several quantitative studies described the use of skilled maternal health services among adolescent girls. So far, very little qualitative evidence exists about attitudes and practices related to maternal health. To fill this gap, we aimed at exploring maternal health care-seeking behavior of adolescent girls and their experiences related to pregnancy and delivery in Bangladesh. A prospective qualitative study was conducted among thirty married adolescent girls from three Upazilas (sub-districts) of Rangpur district. They were interviewed in two subsequent phases (2014 and 2015). To triangulate and validate the data collected from these married adolescent girls, key informant interviews (KIIs) and focus group discussions (FGDs) were conducted with different stakeholders. Data analysis was guided by the Social-Ecological Model (SEM) including four levels of factors (individual, interpersonal and family, community and social, and organizational and health systems level) which influenced the maternal health care-seeking behavior of adolescent girls. While adolescent girls showed little decision making-autonomy, interpersonal and family level factors played an important role in their use of skilled maternal health services. In addition, community and social factors and as well as organizational and health systems factors shaped adolescent girls' maternal health care-seeking behavior. In order to improve the maternal health of adolescent girls, all four levels of factors of SEM should be taken into account while developing health interventions targeting adolescent girls.

  9. Animal health care seeking behavior of pets or livestock owners and knowledge and awareness on zoonoses in a university community.

    PubMed

    Awosanya, Emmanuel J; Akande, H O

    2015-07-01

    We investigated the attitude of pets or livestock owning households in a university community to animal health care services and assessed the knowledge and awareness level of the residents on zoonoses. Structured questionnaire was used to obtain information on demography, pet or livestock ownership, animal health care seeking behavior, awareness and knowledge of zoonoses from 246 households. We did descriptive statistics and bivariate analysis to determine the level of association in discrete variables between owners and non-owners of pets or livestock at a significant level of p<0.05. Of the 246 respondents, 80 (32.5%) were either pet or livestock owners. The animal health care seeking behavior of the 80 pets or livestock owners in terms of treatment and vaccination was 70%. Of the 56 (70%) who provided health care services for their animals, about 48 (85.7%) engaged the services of a veterinarian. Dog owning households (42) had the highest frequency of treating their pets against endoparasites (97.6%); ectoparasites (81%) and vaccination against diseases (73.8%). Of the 246 respondents, only 47 (19.1%) have heard of the term zoonoses. Of the considered zoonoses; their awareness of rabies (79.3%) was the highest, followed by Lassa fever (66.3%), the least was pasteurellosis with 18.7%. Having pets or livestock was significantly associated (p=0.04) with rabies awareness. However, there is no significant difference in the level of awareness of zoonoses; knowledge of zoonoses, knowledge of prevention of zoonoses and knowledge of risk of zoonoses between owners and non-owners of pets or livestock. The animal health care seeking behavior of households with pets or livestock is good and should be encouraged. Public education should be created for other zoonoses aside from rabies, Lassa fever, and avian influenza.

  10. Animal health care seeking behavior of pets or livestock owners and knowledge and awareness on zoonoses in a university community

    PubMed Central

    Awosanya, Emmanuel J.; Akande, H. O.

    2015-01-01

    Aim: We investigated the attitude of pets or livestock owning households in a university community to animal health care services and assessed the knowledge and awareness level of the residents on zoonoses. Materials and Methods: Structured questionnaire was used to obtain information on demography, pet or livestock ownership, animal health care seeking behavior, awareness and knowledge of zoonoses from 246 households. We did descriptive statistics and bivariate analysis to determine the level of association in discrete variables between owners and non-owners of pets or livestock at a significant level of p<0.05. Results: Of the 246 respondents, 80 (32.5%) were either pet or livestock owners. The animal health care seeking behavior of the 80 pets or livestock owners in terms of treatment and vaccination was 70%. Of the 56 (70%) who provided health care services for their animals, about 48 (85.7%) engaged the services of a veterinarian. Dog owning households (42) had the highest frequency of treating their pets against endoparasites (97.6%); ectoparasites (81%) and vaccination against diseases (73.8%). Of the 246 respondents, only 47 (19.1%) have heard of the term zoonoses. Of the considered zoonoses; their awareness of rabies (79.3%) was the highest, followed by Lassa fever (66.3%), the least was pasteurellosis with 18.7%. Having pets or livestock was significantly associated (p=0.04) with rabies awareness. However, there is no significant difference in the level of awareness of zoonoses; knowledge of zoonoses, knowledge of prevention of zoonoses and knowledge of risk of zoonoses between owners and non-owners of pets or livestock. Conclusion: The animal health care seeking behavior of households with pets or livestock is good and should be encouraged. Public education should be created for other zoonoses aside from rabies, Lassa fever, and avian influenza. PMID:27047163

  11. 42 CFR 436.120 - Qualified pregnant women and children who are not qualified family members.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 4 2010-10-01 2010-10-01 false Qualified pregnant women and children who are not... women and children who are not qualified family members. (a) The Medicaid agency must provide Medicaid to a pregnant woman whose pregnancy has been medically verified and who— (1) Would be eligible for...

  12. 42 CFR 436.120 - Qualified pregnant women and children who are not qualified family members.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 42 Public Health 4 2011-10-01 2011-10-01 false Qualified pregnant women and children who are not... women and children who are not qualified family members. (a) The Medicaid agency must provide Medicaid to a pregnant woman whose pregnancy has been medically verified and who— (1) Would be eligible for an...

  13. 42 CFR 436.120 - Qualified pregnant women and children who are not qualified family members.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 42 Public Health 4 2014-10-01 2014-10-01 false Qualified pregnant women and children who are not... women and children who are not qualified family members. (a) The Medicaid agency must provide Medicaid to a pregnant woman whose pregnancy has been medically verified and who— (1) Would be eligible for...

  14. 42 CFR 436.120 - Qualified pregnant women and children who are not qualified family members.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 42 Public Health 4 2012-10-01 2012-10-01 false Qualified pregnant women and children who are not... women and children who are not qualified family members. (a) The Medicaid agency must provide Medicaid to a pregnant woman whose pregnancy has been medically verified and who— (1) Would be eligible for...

  15. 42 CFR 436.120 - Qualified pregnant women and children who are not qualified family members.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 42 Public Health 4 2013-10-01 2013-10-01 false Qualified pregnant women and children who are not... women and children who are not qualified family members. (a) The Medicaid agency must provide Medicaid to a pregnant woman whose pregnancy has been medically verified and who— (1) Would be eligible for...

  16. Considering Care-Seeking Behaviors Reveals Important Differences Among HIV-Positive Women Not Engaged in Care: Implications for Intervention

    PubMed Central

    Fletcher, Jason J.; Verdecias, Niko; Cunningham, Chinazo O.

    2015-01-01

    Abstract We sought to examine characteristics of HIV-positive women with varying levels of engagement in care and care-seeking behaviors. From 2010 to 2013, in a multi-site US-based study of engagement in care among HIV-positive women, we conducted baseline interviews, which included socio-demographic, clinical, and risk behavior characteristics, and barriers to care. We used multinomial logistic regression to compare differences among three distinct categories of 748 women: engaged in care; not engaged in care, but seeking care (“seekers”); and not engaged in care and not seeking care (“non-seekers”). Compared with women in care, seekers were more likely to be uninsured and to report fair or poor health status. In contrast, non-seekers were not only more likely to be uninsured, but, also, to report current high-risk drug use and sexual behaviors, and less likely to report transportation as a barrier to care. Examining care-seeking behaviors among HIV-positive women not engaged in care revealed important differences in high-risk behaviors. Because non-seekers represent a particularly vulnerable population of women who are not engaged in care, interventions targeting this population likely need to address drug use and be community-based given their limited interaction with the health care system. PMID:25561307

  17. The Association Between Internet Use and Ambulatory Care-Seeking Behaviors in Taiwan: A Cross-Sectional Study.

    PubMed

    Hsieh, Ronan Wenhan; Chen, Likwang; Chen, Tsung-Fu; Liang, Jyh-Chong; Lin, Tzu-Bin; Chen, Yen-Yuan; Tsai, Chin-Chung

    2016-12-07

    Compared with the traditional ways of gaining health-related information from newspapers, magazines, radio, and television, the Internet is inexpensive, accessible, and conveys diverse opinions. Several studies on how increasing Internet use affected outpatient clinic visits were inconclusive. The objective of this study was to examine the role of Internet use on ambulatory care-seeking behaviors as indicated by the number of outpatient clinic visits after adjusting for confounding variables. We conducted this study using a sample randomly selected from the general population in Taiwan. To handle the missing data, we built a multivariate logistic regression model for propensity score matching using age and sex as the independent variables. The questionnaires with no missing data were then included in a multivariate linear regression model for examining the association between Internet use and outpatient clinic visits. We included a sample of 293 participants who answered the questionnaire with no missing data in the multivariate linear regression model. We found that Internet use was significantly associated with more outpatient clinic visits (P=.04). The participants with chronic diseases tended to make more outpatient clinic visits (P<.01). The inconsistent quality of health-related information obtained from the Internet may be associated with patients' increasing need for interpreting and discussing the information with health care professionals, thus resulting in an increasing number of outpatient clinic visits. In addition, the media literacy of Web-based health-related information seekers may also affect their ambulatory care-seeking behaviors, such as outpatient clinic visits.

  18. Determinants of health care seeking for diarrheal illness in young children in urban slums of Kolkata, India.

    PubMed

    Manna, Byomkesh; Nasrin, Dilruba; Kanungo, Suman; Roy, Subhasis; Ramamurthy, Thandavarayan; Kotloff, Karen L; Levine, Myron M; Sur, Dipika

    2013-07-01

    Maternal practices regarding children's health care have been recognized as an important factor associated with mortality rates among children < 5 years of age. We focused on health care-seeking practices of primary caretakers of children < 5 years of age with diarrheal disease in Kolkata. We interviewed caretakers of 1,058 children in a baseline survey and 6,077 children on six subsequent surveys. The prevalence of diarrhea during the preceding 2 weeks was 7.9% in the baseline survey and 5.7% (lowest 3.5% to highest 7.8%) in subsequent surveys. Multivariate logistic regression showed that formal education of primary caretakers was associated with seeking care outside the home (odds ratio [OR] = 15.5; 95% confidence interval [CI] [2.5-85.7]; P = 0.002). Multinomial logistic regression showed that formal education of the primary caretaker (OR = 21.4; 95% CI [3.2-139.0]; P = 0.002) and presence of dry mouth during diarrhea (OR = 17.3; 95% CI [2.7-110.9]; P = 0.003) were associated with seeking care from licensed providers compared with the children for whom care was not sought outside of the home. This health care utilization and attitudes survey (HUAS) can serve as a tool to identify the factors that influence a better health care-seeking pattern in urban slums of Kolkata.

  19. Determinants of Health Care Seeking for Diarrheal Illness in Young Children in Urban Slums of Kolkata, India

    PubMed Central

    Manna, Byomkesh; Nasrin, Dilruba; Kanungo, Suman; Roy, Subhasis; Ramamurthy, Thandavarayan; Kotloff, Karen L.; Levine, Myron M.; Sur, Dipika

    2013-01-01

    Maternal practices regarding children's health care have been recognized as an important factor associated with mortality rates among children < 5 years of age. We focused on health care-seeking practices of primary caretakers of children < 5 years of age with diarrheal disease in Kolkata. We interviewed caretakers of 1,058 children in a baseline survey and 6,077 children on six subsequent surveys. The prevalence of diarrhea during the preceding 2 weeks was 7.9% in the baseline survey and 5.7% (lowest 3.5% to highest 7.8%) in subsequent surveys. Multivariate logistic regression showed that formal education of primary caretakers was associated with seeking care outside the home (odds ratio [OR] = 15.5; 95% confidence interval [CI] [2.5–85.7]; P = 0.002). Multinomial logistic regression showed that formal education of the primary caretaker (OR = 21.4; 95% CI [3.2–139.0]; P = 0.002) and presence of dry mouth during diarrhea (OR = 17.3; 95% CI [2.7–110.9]; P = 0.003) were associated with seeking care from licensed providers compared with the children for whom care was not sought outside of the home. This health care utilization and attitudes survey (HUAS) can serve as a tool to identify the factors that influence a better health care-seeking pattern in urban slums of Kolkata. PMID:23629936

  20. A Community-Based Intervention Designed to Increase Preventive Health Care Seeking Among Adolescents: The Gonorrhea Community Action Project

    PubMed Central

    VanDevanter, Nancy L.; Messeri, Peter; Middlestadt, Susan E.; Bleakley, Amy; Merzel, Cheryl R.; Hogben, Matthew; Ledsky, Rebecca; Malotte, C. Kevin; Cohall, Renee M.; Gift, Thomas L.; St. Lawrence, Janet S.

    2005-01-01

    Objectives. We evaluated the effectiveness of an intervention designed to increase preventive health care seeking among adolescents. Methods. Adolescents and young adults aged 12 to 21 years, recruited from community-based organizations in 2 different communities, were randomized into either a 3-session intervention or a control condition. We estimated outcomes from 3-month follow-up data using logistic and ordinary least squares regression. Results. Female intervention participants were significantly more likely than female control participants to have scheduled a health care appointment (odds ratio [OR]=3.04), undergone a checkup (OR=2.87), and discussed with friends or family members the importance of undergoing a checkup (OR=4.5). There were no differences between male intervention and male control participants in terms of outcomes. Conclusions. This theory-driven, community-based group intervention significantly increased preventive health care seeking among female adolescents. Further research is needed, however, to identify interventions that will produce successful outcomes among male adolescents. PMID:15671472

  1. Divorce, divorce rates, and professional care seeking for mental health problems in Europe: a cross-sectional population-based study

    PubMed Central

    2010-01-01

    Background Little is known about differences in professional care seeking based on marital status. The few existing studies show more professional care seeking among the divorced or separated compared to the married or cohabiting. The aim of this study is to determine whether, in a sample of the European general population, the divorced or separated seek more professional mental health care than the married or cohabiting, regardless of self-reported mental health problems. Furthermore, we examine whether two country-level features--the supply of mental health professionals and the country-level divorce rates--contribute to marital status differences in professional care-seeking behavior. Methods We use data from the Eurobarometer 248 on mental well-being that was collected via telephone interviews. The unweighted sample includes 27,146 respondents (11,728 men and 15,418 women). Poisson hierarchical regression models were estimated to examine whether the divorced or separated have higher professional health care use for emotional or psychological problems, after controlling for mental and somatic health, sociodemographic characteristics, support from family and friends, and degree of urbanization. We also considered country-level divorce rates and indicators of the supply of mental health professionals, and applied design and population weights. Results We find that professional care seeking is strongly need based. Moreover, the divorced or separated consult health professionals for mental health problems more often than people who are married or who cohabit do. In addition, we find that the gap between the divorced or separated and the married or cohabiting is highest in countries with low divorce rates. Conclusions The higher rates of professional care seeking for mental health problems among the divorced or separated only partially correlates with their more severe mental health problems. In countries where marital dissolution is more common, the marital status

  2. Divorce, divorce rates, and professional care seeking for mental health problems in Europe: a cross-sectional population-based study.

    PubMed

    Bracke, Piet F; Colman, Elien; Symoens, Sara A A; Van Praag, Lore

    2010-04-29

    Little is known about differences in professional care seeking based on marital status. The few existing studies show more professional care seeking among the divorced or separated compared to the married or cohabiting. The aim of this study is to determine whether, in a sample of the European general population, the divorced or separated seek more professional mental health care than the married or cohabiting, regardless of self-reported mental health problems. Furthermore, we examine whether two country-level features--the supply of mental health professionals and the country-level divorce rates--contribute to marital status differences in professional care-seeking behavior. We use data from the Eurobarometer 248 on mental well-being that was collected via telephone interviews. The unweighted sample includes 27,146 respondents (11,728 men and 15,418 women). Poisson hierarchical regression models were estimated to examine whether the divorced or separated have higher professional health care use for emotional or psychological problems, after controlling for mental and somatic health, sociodemographic characteristics, support from family and friends, and degree of urbanization. We also considered country-level divorce rates and indicators of the supply of mental health professionals, and applied design and population weights. We find that professional care seeking is strongly need based. Moreover, the divorced or separated consult health professionals for mental health problems more often than people who are married or who cohabit do. In addition, we find that the gap between the divorced or separated and the married or cohabiting is highest in countries with low divorce rates. The higher rates of professional care seeking for mental health problems among the divorced or separated only partially correlates with their more severe mental health problems. In countries where marital dissolution is more common, the marital status gap in professional care seeking is

  3. Association between caregivers' knowledge and care seeking behaviour for children with symptoms of pneumonia in six sub-Saharan African Countries.

    PubMed

    Noordam, Aaltje Camielle; Sharkey, Alyssa B; Hinssen, Paddy; Dinant, GeertJan; Cals, Jochen W L

    2017-02-02

    Pneumonia is the main cause of child mortality world-wide and most of these deaths occur in sub-Saharan Africa (SSA). Treatment with effective antibiotics is crucial to prevent these deaths; nevertheless only 2 out of 5 children with symptoms of pneumonia are taken to an appropriate care provider in SSA. While various factors associated with care seeking have been identified, the relationship between caregivers' knowledge of pneumonia symptoms and actual care seeking for their child with symptoms of pneumonia is not well researched. Based on data from Multiple Indicator Cluster Surveys, we assessed the association between caregivers' knowledge of symptoms related to pneumonia - namely fast or difficulty breathing - and care seeking behaviour for these symptoms. We analysed data of 4,163 children with symptoms of pneumonia and their caregivers. A Chi-square tests and multivariable logistic regression was performed to assess the association between care seeking and knowledge of at least one symptom (i.e., fast or difficulty breathing). Across all 6 countries only around 30% of caregivers were aware of at least one of the two symptoms of pneumonia (i.e., fast or difficulty breathing). Our study shows that in the Democratic Republic of the Congo and Nigeria there was a positive association between knowledge and care seeking (P ≤ 0.01), even after adjusting for key variables (including wealth, residence, education). We found no association between caregivers' knowledge of pneumonia symptoms and actual care seeking for their child with symptoms of pneumonia in Central African Republic, Chad, Malawi, and Sierra Leone. These findings reveal an urgent need to increase community awareness of pneumonia symptoms, while simultaneously designing context specific strategies to address the fundamental challenges associated with timely care seeking.

  4. Care-seeking behavior by survivors of sexual assault in the Democratic Republic of the Congo.

    PubMed

    Casey, Sara E; Gallagher, Meghan C; Makanda, Babou Rukengeza; Meyers, Janet L; Vinas, Mereia Cano; Austin, Judy

    2011-06-01

    In February 2008, trained female interviewers collected data on sexual violence and use of medical services following sexual assault from 607 women in the Democratic Republic of the Congo (DRC). Exposure to sexual violence during the DRC's civil war was reported by 17.8% of the women; 4.8% of the women reported exposure to sexual violence after the war. Few sexual-assault survivors accessed timely medical care. Facility assessments showed that this care was rarely available. Clinical care for sexual-assault survivors must be integrated into primary health care for DRC women.

  5. Prevalence of Unmet Health Care needs and description of health care-seeking behavior among displaced people after the 2007 California wildfires.

    PubMed

    Jenkins, J Lee; Hsu, Edbert B; Sauer, Lauren M; Hsieh, Yu-Hsiang; Kirsch, Thomas D

    2009-06-01

    The southern California wildfires in autumn 2007 resulted in widespread disruption and one of the largest evacuations in the state's history. This study aims to identify unmet medical needs and health care-seeking patterns as well as prevalence of acute and chronic disease among displaced people following the southern California wildfires. These data can be used to increase the accuracy, and therefore capacity, of the medical response. A team of emergency physicians, nurses, and epidemiologists conducted surveys of heads of households at shelters and local assistance centers in San Diego and Riverside counties for 3 days beginning 10 days postdisaster. All households present in shelters on the day of the survey were interviewed, and at the local assistance centers, a 2-stage sampling method was used that included selecting a sample size proportionate to the number of registered visits to that site compared with all sites followed by a convenience sampling of people who were not actively being aided by local assistance center personnel. The survey covered demographics; needs following the wildfires (shelter, food, water, and health care); acute health symptoms; chronic health conditions; access to health care; and access to prescription medications. Among the 175 households eligible, 161 (92.0%) households participated. Within the 47 households that reported a health care need since evacuation, 13 (27.7%) did not receive care that met their perceived need. Need for prescription medication was reported by 47 (29.2%) households, and 20 (42.6%) of those households did not feel that their need for prescription medication had been met. Mental health needs were reported by 14 (8.7%) households with 7 of these (50.0%) reporting unmet needs. At least 1 family member per household left prescription medication behind during evacuation in 46 households (28.6%), and 1 family member in 48 households (29.8%) saw a health care provider since their evacuation. Most people sought

  6. Program synergies and social relations: implications of integrating HIV testing and counselling into maternal health care on care seeking.

    PubMed

    An, Selena J; George, Asha S; LeFevre, Amnesty; Mpembeni, Rose; Mosha, Idda; Mohan, Diwakar; Yang, Ann; Chebet, Joy; Lipingu, Chrisostom; Killewo, Japhet; Winch, Peter; Baqui, Abdullah H; Kilewo, Charles

    2015-01-21

    Women and children in sub-Saharan Africa bear a disproportionate burden of HIV/AIDS. Integration of HIV with maternal and child services aims to reduce the impact of HIV/AIDS. To assess the potential gains and risks of such integration, this paper considers pregnant women's and providers' perceptions about the effects of integrated HIV testing and counselling on care seeking by pregnant women during antenatal care in Tanzania. From a larger evaluation of an integrated maternal and newborn health care program in Morogoro, Tanzania, this analysis included a subset of information from 203 observations of antenatal care and interviews with 57 providers and 190 pregnant women from 18 public health centers in rural and peri-urban settings. Qualitative data were analyzed manually and with Atlas.ti using a framework approach, and quantitative data of respondents' demographic information were analyzed with Stata 12.0. Perceptions of integrating HIV testing with routine antenatal care from women and health providers were generally positive. Respondents felt that integration increased coverage of HIV testing, particularly among difficult-to-reach populations, and improved convenience, efficiency, and confidentiality for women while reducing stigma. Pregnant women believed that early detection of HIV protected their own health and that of their children. Despite these positive views, challenges remained. Providers and women perceived opt out HIV testing and counselling during antenatal services to be compulsory. A sense of powerlessness and anxiety pervaded some women's responses, reflecting the unequal relations, lack of supportive communications and breaches in confidentiality between women and providers. Lastly, stigma surrounding HIV was reported to lead some women to discontinue services or seek care through other access points in the health system. While providers and pregnant women view program synergies from integrating HIV services into antenatal care positively, lack

  7. Illness recognition, home care, and care-seeking for sick infants less than two months of age in Shebedino District, Sidama Zone, Ethiopia.

    PubMed

    Tefera, Worku; Tesfaye, Hailu; Kayessa, Elias; Waltensperger, Karen Z; Tadesse, Yenealem; Marsh, David R

    2014-10-01

    The incidence of newborn and young infant health danger signs is unknown in Ethiopia. Neverthe- less, experience shows that care-seeking is far lower than conservative morbidity estimates would project. To examine illness recognition, home care, decision-making, and care-seeking for sick infants less than two months of age in Shebedino District, Southern Nations, Nationalities and Peoples Region in 2011. Focus group interviews of mothers (n = 60) of recently ill children. Mothers reported recognizing many, but not all, evidence-based newborn danger signs. Home care ranged from probably harmless to harmful and delayed definitive care-seeking. Decision-making was widespread, but patterns of care-seeking rarely led to prompt, evidence-based care. Mothers reported 10 barriers to care- seeking at health posts: lack of knowledge about availability of curative services, fear of evil eye, social stigma, perceived financial barrier, perceived young infant fragility, an elder's contrary advice, distance, husband's re- fusal, fear of injection, and belief in recovery without medicine. Young infants are more vulnerable to illness than their older counterparts, yet they are less likely to receive the care they need without a targeted, contextualized communication strategy to generate demand for case management services that are accessible, available, and of good quality.

  8. Urban–Rural Differences in Health-Care-Seeking Pattern of Residents of Abia State, Nigeria, and the Implication in the Control of NCDs

    PubMed Central

    Onyeonoro, Ugochukwu U.; Ogah, Okechukwu S.; Ukegbu, Andrew U.; Chukwuonye, Innocent I.; Madukwe, Okechukwu O.; Moses, Akhimiem O.

    2016-01-01

    BACKGROUND Understanding the differences in care-seeking pattern is key in designing interventions aimed at improving health-care service delivery, including prevention and control of noncommunicable diseases. The aim of this study was to identify the differences and determinants of care-seeking patterns of urban and rural residents in Abia State in southeast Nigeria. METHODS This was a cross-sectional, community-based, study involving 2999 respondents aged 18 years and above. Data were collected using the modified World Health Organization’s STEPS questionnaire, including data on care seeking following the onset of illness. Descriptive statistics and logistic regressions were used to analyze care-seeking behavior and to identify differences among those seeking care in urban and rural areas. RESULTS In both urban and rural areas, patent medicine vendors (73.0%) were the most common sources of primary care following the onset of illness, while only 20.0% of the participants used formal care. Significant predictors of difference in care-seeking practices between residents in urban and rural communities were educational status, income, occupation, and body mass index. CONCLUSIONS Efforts should be made to reduce barriers to formal health-care service utilization in the state by increasing health insurance coverage, strengthening the health-care system, and increasing the role of patent medicine vendors in the formal health-care delivery system. PMID:27721654

  9. Cause, nature and care-seeking behaviour for injuries among community-dwelling older adults, USA, 2004-2013.

    PubMed

    Xu, Dongjuan; Drew, Julia A Rivera

    2016-02-01

    To describe the cause and nature of injuries, and care-seeking behaviour following injury, among community-dwelling older adults. We used 10 years of the nationally representative Integrated Health Interview Series data, providing information on individual characteristics, cause and nature of injuries, and care-seeking behaviour for 3074 adults 65 years of age and older. Univariate and bivariate analyses were used to evaluate overall patterns and test for group-level differences. Approximately 40% of injuries were characterised as hip fracture, head injury and/or other fracture, with the remaining 60% consisting of other, milder types of injuries like bruises, strains and sprains. Fifty-eight per cent of injuries required a visit to the emergency room or transportation via an emergency vehicle, and 19% required hospitalisation. Injuries sustained in a fall were more likely to be serious than those due to other reasons. Older women, those ages 80+, those living with others with no spouse or partner present and those with activities of daily living/instrumental activities of daily living disabilities were more vulnerable to serious injuries and serious injury consequences relative to other older adults. Our results suggest that injuries, especially falls, are a pressing public health concern for the growing population of older adults. Injury prevention outreach should take extra measures to reach certain subgroups of older adults that have been identified as especially vulnerable. Because so many injuries are due to reasons other than falling and/or do not result in hospitalisation, more interventions should be designed for general injury prevention and outpatient settings. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  10. The Association Between Internet Use and Ambulatory Care-Seeking Behaviors in Taiwan: A Cross-Sectional Study

    PubMed Central

    Chen, Tsung-Fu; Liang, Jyh-Chong; Lin, Tzu-Bin; Tsai, Chin-Chung

    2016-01-01

    Background Compared with the traditional ways of gaining health-related information from newspapers, magazines, radio, and television, the Internet is inexpensive, accessible, and conveys diverse opinions. Several studies on how increasing Internet use affected outpatient clinic visits were inconclusive. Objective The objective of this study was to examine the role of Internet use on ambulatory care-seeking behaviors as indicated by the number of outpatient clinic visits after adjusting for confounding variables. Methods We conducted this study using a sample randomly selected from the general population in Taiwan. To handle the missing data, we built a multivariate logistic regression model for propensity score matching using age and sex as the independent variables. The questionnaires with no missing data were then included in a multivariate linear regression model for examining the association between Internet use and outpatient clinic visits. Results We included a sample of 293 participants who answered the questionnaire with no missing data in the multivariate linear regression model. We found that Internet use was significantly associated with more outpatient clinic visits (P=.04). The participants with chronic diseases tended to make more outpatient clinic visits (P<.01). Conclusions The inconsistent quality of health-related information obtained from the Internet may be associated with patients’ increasing need for interpreting and discussing the information with health care professionals, thus resulting in an increasing number of outpatient clinic visits. In addition, the media literacy of Web-based health-related information seekers may also affect their ambulatory care-seeking behaviors, such as outpatient clinic visits. PMID:27927606

  11. Care-seeking behaviour and diagnostic processes for symptomatic giardiasis in children attending an academic paediatric hospital.

    PubMed

    Escobedo, Angel A; Almirall, Pedro; Ávila, Ivonne; Salazar, Yohana; Alfonso, Maydel

    2014-09-01

    Giardiasis is one of the commonest intestinal parasitic infections in Cuba. In order to determine care-seeking behaviour and diagnostic processes in paediatric in-patients with giardiasis, structured questionnaires were administered by interview mothers of children with giardiasis during January to December 2010. During the study period, 97 children were diagnosed with giardiasis, of whom 86 (88·6%) caregivers were interviewed. The median number of days from symptoms onset to the first presentation in a health unit was 2 days (range: 0-15 days). The pattern of care-seeking behaviour was variable; 41 (47·7%) of children initially visited the emergency unit in a paediatric hospital. Sixty-six children had, at least, one further contact for help before diagnosis of giardiasis was made (range: 1-5 contacts) and of the 128 contact visits, 94 (73·4%) were also targeted more to hospitals. There was a median time of 6 days between the first presentation to a health unit until diagnosis, which was mainly made by microscopic examination of duodenal aspiration. Among factors investigated in mothers, only knowing other person with giardiasis had significant association with their ability to suspect giardiasis [odds ratio (OR): 29·8, 95% confidence interval (CI): 3·71-239·4, P = 0·001]. Requesting a faecal specimen or ordering duodenal aspiration for microscopic examination during the first visit appeared associated with correct diagnosis (OR: 3·84, 95% CI: 1·57-9·40, P = 0·003). Efforts should be made to increase doctors' awareness of- and diagnostic skills for childhood giardiasis. At the same time, it is necessary to improve caregivers' awareness about giardiasis.

  12. Care-seeking behaviour and diagnostic processes for symptomatic giardiasis in children attending an academic paediatric hospital

    PubMed Central

    Escobedo, Angel A; Almirall, Pedro; Ávila, Ivonne; Salazar, Yohana; Alfonso, Maydel

    2014-01-01

    Giardiasis is one of the commonest intestinal parasitic infections in Cuba. In order to determine care-seeking behaviour and diagnostic processes in paediatric in-patients with giardiasis, structured questionnaires were administered by interview mothers of children with giardiasis during January to December 2010. During the study period, 97 children were diagnosed with giardiasis, of whom 86 (88.6%) caregivers were interviewed. The median number of days from symptoms onset to the first presentation in a health unit was 2 days (range: 0–15 days). The pattern of care-seeking behaviour was variable; 41 (47.7%) of children initially visited the emergency unit in a paediatric hospital. Sixty-six children had, at least, one further contact for help before diagnosis of giardiasis was made (range: 1–5 contacts) and of the 128 contact visits, 94 (73.4%) were also targeted more to hospitals. There was a median time of 6 days between the first presentation to a health unit until diagnosis, which was mainly made by microscopic examination of duodenal aspiration. Among factors investigated in mothers, only knowing other person with giardiasis had significant association with their ability to suspect giardiasis [odds ratio (OR): 29.8, 95% confidence interval (CI): 3.71–239.4, P = 0.001]. Requesting a faecal specimen or ordering duodenal aspiration for microscopic examination during the first visit appeared associated with correct diagnosis (OR: 3.84, 95% CI: 1.57–9.40, P = 0.003). Efforts should be made to increase doctors’ awareness of- and diagnostic skills for childhood giardiasis. At the same time, it is necessary to improve caregivers’ awareness about giardiasis. PMID:25253040

  13. Finding Medical Care for Colorectal Cancer Symptoms: Experiences among Those Facing Financial Barriers

    ERIC Educational Resources Information Center

    Thomson, Maria D.; Siminoff, Laura A.

    2015-01-01

    Financial barriers can substantially delay medical care seeking. Using patient narratives provided by 252 colorectal cancer patients, we explored the experience of financial barriers to care seeking. Of the 252 patients interviewed, 84 identified financial barriers as a significant hurdle to obtaining health care for their colorectal cancer…

  14. Finding Medical Care for Colorectal Cancer Symptoms: Experiences among Those Facing Financial Barriers

    ERIC Educational Resources Information Center

    Thomson, Maria D.; Siminoff, Laura A.

    2015-01-01

    Financial barriers can substantially delay medical care seeking. Using patient narratives provided by 252 colorectal cancer patients, we explored the experience of financial barriers to care seeking. Of the 252 patients interviewed, 84 identified financial barriers as a significant hurdle to obtaining health care for their colorectal cancer…

  15. Effect of residence on mothers' health care seeking behavior for common childhood illness in Northwest Ethiopia: a community based comparative cross--sectional study.

    PubMed

    Gelaw, Yalemzewod Assefa; Biks, Gashaw Andargie; Alene, Kefyalew Addis

    2014-10-08

    Children are at higher risk of acquiring infections and developing severe disease. This study assessed the health care seeking behavior and associated factors of urban and rural mothers for common childhood illness in Northwest Ethiopia. A comparative community based cross-sectional study was conducted among urban and rural mothers living in the district. A multistage sampling technique was used to select the study participants. A pre-tested and structured questioner via interview was used to collect the data. Binary logistic regression analysis was used to identify associated factors. Odds ratio with 95% CI was computed to assess the strength of the associations. A total of 827 (274 urban and 553 rural) mothers were interviewed. Among these, 79.3% (95% CI: (76.5%, 82.06%)) of the mothers were sought health care in the district. Health care seeking behavior was higher among urban mothers (84.6%) than rural mothers (76.7%). Marital status, completion health extension package, and sex of child were significantly associated with health care seeking behavior of urban mothers. Whereas age of child, age and occupation of mothers, educational level of fathers, wealth quintile, and type of reported illness were significantly associated with rural mothers. Perceived severity of illness was significantly associated with both urban and rural mothers for health care seeking behavior. The overall health seeking behaviors of mothers for common childhood illness was high. However, urban mothers seek health care more than rural. Socio Economic position and types of reported illness has an effect for health seeking behavior of rural mothers. Whereas child sex preference and graduation status for health extension package has an effect for health care seeking behavior of urban mothers. Work on strengthen accessibility of health care services in the rural mothers and increase awareness of mothers about the disadvantage of sex preferences will improve the health care seek behavior of

  16. A comprehensive systematic review of the use of simulation in the continuing education and training of qualified medical, nursing and midwifery staff.

    PubMed

    Elliott, Sharon; Murrell, Karen; Harper, Peter; Stephens, Tim; Pellowe, Carol

    2011-01-01

    Simulation can be defined as a person, device or set of conditions made to resemble a real life situation. It is used in many high-risk industries particularly when reality is dangerous, critical events are rare and errors are costly in human and/or financial terms. The use of simulation in the UK is now considered an essential component of education programmes designed for healthcare practitioners. However the use of simulation in undergraduate education has been studied in depth but little is known about its use in postgraduate education. The aim of this systematic review was to establish: where and in which context is simulation an effective educational medium in post qualifying/continuing education; what is the benefit to learners of using simulation in respect of their knowledge, skills and confidence and what are the implications for future research in this area? This review looked for both quantitative and qualitative evidence in the form of primary research.The review focused on post qualification medical, nursing and midwifery staff undertaking educational development programmes utilising simulation. Types of interventions: the intervention explored in this review is simulation in the form of the re-creation of a patient centred scenario / event in a realistic context. The review explicitly excluded simulation designed to specifically to improve motor skills in isolation from context, such as part task trainers. The outcome measures to be explored in this review were: demonstration of the application of knowledge to the simulated clinical situation; demonstrable improvement in knowledge of the environment and equipment; demonstration of risk assessment; safe working practice in relation to the clinical environment; recognition of own limitations and knowing when to call for help; effective communication; team working and leadership skills; evidence from learners in relation to the educational experience; evidence of increased learner confidence following

  17. Functional consequences and health-care seeking behaviour for recurrent non-specific low back pain in Zimbabwean adolescents: a cross-sectional study.

    PubMed

    Chiwaridzo, Matthew; Naidoo, Nirmala

    2016-02-01

    The purpose of the study was to investigate the consequences of recurrent non-specific low back pain in Zimbabwean adolescents. Recurrent non-specific low back pain is a common cause of adult disability in low-income countries. However, its impact in adolescents has been a matter of debate in the literature. A survey was conducted using a cluster sample of 544 school children between the ages of 13 and 19 years. The school children were randomly selected from government-administered secondary schools in Harare, Zimbabwe. Parental and students' response rate were 90.3 and 97.8 %, respectively. Almost a third (28.8 %) of school children reported recurrent symptoms (CI 27.8-31.6). However, the majority (84 %) of these cases were unknown to parents. Twenty-seven percent reported having sought medical treatment. On the nine-item Hanover Low Back Pain Disability Questionnaire, 71.2 % of school children had at least one activity of daily living compromised by recurrent NSLBP, especially sports participation. However, severe disability was reported in 28 % of the adolescents. Health-care seeking behaviour was not associated with the level of disability [χ (2)(1) = 0.36, p = 0.55]. Although most parents are unaware, recurrent NSLBP is common in Zimbabwean school children. However, treatment is rarely sought for the symptoms. A preponderance of adolescents with recurrent NSLBP experiences some degree of functional consequences, although severe disability is rare. There is need to raise awareness of the condition in schools and to parents. Spinal health educational programmes may need to be implemented to avert the functional consequences. Further studies are needed in the future to investigate the coping strategies for pain in adolescents.

  18. Influence of beliefs about health and illness on self-care and care-seeking in foreign-born people with diabetic foot ulcers: dissimilarities related to origin.

    PubMed

    Hjelm, K; Apelqvist, J

    2016-11-02

    To describe beliefs about health and illness among foreign-born people with diabetic foot ulcers that might affect self-reported self-care and health-care seeking and to study whether there are dissimilarities related to origin. Qualitative descriptive study. Semi-structured interviews with people aged 38-86 years; 13 born in European and 13 in non-European countries (all except one in the Middle East). All resident in Sweden for 7-60 years (median: 18.5 years). Most believed foot ulcers were unavoidable and difficult to detect. Foot problems were mainly believed to be due to internal factors (diabetes), sometimes combined with external factors (inappropriate footwear, hot water, or barefoot walking). Health was described as freedom from illness and health professionals were seen as important sources of information. Perceived health deteriorated after the onset of the foot problems due to immobility and pain. People from the Middle East differed from other respondents as they discussed the importance of adapting to the will of Allah, leading to even poorer quality of life and a more negative view of future health. They also described more foot problems and perceived religion (Islam) with ritual washing of the feet to be important for health. However, they were regularly monitored to a lesser extent than European migrants. Economy affected health, more so in Europeans, due to expenses for medications and shoes. Many described limited activity in self-care, few had sought help for their problems and then solely among professionals, and had limited knowledge about the influence of glycaemic control on diabetes and foot status. Foreign-born people felt unable to prevent the incidence of foot ulcers, experienced problems with detection, and had limited knowledge of self-care. Dissimilarities in beliefs related to origin negatively influenced self-care of the feet, so it is important to assess individual beliefs and plan care and education accordingly.

  19. Mental disorders and health care seeking in Bandiagara: a community survey in the Dogon Plateau.

    PubMed

    Carta, M G; Coppo, P; Carpiniello, B; Mounkuoro, P P

    1997-05-01

    A two-level community study was carried out among the Peul and Dogon populations of the Bandiagara plateau (Mali). For the purpose of the study the Questionnaire pour le depistage en santé mentale (QDSM), a 23-item screening questionnaire derived from the Self-Reporting Questionnaire (SRQ), was adapted and validated; internal consistency and accuracy were evaluated. In the first phase of the study, 466 subjects randomly selected on a residential basis were evaluated by means of the QDSM. In the second phase all subjects who were "positive" at the screening, as well as a sample who were "negative", were examined by means of a semistructured interview. When necessary, clinical and laboratory investigations were performed. The estimated prevalence of psychiatric cases was 6.4%. A significant risk was associated with age and education. Somatic diseases frequently associated with psychiatric disorders were genitourinary tract disorders, tuberculosis and disabling cardiopathies. The main factor determining the seeking of medical help either through traditional of conventional health systems was the presence of a somatic disorder. The presence of a true minor psychiatric disorder, however, was often associated with divining practices.

  20. Screening utility, local perceptions, and care-seeking for reported jaundeesh among respondents lacking signs of icterus in rural Bangladesh.

    PubMed

    Hossain, Mohammad Z; Sikder, Shegufta S; Zaman, K; Saha, Parimalendu; Yunus, Mohammad; Nelson, Kenrad E; Labrique, Alain B

    2013-09-01

    In rural Bangladesh, acute viral hepatitis presents a significant burden on the public-health system. As part of the formative work for a large epidemiologic study of hepatitis E in rural Bangladesh, we sought to identify local terms that could be used for population-based screening of acute viral hepatitis. Exploration of the local term jaundeesh for screening utility identified a high burden of reported jaundeesh among individuals without symptoms of icterus. Recognizing that local perceptions of illness may differ from biomedical definitions of disease, we also sought to characterize the perceived aetiology, care-seeking patterns, diagnostic symptoms, and treatments for reported jaundeesh in the absence of icteric symptoms to inform future population-based studies on reported morbidities. We conducted a cross-sectional survey among 1,441 randomly-selected subjects to identify the prevalence of reported jaundeesh and to test the validity of this local term to detect signs of icterus. To characterize the perceived aetiology and care-seeking patterns for jaundeesh among the majority of respondents, we conducted in-depth interviews with 100 respondents who self-reported jaundeesh but lacked clinical signs of icterus. To describe diagnostic symptoms and treatments, in-depth interviews were also performed with 25 kabirajs or traditional faith healers commonly visited for jaundeesh. Of the 1,441 randomly-selected participants, one-fourth (n=361) reported jaundeesh, with only a third (n=122) reporting yellow eyes or skin, representative of icterus; Jaundeesh had a positive predictive value of 34% for detection of yellow eyes or skin. Anicteric patients with reported jaundeesh perceived their illnesses to result from humoral imbalances, most commonly treated by amulets, ritual handwashing, and bathing with herbal medicines. Jaundeesh patients primarily sought folk and spiritual remedies from informal care providers, with only 19% visiting allopathic care providers

  1. Community perceptions on malaria and care-seeking practices in endemic Indian settings: policy implications for the malaria control programme

    PubMed Central

    2013-01-01

    Background The focus of India’s National Malaria Programme witnessed a paradigm shift recently from health facility to community-based approaches. The current thrust is on diagnosing and treating malaria by community health workers and prevention through free provision of long-lasting insecticidal nets. However, appropriate community awareness and practice are inevitable for the effectiveness of such efforts. In this context, the study assessed community perceptions and practice on malaria and similar febrile illnesses. This evidence base is intended to direct the roll-out of the new strategies and improve community acceptance and utilization of services. Methods A qualitative study involving 26 focus group discussions and 40 key informant interviews was conducted in two districts of Odisha State in India. The key points of discussion were centred on community perceptions and practice regarding malaria prevention and treatment. Thematic analysis of data was performed. Results The 272 respondents consisted of 50% females, three-quarter scheduled tribe community and 30% students. A half of them were literates. Malaria was reported to be the most common disease in their settings with multiple modes of transmission by the FGD participants. Adoption of prevention methods was seasonal with perceived mosquito density. The reported use of bed nets was low and the utilization was determined by seasonality, affordability, intoxication and alternate uses of nets. Although respondents were aware of malaria-related symptoms, care-seeking from traditional healers and unqualified providers was prevalent. The respondents expressed lack of trust in the community health workers due to frequent drug stock-outs. The major determinants of health care seeking were socio-cultural beliefs, age, gender, faith in the service provider, proximity, poverty, and perceived effectiveness of available services. Conclusion Apart from the socio-cultural and behavioural factors, the availability of

  2. Pattern and predictors of maternal care-seeking practices for severe neonatal jaundice in Nigeria: a multi-centre survey

    PubMed Central

    2014-01-01

    Background Nigeria is frequently associated with disproportionately high rates of severe neonatal jaundice (NNJ) underpinned by widespread Glucose-6-phosphate dehydrogenase (G6PD) deficiency. Timely and appropriate treatment of NNJ is crucial for preventing the associated morbidity and neuro-developmental sequelae. Since mothers are likely to be the first mostly to observe the onset of severe illness in their newborns, we set out to identify the pattern and predictors of maternal care-seeking practices for NNJ in three culturally-distinct settings in Nigeria. Methods A multi-centre study was conducted among women attending antenatal clinics in Abuja, Lagos and Port Harcourt from October 2011 to April 2012 using a pretested questionnaire. Predictors of awareness of NNJ, accurate recognition of NNJ, use of potentially harmful therapies and preference for future hospital treatment were determined with multivariate logistic regressions. Results Of the 488 participants drawn from the three locations, 431 (88.3%) reported awareness of NNJ, predominantly (57.8%) attributable to professional health workers. A total of 309 (63.3%) mothers with prior knowledge of NNJ claimed they could recognise NNJ, but 270 (87.4%) from this group accurately identified the features of NNJ. Multiparous mothers (Adjusted odds ratio, AOR:4.05; 95% CI:1.75-9.36), those with tertiary education (AOR:1.91; CI:1.01-3.61), and those residing in Lagos (AOR:2.96; CI:1.10-7.97) were more likely to have had prior knowledge of NNJ. Similarly, multiparous mothers (AOR:2.38; CI:1.27-4.46) and those with tertiary education (AOR:1.92; CI:1.21-3.05) were more likely to recognise an infant with jaundice accurately. Mothers educated by health workers were 40% less likely to resort to potentially harmful treatment for NNJ (AOR:0.60; CI:0.39-0.92) but more likely to seek hospital treatment in future for an infant suspected with jaundice (AOR:1.88; CI:1.20-2.95). Conclusions Women with tertiary education and

  3. ISS qualified thermal carrier equipment

    NASA Astrophysics Data System (ADS)

    Deuser, Mark S.; Vellinger, John C.; Jennings, Wm. M.

    2000-01-01

    Biotechnology is undergoing a period of rapid and sustained growth, a trend which is expected to continue as the general population ages and as new medical treatments and products are conceived. As pharmaceutical and biomedical companies continue to search for improved methods of production and, for answers to basic research questions, they will seek out new avenues of research. Space processing on the International Space Station (ISS) offers such an opportunity! Space is rapidly becoming an industrial laboratory for biotechnology research and processing. Space bioprocessing offers exciting possibilities for developing new pharmaceuticals and medical treatments, which can be used to benefit mankind on Earth. It also represents a new economic frontier for the private sector. For over eight years, the thermal carrier development team at SHOT has been working with government and commercial sector scientists who are conducting microgravity experiments that require thermal control. SHOT realized several years ago that the hardware currently being used for microgravity thermal control was becoming obsolete. It is likely that the government, academic, and industrial bioscience community members could utilize SHOT's hardware as a replacement to their current microgravity thermal carrier equipment. Moreover, SHOT is aware of several international scientists interested in utilizing our space qualified thermal carrier. SHOT's economic financing concept could be extremely beneficial to the international participant, while providing a source of geographic return for their particular region. Beginning in 2000, flight qualified thermal carriers are expected to be available to both the private and government sectors. .

  4. Strategies for improving health care seeking for maternal and newborn illnesses in low- and middle-income countries: a systematic review and meta-analysis.

    PubMed

    Lassi, Zohra S; Middleton, Philippa F; Bhutta, Zulfiqar A; Crowther, Caroline

    2016-01-01

    Lack of appropriate health care seeking for ill mothers and neonates contributes to high mortality rates. A major challenge is the appropriate mix of strategies for creating demand as well as provision of services. Systematic review and meta-analysis of experimental studies (last search: Jan 2015) to assess the impact of different strategies to improve maternal and neonatal health care seeking in low- and middle-income countries (LMIC). Fifty-eight experimental [randomized controlled trials (RCTs), non-RCTs, and before-after studies] with 310,652 participants met the inclusion criteria. Meta-analyses from 29 RCTs with a range of different interventions (e.g. mobilization, home visitation) indicated significant improvement in health care seeking for neonatal illnesses when compared with standard/no care [risk ratio (RR) 1.40; 95 confidence interval (CI): 1.17-1.68, 9 studies, n=30,572], whereas, no impact was seen on health care seeking for maternal illnesses (RR 1.06; 95% CI: 0.92-1.22, 5 studies, n=15,828). These interventions had a significant impact on reducing stillbirths (RR 0.82; 95% CI: 0.73-0.93, 11 studies, n=176,683), perinatal deaths (RR 0.84; 95% CI: 0.77-0.90, 15 studies, n=279,618), and neonatal mortality (RR 0.80; 95% CI: 0.72-0.89, 20 studies, n=248,848). On GRADE approach, evidence was high quality except for the outcome of maternal health care seeking, which was moderate. Community-based interventions integrating strategies such as home visiting and counseling can help to reduce fetal and neonatal mortality in LMIC.

  5. Plausible role for CHW peer support groups in increasing care-seeking in an integrated community case management project in Rwanda: a mixed methods evaluation.

    PubMed

    Langston, Anne; Weiss, Jennifer; Landegger, Justine; Pullum, Thomas; Morrow, Melanie; Kabadege, Melene; Mugeni, Catherine; Sarriot, Eric

    2014-08-01

    The Kabeho Mwana project (2006-2011) supported the Rwanda Ministry of Health (MOH) in scaling up integrated community case management (iCCM) of childhood illness in 6 of Rwanda's 30 districts. The project trained and equipped community health workers (CHWs) according to national guidelines. In project districts, Kabeho Mwana staff also trained CHWs to conduct household-level health promotion and established supervision and reporting mechanisms through CHW peer support groups (PSGs) and quality improvement systems. The 2005 and 2010 Demographic and Health Surveys were re-analyzed to evaluate how project and non-project districts differed in terms of care-seeking for fever, diarrhea, and acute respiratory infection symptoms and related indicators. We developed a logit regression model, controlling for the timing of the first CHW training, with the district included as a fixed categorical effect. We also analyzed qualitative data from the final evaluation to examine factors that may have contributed to improved outcomes. While there was notable improvement in care-seeking across all districts, care-seeking from any provider for each of the 3 conditions, and for all 3 combined, increased significantly more in the project districts. CHWs contributed a larger percentage of consultations in project districts (27%) than in non-project districts (12%). Qualitative data suggested that the PSG model was a valuable sub-level of CHW organization associated with improved CHW performance, supervision, and social capital. The iCCM model implemented by Kabeho Mwana resulted in greater improvements in care-seeking than those seen in the rest of the country. Intensive monitoring, collaborative supervision, community mobilization, and CHW PSGs contributed to this success. The PSGs were a unique contribution of the project, playing a critical role in improving care-seeking in project districts. Effective implementation of iCCM should therefore include CHW management and social support

  6. Perceptions, health care seeking behaviour and implementation of a tuberculosis control programme in Lambaréné, Gabon.

    PubMed

    Cremers, A L; Janssen, S; Huson, M A M; Bikene, G; Bélard, S; Gerrets, R P M; Grobusch, M P

    2013-12-21

    Lambaréné, Gabon. To describe patient perceptions of tuberculosis (TB) and to determine factors that influence health care seeking behaviour to gain insight into the management of multidrug-resistant TB. Participant observation, in-depth semi-structured interviews and focus group discussions were conducted with 30 TB patients, 36 relatives, 11 health care providers and 18 traditional/spiritual healers. Recruitment of patients was linked to the PanEpi study and took place at the Albert Schweitzer Hospital, the General Hospital and the TB-HIV (human immunodeficiency virus) clinic. Patients generally described TB as a natural and/or magical disease. The majority of the patients combined treatment at the hospital with (herbal) self-treatment and traditional/spiritual healing. Despite the free availability of anti-tuberculosis treatment in principle, patient adherence was problematic, hindering effective TB control. Most patients delayed or defaulted from treatment due to financial constraints, stigmatisation, ignorance about treatment, change of health care service or use of non-prescribed antibiotics. The situation was occasionally complicated by drug stockouts. There is an urgent need to bridge the gap between patients and the hospital by avoiding drug shortages, intensifying culturally sensitive TB health education, embedding TB care into the cultural context and enhancing cooperation between hospitals, patients, traditional healers and communities.

  7. [Management of tuberculosis patients in the urban setting: health service delivery and health care-seeking behavior].

    PubMed

    Nana Yakam, André; Noeske, Juergen; Angumua, Carrine; Bowong, Samuel; Aimé Fono, Louis

    2013-01-01

    This descriptive and prospective study was designed to determine the incidence of smear-positive pulmonary tuberculosis (PTB+) by health area (HA) in Douala, use of Diagnosis and Treatment Centres (DTCs) and the factors influencing the choice of DTC. Over a one-year period, the residence of all PTB+ patients and the DTC at which they were treated were located by means of a GPS system and represented on a geo-referenced health map. Incidence of PTB+ per HA was calculated. Focus group discussions with TB patients were then held in seven of the nineteen DTCs chosen by convenience. The incidence of PTB+ is not randomly distributed between HAs, as the incidence is fivefold higher than the mean in some HAs. More than one half of patients (65%) were not treated in the DTC to which they were designated by the health system. Attendance in a DTC mostly depends on chance decisions based on previous experiences with a health care unit, recommendations from family members, friends or strangers, or the (sometimes erroneous) reference by health care personnel. References rarely follow the logic of the system. The provision of health care for TB in the city of Douala and health care-seeking behaviour of patients frequently do not correspond. Information and communication on TB care delivery could make the management of tuberculosis more efficient and more effective.

  8. Prevalence of chest symptoms amongst brick kiln migrant workers and care seeking behaviour: a study from South India.

    PubMed

    Thomas, Beena E; Charles, Niruparani; Watson, Basilea; Chandrasekaran, V; Senthil Kumar, R; Dhanalakshmi, A; Wares, Fraser; Swaminathan, Soumya

    2015-12-01

    Early detection and treatment of tuberculosis (TB) have been key principles of TB control. However, this can be a challenge with 'hard to reach' populations such as migrants. Brick kiln workers are one such group of migrants who are exposed to smoke, heat and dust from brick kilns which are one of the major causes of respiratory illnesses. A cross-sectional community based study was carried out in Thiruvallur, Tamil Nadu, South India, from August 2011 to June 2012. A total of 4002 individuals from 55 brick kiln chambers were interviewed to determine the prevalence of chest symptoms and care seeking behaviour patterns. Three hundred and seventy-seven (9.4%) chest symptomatics were identified. The most significant variables associated with chest symptoms were illiteracy, alcohol abuse and heavy smoking. Of the chest symptomatics identified, 50.4% took action to get relief from their symptoms. The duration of over 6-month stay in the chamber was significantly associated with taking action (OR, 5.5, 95% CI: 2.3, 13.3). The TB control programme needs to further explore how to extend its services to such 'hard to reach' groups. Active case finding to ensure early diagnosis and treatment initiation amongst such groups needs consideration. © The Author 2014. Published by Oxford University Press on behalf of Faculty of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  9. Perceptions, health care seeking behaviour and implementation of a tuberculosis control programme in Lambaréné, Gabon

    PubMed Central

    Cremers, A. L.; Janssen, S.; Huson, M. A. M.; Bikene, G.; Bélard, S.; Gerrets, R. P. M.

    2013-01-01

    Setting: Lambaréné, Gabon. Objectives: To describe patient perceptions of tuberculosis (TB) and to determine factors that influence health care seeking behaviour to gain insight into the management of multidrug-resistant TB. Design: Participant observation, in-depth semi-structured interviews and focus group discussions were conducted with 30 TB patients, 36 relatives, 11 health care providers and 18 traditional/spiritual healers. Recruitment of patients was linked to the PanEpi study and took place at the Albert Schweitzer Hospital, the General Hospital and the TB-HIV (human immunodeficiency virus) clinic. Results: Patients generally described TB as a natural and/or magical disease. The majority of the patients combined treatment at the hospital with (herbal) self-treatment and traditional/spiritual healing. Despite the free availability of anti-tuberculosis treatment in principle, patient adherence was problematic, hindering effective TB control. Most patients delayed or defaulted from treatment due to financial constraints, stigmatisation, ignorance about treatment, change of health care service or use of non-prescribed antibiotics. The situation was occasionally complicated by drug stockouts. Conclusion: There is an urgent need to bridge the gap between patients and the hospital by avoiding drug shortages, intensifying culturally sensitive TB health education, embedding TB care into the cultural context and enhancing cooperation between hospitals, patients, traditional healers and communities. PMID:26393056

  10. Inequalities in Care-seeking for Febrile Illness of Under-five Children in Urban Dhaka, Bangladesh

    PubMed Central

    Bennett, Catherine M.; Luby, Stephen P.

    2011-01-01

    children with decreased level of consciousness (OR=5.3, 95% CI 2.0-14.2). Disparities across socioeconomic groups and gender persisted in seeking quality healthcare for under-five children with febrile illness in urban Dhaka. Girls from poor families were less likely to access qualified medical care. To reduce child mortality in the short term, health education and behaviour-change communication interventions should target low-income caregivers to improve their recognition of danger-signs; reducing societal inequalities remains an important long-term goal. PMID:22106759

  11. Inequalities in care-seeking for febrile illness of under-five children in urban Dhaka, Bangladesh.

    PubMed

    Najnin, Nusrat; Bennett, Catherine M; Luby, Stephen P

    2011-10-01

    children with decreased level of consciousness (OR=5.3, 95% CI 2.0-14.2). Disparities across socioeconomic groups and gender persisted in seeking quality healthcare for under-five children with febrile illness in urban Dhaka. Girls from poor families were less likely to access qualified medical care. To reduce child mortality in the short term, health education and behaviour-change communication interventions should target low-income caregivers to improve their recognition of danger-signs; reducing societal inequalities remains an important long-term goal.

  12. Profitability of Qualified-Labour-Power Production

    ERIC Educational Resources Information Center

    Baldino, Roberto Ribeiro; Cabral, Tânia Cristina Baptista

    2015-01-01

    In Baldino and Cabral (2013) we introduced the concept of qualified labour-power as the commodity produced by the school system. In the present article we outline a quantitative model to evaluate the profit rate of educational programmes. We compare a medical school programme with a teacher education programme at a public university in Brazil,…

  13. Profitability of Qualified-Labour-Power Production

    ERIC Educational Resources Information Center

    Baldino, Roberto Ribeiro; Cabral, Tânia Cristina Baptista

    2015-01-01

    In Baldino and Cabral (2013) we introduced the concept of qualified labour-power as the commodity produced by the school system. In the present article we outline a quantitative model to evaluate the profit rate of educational programmes. We compare a medical school programme with a teacher education programme at a public university in Brazil,…

  14. QF monitoring. [Qualifying Facilities

    SciTech Connect

    Greenwald, S. ); Hoffman, B. )

    1991-10-01

    This article examines the effects on project financing of independent power projects of the California Public Utilities Commission decision to grant authority to California utilities to monitor and enforce compliance with the Federal Energy Regulatory Commission Qualifying Facility standards. The topics of the article include monitoring proposals, monitoring guidelines, the effects of monitoring, minimizing status loss and monitoring requirements.

  15. Fear of deportation is not associated with medical or dental care use among Mexican-origin farmworkers served by a federally-qualified health center--faith-based partnership: an exploratory study.

    PubMed

    López-Cevallos, Daniel F; Lee, Junghee; Donlan, William

    2014-08-01

    Migrant and seasonal farmworkers face many health risks with limited access to health care and promotion services. This study explored whether fear of deportation (as a barrier), and church attendance (as an enabling factor), were associated with medical and dental care use among Mexican-origin farmworkers. Interviews were conducted with 179 farmworkers who attended mobile services provided by a local federally-qualified health center (FQHC) in partnership with area churches, during the 2007 agricultural season. The majority of respondents (87 %) were afraid of being deported, and many (74 %) attended church. Although about half of participants reported poor/fair physical (49 %) and dental (58 %) health, only 37 % of farmworkers used medical care and 20 % used dental care during the previous year. Fear of deportation was not associated with use of medical or dental care; while church attendance was associated with use of dental care. Findings suggest that despite high prevalence of fear of deportation, support by FQHCs and churches may enable farmworkers to access health care services.

  16. Effect of the Uganda Newborn Study on care-seeking and care practices: a cluster-randomised controlled trial.

    PubMed

    Waiswa, Peter; Pariyo, George; Kallander, Karin; Akuze, Joseph; Namazzi, Gertrude; Ekirapa-Kiracho, Elizabeth; Kerber, Kate; Sengendo, Hanifah; Aliganyira, Patrick; Lawn, Joy E; Peterson, Stefan

    2015-01-01

    Care for women and babies before, during, and after the time of birth is a sensitive measure of the functionality of any health system. Engaging communities in preventing newborn deaths is a promising strategy to achieve further progress in child survival in sub-Saharan Africa. To assess the effect of a home visit strategy combined with health facility strengthening on uptake of newborn care-seeking, practices and services, and to link the results to national policy and scale-up in Uganda. The Uganda Newborn Study (UNEST) was a two-arm cluster-randomised controlled trial in rural eastern Uganda. In intervention villages volunteer community health workers (CHWs) were trained to identify pregnant women and make five home visits (two during pregnancy and three in the first week after birth) to offer preventive and promotive care and counselling, with extra visits for sick and small newborns to assess and refer. Health facility strengthening was done in all facilities to improve quality of care. Primary outcomes were coverage of key essential newborn care behaviours (breastfeeding, thermal care, and cord care). Analyses were by intention to treat. This study is registered as a clinical trial, number ISRCTN50321130. The intervention significantly improved essential newborn care practices, although many interventions saw major increases in both arms over the study period. Immediate breastfeeding after birth and exclusive breastfeeding were significantly higher in the intervention arm compared to the control arm (72.6% vs. 66.0%; p=0.016 and 81.8% vs. 75.9%, p=0.042, respectively). Skin-to-skin care immediately after birth and cord cutting with a clean instrument were marginally higher in the intervention arm versus the control arm (80.7% vs. 72.2%; p=0.071 and 88.1% vs. 84.4%; p=0.023, respectively). Half (49.6%) of the mothers in the intervention arm waited more than 24 hours to bathe the baby, compared to 35.5% in the control arm (p<0.001). Dry umbilical cord care was

  17. Effect of the Uganda Newborn Study on care-seeking and care practices: a cluster-randomised controlled trial

    PubMed Central

    Waiswa, Peter; Pariyo, George; Kallander, Karin; Akuze, Joseph; Namazzi, Gertrude; Ekirapa-Kiracho, Elizabeth; Kerber, Kate; Sengendo, Hanifah; Aliganyira, Patrick; Lawn, Joy E.; Peterson, Stefan

    2015-01-01

    Background Care for women and babies before, during, and after the time of birth is a sensitive measure of the functionality of any health system. Engaging communities in preventing newborn deaths is a promising strategy to achieve further progress in child survival in sub-Saharan Africa. Objective To assess the effect of a home visit strategy combined with health facility strengthening on uptake of newborn care-seeking, practices and services, and to link the results to national policy and scale-up in Uganda. Design The Uganda Newborn Study (UNEST) was a two-arm cluster-randomised controlled trial in rural eastern Uganda. In intervention villages volunteer community health workers (CHWs) were trained to identify pregnant women and make five home visits (two during pregnancy and three in the first week after birth) to offer preventive and promotive care and counselling, with extra visits for sick and small newborns to assess and refer. Health facility strengthening was done in all facilities to improve quality of care. Primary outcomes were coverage of key essential newborn care behaviours (breastfeeding, thermal care, and cord care). Analyses were by intention to treat. This study is registered as a clinical trial, number ISRCTN50321130. Results The intervention significantly improved essential newborn care practices, although many interventions saw major increases in both arms over the study period. Immediate breastfeeding after birth and exclusive breastfeeding were significantly higher in the intervention arm compared to the control arm (72.6% vs. 66.0%; p=0.016 and 81.8% vs. 75.9%, p=0.042, respectively). Skin-to-skin care immediately after birth and cord cutting with a clean instrument were marginally higher in the intervention arm versus the control arm (80.7% vs. 72.2%; p=0.071 and 88.1% vs. 84.4%; p=0.023, respectively). Half (49.6%) of the mothers in the intervention arm waited more than 24 hours to bathe the baby, compared to 35.5% in the control arm (p

  18. Health care seeking for Childhood Diarrhea in Developing Countries: Evidence from Seven Sites in Africa and Asia

    PubMed Central

    Nasrin, Dilruba; Wu, Yukun; Blackwelder, William C.; Farag, Tamer H.; Saha, Debasish; Sow, Samba O.; Alonso, Pedro L.; Breiman, Robert F.; Sur, Dipika; Faruque, Abu S. G.; Zaidi, Anita K. M.; Biswas, Kousick; Van Eijk, Anna Maria; Walker, Damian G.; Levine, Myron M.; Kotloff, Karen L.

    2013-01-01

    We performed serial Health Care Utilization and Attitudes Surveys (HUASs) among caretakers of children ages 0–59 months randomly selected from demographically defined populations participating in the Global Enteric Multicenter Study (GEMS), a case-control study of moderate-to-severe diarrhea (MSD) in seven developing countries. The surveys aimed to estimate the proportion of children with MSD who would present to sentinel health centers (SHCs) where GEMS case recruitment would occur and provide a basis for adjusting disease incidence rates to include cases not seen at the SHCs. The proportion of children at each site reported to have had an incident episode of MSD during the 7 days preceding the survey ranged from 0.7% to 4.4% for infants (0–11 months of age), from 0.4% to 4.7% for toddlers (12–23 months of age), and from 0.3% to 2.4% for preschoolers (24–59 months of age). The proportion of MSD episodes at each site taken to an SHC within 7 days of diarrhea onset was 15–56%, 17–64%, and 7–33% in the three age strata, respectively. High cost of care and insufficient knowledge about danger signs were associated with lack of any care-seeking outside the home. Most children were not offered recommended fluids and continuing feeds at home. We have shown the utility of serial HUASs as a tool for optimizing operational and methodological issues related to the performance of a large case-control study and deriving population-based incidence rates of MSD. Moreover, the surveys suggest key targets for educational interventions that might improve the outcome of diarrheal diseases in low-resource settings. PMID:23629939

  19. Health care seeking for childhood diarrhea in developing countries: evidence from seven sites in Africa and Asia.

    PubMed

    Nasrin, Dilruba; Wu, Yukun; Blackwelder, William C; Farag, Tamer H; Saha, Debasish; Sow, Samba O; Alonso, Pedro L; Breiman, Robert F; Sur, Dipika; Faruque, Abu S G; Zaidi, Anita K M; Biswas, Kousick; Van Eijk, Anna Maria; Walker, Damian G; Levine, Myron M; Kotloff, Karen L

    2013-07-01

    We performed serial Health Care Utilization and Attitudes Surveys (HUASs) among caretakers of children ages 0-59 months randomly selected from demographically defined populations participating in the Global Enteric Multicenter Study (GEMS), a case-control study of moderate-to-severe diarrhea (MSD) in seven developing countries. The surveys aimed to estimate the proportion of children with MSD who would present to sentinel health centers (SHCs) where GEMS case recruitment would occur and provide a basis for adjusting disease incidence rates to include cases not seen at the SHCs. The proportion of children at each site reported to have had an incident episode of MSD during the 7 days preceding the survey ranged from 0.7% to 4.4% for infants (0-11 months of age), from 0.4% to 4.7% for toddlers (12-23 months of age), and from 0.3% to 2.4% for preschoolers (24-59 months of age). The proportion of MSD episodes at each site taken to an SHC within 7 days of diarrhea onset was 15-56%, 17-64%, and 7-33% in the three age strata, respectively. High cost of care and insufficient knowledge about danger signs were associated with lack of any care-seeking outside the home. Most children were not offered recommended fluids and continuing feeds at home. We have shown the utility of serial HUASs as a tool for optimizing operational and methodological issues related to the performance of a large case-control study and deriving population-based incidence rates of MSD. Moreover, the surveys suggest key targets for educational interventions that might improve the outcome of diarrheal diseases in low-resource settings.

  20. The impact of home-based HIV counseling and testing on care-seeking and incidence of common infectious disease syndromes in rural western Kenya

    PubMed Central

    2014-01-01

    similar decreases in the other two groups. Conclusions Large scale HBCT enabled a large number of newly diagnosed HIV-infected persons to know their HIV status, leading to a change in care seeking behavior and ultimately a decrease in incidence of common infectious disease syndromes through appropriate treatment and care. PMID:25005353

  1. The impact of home-based HIV counseling and testing on care-seeking and incidence of common infectious disease syndromes in rural western Kenya.

    PubMed

    Bigogo, Godfrey; Amolloh, Manase; Laserson, Kayla F; Audi, Allan; Aura, Barrack; Dalal, Warren; Ackers, Marta; Burton, Deron; Breiman, Robert F; Feikin, Daniel R

    2014-07-08

    groups. Large scale HBCT enabled a large number of newly diagnosed HIV-infected persons to know their HIV status, leading to a change in care seeking behavior and ultimately a decrease in incidence of common infectious disease syndromes through appropriate treatment and care.

  2. Health-Care-Seeking Patterns in the Emerging Private Sector in Burkina Faso: A Population-Based Study of Urban Adult Residents in Ouagadougou

    PubMed Central

    Beogo, Idrissa; Liu, Chieh-Yu; Chou, Yiing-Jenq; Chen, Chuan-Yu; Huang, Nicole

    2014-01-01

    Background The private medical care sector is expanding in urban cities in Sub-Saharan Africa (SSA). However, people’s health-care-seeking behaviors in this new landscape remain poorly understood; furthermore, distinguishing between public and private providers and among various types of private providers is critical in this investigation. This study assessed, by type, the healthcare providers urban residents in Burkina Faso visit, and their choice determinants. Method We conducted a population-based survey of a representative sample of 1,600 households in Ouagadougou from July to November 2011, consisting of 5,820 adults. We assessed the types of providers people typically sought for severe and non-severe conditions. We applied generalized estimating equations in this study. Results Among those surveyed, 97.7% and 53.1% indicated that they seek a formal provider for treating severe and non-severe conditions, respectively. Among the formal provider seekers, 20.5% and 17.0% chose for-profit (FP) providers for treating severe and non-severe conditions, respectively. Insurance coverage was held by 2.0% of those surveyed. Possessing insurance was the strongest predictor for seeking FP, for both severe (odds ratio [OR] = 1.15, 95% confidence interval [CI] = 1.04–1.28), and non-severe conditions (OR = 1.22, 95% CI = 1.07–1.39). Other predictors included being a formal jobholder and holding a higher level education. By contrast, we observed no significant difference in predisposing, enabling, or need characteristics between not-for-profit (NFP) provider seekers and public provider seekers. Proximity was the primary reason for choosing a provider. Conclusion The results suggested that FP providers play a crucial role in the urban healthcare market in SSA. Socioeconomic status and insurance status are significant predictors of provider choice. The findings can serve as a crucial reference for policymakers in response to the emergence of FP providers in

  3. Hot Billet Surface Qualifier

    SciTech Connect

    Tzyy-Shuh Chang

    2007-04-30

    OG Technologies, Inc. (OGT), developed a prototype of a Hot Billet Surface Qualifier (“Qualifier”) based on OGT’s patented HotEye™ technology and other proprietary imaging and computing technologies. The Qualifier demonstrated its ability of imaging the cast billets in line with high definition pictures, pictures capable of supporting the detection of surface anomalies on the billets. The detection will add the ability to simplify the subsequent process and to correct the surface quality issues in a much more timely and efficient manner. This is challenging due to the continuous casting environment, in which corrosive water, temperature, vibration, humidity, EMI and other unbearable factors exist. Each installation has the potential of 249,000 MMBTU in energy savings per year. This represents a cost reduction, reduced emissions, reduced water usage and reduced mill scale.

  4. Change in attitudes to psychiatry and intention to pursue psychiatry as a career in newly qualified doctors: a follow-up of two cohorts of medical students.

    PubMed

    Maidment, Rachel; Livingston, Gill; Katona, Cornelius; McParland, Monica; Noble, Lorraine

    2004-09-01

    This follow-up study of 234 doctors examined whether improvements in attitudes to psychiatry following an undergraduate psychiatry attachment were maintained after graduation, and explored the relationship between attitudes to psychiatry and intention to pursue psychiatry as a career. Improvements in attitudes following undergraduate psychiatric attachment decayed over time but remained higher than pre-attachment levels. Attitudes of doctors who definitely intended to pursue psychiatry, however, increased at each stage. Attitudes of doctors were predicted by post-attachment attitudes, which in turn were predicted by encouragement from consultants and influences of specialist registrars during the attachment at medical school. There were no differences between a problem-based and a traditional psychiatry curriculum in attitude change. The findings suggest that encouragement during medical school from more senior doctors increases the numbers wanting to pursue psychiatry and may increase the number who subsequently pursue psychiatry as a career.

  5. Determinants of delay in malaria care-seeking behaviour for children 15 years and under in Bata district, Equatorial Guinea.

    PubMed

    Romay-Barja, Maria; Cano, Jorge; Ncogo, Policarpo; Nseng, Gloria; Santana-Morales, Maria A; Valladares, Basilio; Riloha, Matilde; Benito, Agustin

    2016-03-31

    Malaria remains a major cause of morbidity and mortality in children under 5 years of age in Equatorial Guinea. Early appropriate treatment can reduce progression of the illness to severe stages, thus reducing of mortality, morbidity and onward transmission. The factors that contribute to malaria treatment delay have not been studied previously in Equatorial Guinea. The objective of this study was to assess the determinants of delay in seeking malaria treatment for children in the Bata district, in mainland Equatorial Guinea. A cross-sectional study was conducted in Bata district, in 2013, which involved 428 houses in 18 rural villages and 26 urban neighbourhoods. Household caregivers were identified in each house and asked about their knowledge of malaria and about the management of the last reported malaria episode in a child 15 years and younger under their care. Bivariate and multivariate statistical analyses were conducted to determine the relevance of socio-economic, geographical and behavioural factors on delays in care-seeking behaviour. Nearly half of the children sought treatment at least 24 h after the onset of the symptoms. The median delay in seeking care was 2.8 days. Children from households with the highest socio-economic status were less likely to be delayed in seeking care than those from households with the lowest socio-economic status (OR 0.37, 95% CI 0.19-0.72). Children that first received treatment at home, mainly paracetamol, were more than twice more likely to be delayed for seeking care, than children who did not first receive treatment at home (OR 2.36, 95% CI 1.45-3.83). Children living in a distance >3 km from the nearest health facility were almost two times more likely to be delayed in seeking care than those living closer to a facility but with non significant association once adjusted for other variables (OR 1.75, 95% CI 0.88-3.47). To decrease malaria morbidity and mortality in Bata district, efforts should be addressed to reduce

  6. Exploratory study into awareness of heart disease and health care seeking behavior among Emirati women (UAE) - Cross sectional descriptive study.

    PubMed

    Khan, Sarah; Ali, Syed Adnan

    2017-09-26

    Cardiovascular disease was the leading cause of death among women in the United Arab Emirates (UAE) in 2010. Heart attacks usually happen in older women thus symptoms of heart disease may be masked by symptoms of chronic diseases, which could explain the delay in seeking health care and higher mortality following an ischaemic episode among women. This study seeks to a) highlight the awareness of heart diseases among Emirati women and b) to understand Emirati women's health care seeking behaviour in UAE. A cross sectional, descriptive study was conducted using a survey instrument adapted from the American Heart Association National survey. A convenience sample of 676 Emirati women between the ages of 18-55 years completed the questionnaire. The study showed low levels of awareness of heart disease and associated risk factors in Emirati women; only 19.4% participants were found to be aware of heart diseases. Awareness levels were highest in Dubai (OR 2.18, p < 0.05) among all the other emirates and in the 18-45 years age group (OR 2.74, p < 0.05). Despite low awareness levels, women paradoxically perceived themselves to be self-efficacious in seeking health care. Interestingly, just 49.1% Emirati women believed that good quality and affordable health care was available in the UAE. Only 28.8% of the participants believed there were sufficient female doctors to respond to health needs of women in UAE. Furthermore, only 36.7% Emirati women chose to be treated in the UAE over treatment in other countries. Emirati women clearly lack the knowledge on severity and vulnerability to heart disease in the region that is essential to improve cardiovascular related health outcomes. This study has identified the need for wider outreach that focuses on gender and age specific awareness on heart disease risks and symptoms. The study has also highlighted potential modifiable barriers in seeking health care that should be overcome to reduce morbidity and mortality due to heart

  7. Plausible role for CHW peer support groups in increasing care-seeking in an integrated community case management project in Rwanda: a mixed methods evaluation

    PubMed Central

    Langston, Anne; Weiss, Jennifer; Landegger, Justine; Pullum, Thomas; Morrow, Melanie; Kabadege, Melene; Mugeni, Catherine; Sarriot, Eric

    2014-01-01

    ABSTRACT Background: The Kabeho Mwana project (2006–2011) supported the Rwanda Ministry of Health (MOH) in scaling up integrated community case management (iCCM) of childhood illness in 6 of Rwanda's 30 districts. The project trained and equipped community health workers (CHWs) according to national guidelines. In project districts, Kabeho Mwana staff also trained CHWs to conduct household-level health promotion and established supervision and reporting mechanisms through CHW peer support groups (PSGs) and quality improvement systems. Methods: The 2005 and 2010 Demographic and Health Surveys were re-analyzed to evaluate how project and non-project districts differed in terms of care-seeking for fever, diarrhea, and acute respiratory infection symptoms and related indicators. We developed a logit regression model, controlling for the timing of the first CHW training, with the district included as a fixed categorical effect. We also analyzed qualitative data from the final evaluation to examine factors that may have contributed to improved outcomes. Results: While there was notable improvement in care-seeking across all districts, care-seeking from any provider for each of the 3 conditions, and for all 3 combined, increased significantly more in the project districts. CHWs contributed a larger percentage of consultations in project districts (27%) than in non-project districts (12%). Qualitative data suggested that the PSG model was a valuable sub-level of CHW organization associated with improved CHW performance, supervision, and social capital. Conclusions: The iCCM model implemented by Kabeho Mwana resulted in greater improvements in care-seeking than those seen in the rest of the country. Intensive monitoring, collaborative supervision, community mobilization, and CHW PSGs contributed to this success. The PSGs were a unique contribution of the project, playing a critical role in improving care-seeking in project districts. Effective implementation of i

  8. HIV care-seeking behaviour after HIV self-testing among men who have sex with men in Beijing, China: a cross-sectional study.

    PubMed

    Ren, Xian-Long; Wu, Zun-You; Mi, Guo-Dong; McGoogan, Jennifer M; Rou, Ke-Ming; Zhao, Yan; Zhang, Nanci

    2017-06-28

    Men who have sex with men (MSM) has become the group with the fastest growing HIV epidemic in China. Since many Chinese MSM are conducting HIV self-testing, we aimed to determine the rate of HIV care seeking after self-testing, examine characteristics of "seekers" compared to "non-seekers," and explore factors associated with HIV care-seeking behaviour. A cross-sectional study design was used and an online survey was conducted in Beijing, China in 2016, among users of a popular Chinese gay networking smart phone application. Chi-square test was used to compare characteristics of those who sought HIV care ("seekers") and those who did not ("non-seekers"). Univariate and multivariate logistic regression analyses were conducted to assess factors associated with HIV care seeking. Among 21,785 screened, 2383 participants (10.9%) were included in the study. A total of 380 participants (15.9%) reported seeking HIV care after HIV self-testing while 2003 (84.1%) did not. Lack of knowledge of the "window period" (adjusted odds ratio [AOR] = 0.68, 95% confidence interval [95% CI] = 0.47-0.97, P = 0.04) was associated with reduced odds of seeking HIV care, while lower monthly income (AOR = 1.29, 95% CI = 1.03-1.62, P = 0.03) and obtaining HIV self-testing kits from health facilities (AOR = 2.40, 95% CI = 1.81-3.17, P < 0.001), and non-governmental organizations (AOR = 2.44, 95% CI = 1.79-3.34, P < 0.001) was associated with increased odds of seeking HIV care. Among those who sought HIV care, a large majority (92.4%) had non-reactive HIV self-testing results. Only 29 out of 265 with reactive, uncertain, or unknown results sought HIV care. We found a very low rate of HIV care seeking among our sample of urban Chinese MSM. The observation that most with reactive, uncertain, or unknown results did not seek HIV care is a cause for concern. These people should be paid more attention and helped to enter the care cascade. Our findings highlight that

  9. [Economic evaluation of medical devices not included in the French list of products and services qualifying for reimbursement: Example of biologic meshes].

    PubMed

    Sainfort, A; Denis-Hallouard, I; Aulagner, G; Nuiry, O; Armoiry, X

    2017-09-01

    To present a method aimed to evaluate the economic impact associated with the use of medical devices (DM) not reimbursed in addition to diagnosis related groups (DRGs) tariffs using the example of biological meshes for parietal reinforcement. In this multicenter retrospective cohort study, we included all patients who received a biological mesh between January 2010-April 2014 (University hospitals of Saint-Étienne, France) or between January 2010-March 2015 (Lyon University hospitals, France). Measured costs associated with biologic meshes were compared to those of the "Étude nationale des coûts à méthodologie commune" (2012) to weigh the economic impact of biologic meshes with the French DRGs costs. We also compared these costs to the fares perceived by the hospital from the French sickness fund (GHS). Thirty-six patients received a biological mesh and were treated by a total of 38 biological meshes. Of these, the implant was Protexa(®), Permacol(®) and Strattice(®) in 66%, 29% and 5% of cases respectively. The hospitals incomes were 10,496±5562€ per stay. Meshes-related expenditures represented in average 28% of DRGs costs and 38% of GHS tariffs. The mean additional cost for biological meshes was 3793±2292 euros compared to the mean cost on implantable medical devices in the French DRGs. Given their currently restricted use, the hospital budget impact of biological meshes remains limited although the incremental cost per patient is substantial. Analytic costs data can be useful within the scope of decision-making related to DM not refunded by the French health system. Copyright © 2017 Académie Nationale de Pharmacie. Published by Elsevier Masson SAS. All rights reserved.

  10. Malaria Related Perceptions, Care Seeking after Onset of Fever and Anti-Malarial Drug Use in Malaria Endemic Settings of Southwest Ethiopia

    PubMed Central

    Birhanu, Zewdie; Abebe, Lakew; Sudhakar, Morankar; Dissanayake, Gunawardena; Yihdego, Yemane Ye-ebiyo; Alemayehu, Guda; Yewhalaw, Delenasaw

    2016-01-01

    Background Prompt care seeking and appropriate use of anti-malarial drugs are critical components of malaria prevention and control. This study assessed malaria related perceptions, care seeking behavior and anti-malarial drug use in malaria endemic settings of Ethiopia. Methods Data were generated from a community based cross-sectional study conducted among 798 households during January 2014 as part of a larger household behavioral study in three malaria endemic districts of Jimma Zone, Southwest Ethiopia. Both quantitative and qualitative data were collected and analyzed using SPSS 17.0 and STATA 12.0. Results In this study, only 76.1% of the respondents associated malaria to mosquito bite, and incorrect beliefs and perceptions were noted. Despite moderate level of knowledge (estimated mean = 62.2, Std Err = 0.7, 95% CI: 60.6–63.8%), quite high favorable attitude (overall estimated mean = 91.5, Std Err = 0.6, 95% CI: 90.1–92.9%) were recorded towards malaria preventive measures. The mean attitude score for prompt care seeking, appropriate use of anti-malarial drugs, LLIN use and Indoor Residual Spray acceptance was 98.5 (Std Err = 0.4, 95% CI:97.5–99.4), 92.7 (Std Err = 0.6 95% CI:91.5–93.9), 88.8 (Std Err = 0.5, 95% CI:85.5–92.1) and 86.5 (Std Err = 1.2, 95% CI: 83.9–89.1), respectively. The prevalence of fever was 2.9% (116/4107) and of the study participants with fever, 71.9% (95% CI: 65.5–78.3%) sought care and all of them consulted formal health care system. However, only 17 (19.8%) sought care within 24 hours after onset of fever. The frequency of care seeking was higher (77.8%, n = 21/27) and more prompt (28.6%, 6/21) for children under five as compared to old age groups despite it was not statistically significant (p > 0.05). However, higher median time of seeking first care was observed among Muslims and people who did not attend school (p < 0.05). Of those who used anti-malarial drugs, 9.1% indicated that they used it inappropriately

  11. Debt and Foregone Medical Care

    ERIC Educational Resources Information Center

    Kalousova, Lucie; Burgard, Sarah A.

    2013-01-01

    Most American households carry debt, yet we have little understanding of how debt influences health behavior, especially health care seeking. We examined associations between foregone medical care and debt using a population-based sample of 914 southeastern Michigan residents surveyed in the wake of the late-2000s recession. Overall debt and…

  12. Debt and Foregone Medical Care

    ERIC Educational Resources Information Center

    Kalousova, Lucie; Burgard, Sarah A.

    2013-01-01

    Most American households carry debt, yet we have little understanding of how debt influences health behavior, especially health care seeking. We examined associations between foregone medical care and debt using a population-based sample of 914 southeastern Michigan residents surveyed in the wake of the late-2000s recession. Overall debt and…

  13. Addressing care-seeking as well as insurance-seeking selection biases in estimating the impact of health insurance on out-of-pocket expenditure.

    PubMed

    Ali, Shehzad; Cookson, Richard; Dusheiko, Mark

    2017-03-01

    Health Insurance (HI) programmes in low-income countries aim to reduce the burden of out-of-pocket (OOP) health care expenditure. However, if the decisions to purchase insurance and to seek care when ill are correlated with the expected health care expenditure, the use of naïve regression models may produce biased estimates of the impact of insurance membership on OOP expenditure. Whilst many studies in the literature have accounted for the endogeneity of the insurance decision, the potential selection bias due to the care-seeking decision has not been taken into account. We extend the Heckman selection model to account simultaneously for both care-seeking and insurance-seeking selection biases in the health care expenditure regression model. The proposed model is illustrated in the context of a Vietnamese HI programme using data from a household survey of 1,192 individuals conducted in 1999. Results were compared with those of alternative econometric models making no or partial allowance for selection bias. In this illustrative example, the impact of insurance membership on reducing OOP expenditures was underestimated by 21 percentage points when selection biases were not taken into account. We believe this is an important methodological contribution that will be relevant to future empirical work.

  14. A case-control study of maternal knowledge of malnutrition and health-care-seeking attitudes in rural South India.

    PubMed

    Saito, K; Korzenik, J R; Jekel, J F; Bhattacharji, S

    1997-01-01

    The contribution of maternal nutritional knowledge and attitudes to children's nutritional status was investigated in a case-control study conducted in a rural area in Tamil Nadu, India. 34 cases (mothers of a severely malnourished child under 4 years of age) and 34 controls (mothers of a well-nourished age- and location-matched child) were selected from the Christian Medical Center and Hospital registry. The 68 mothers interviewed were predominantly young (mean age, 25 years), poor, and illiterate (67.6%). Severe malnutrition, defined as less than 60% of expected weight-for-age, was significantly associated with female gender (odds ratio (OR), 3.44) and father's occupation as a laborer (OR, 2.98), as opposed to a civil servant or private sector professional. Knowledge of the role of lack of food or nutrition in mild marasmus-kwashiorkor mixed malnutrition was significantly higher among controls (59%) than cases (35%), but there were no significant differences in health-seeking behaviors. In general, mothers from this area did not regard medical care as an appropriate intervention for malnutrition or measles. Only 28% of mothers indicated they would seek medical care for malnutrition. Conversely, medical care was considered indicated for diarrhea, colds, and worms. These findings indicate a need for intensive nutritional programs targeted toward the families of low-income female children.

  15. Pre-Vaccination Care-Seeking in Females Reporting Severe Adverse Reactions to HPV Vaccine. A Registry Based Case-Control Study

    PubMed Central

    Hansen, Niels Dalum; Valentiner-Branth, Palle

    2016-01-01

    Background Since 2013 the number of suspected adverse reactions to the quadrivalent human papillomavirus (HPV) vaccine reported to the Danish Medicines Agency (DMA) has increased. Due to the resulting public concerns about vaccine safety, the coverage of HPV vaccinations in the childhood vaccination programme has declined. The aim of the present study was to determine health care-seeking prior to the first HPV vaccination among females who suspected adverse reactions to HPV vaccine. Methods In this registry-based case-control study, we included as cases vaccinated females with reports to the DMA of suspected severe adverse reactions. We selected controls without reports of adverse reactions from the Danish vaccination registry and matched by year of vaccination, age of vaccination, and municipality, and obtained from the Danish National Patient Registry and The National Health Insurance Service Register the history of health care usage two years prior to the first vaccine. We analysed the data by logistic regression while adjusting for the matching variables. Results The study included 316 cases who received first HPV vaccine between 2006 and 2014. Age range of cases was 11 to 52 years, with a peak at 12 years, corresponding to the recommended age at vaccination, and another peak at 19 to 28 years, corresponding to a catch-up programme targeting young women. Compared with 163,910 controls, cases had increased care-seeking in the two years before receiving the first HPV vaccine. A multivariable model showed higher use of telephone/email consultations (OR 1.9; 95% CI 1.2–3.2), physiotherapy (OR 2.1; 95% CI 1.6–2.8) and psychologist/psychiatrist (OR 1.9; 95% CI 1.3–2.7). Cases were more likely to have a diagnosis in the ICD-10 chapters of diseases of the digestive system (OR 1.6; 95% CI 1.0–2.4), of the musculoskeletal system (OR 1.6; 95% CI 1.1–2.2), symptoms or signs not classified elsewhere (OR 1.8; 95% CI 1.3–2.5) as well as injuries (OR 1.5; 95% CI 1

  16. Pre-Vaccination Care-Seeking in Females Reporting Severe Adverse Reactions to HPV Vaccine. A Registry Based Case-Control Study.

    PubMed

    Mølbak, Kåre; Hansen, Niels Dalum; Valentiner-Branth, Palle

    2016-01-01

    Since 2013 the number of suspected adverse reactions to the quadrivalent human papillomavirus (HPV) vaccine reported to the Danish Medicines Agency (DMA) has increased. Due to the resulting public concerns about vaccine safety, the coverage of HPV vaccinations in the childhood vaccination programme has declined. The aim of the present study was to determine health care-seeking prior to the first HPV vaccination among females who suspected adverse reactions to HPV vaccine. In this registry-based case-control study, we included as cases vaccinated females with reports to the DMA of suspected severe adverse reactions. We selected controls without reports of adverse reactions from the Danish vaccination registry and matched by year of vaccination, age of vaccination, and municipality, and obtained from the Danish National Patient Registry and The National Health Insurance Service Register the history of health care usage two years prior to the first vaccine. We analysed the data by logistic regression while adjusting for the matching variables. The study included 316 cases who received first HPV vaccine between 2006 and 2014. Age range of cases was 11 to 52 years, with a peak at 12 years, corresponding to the recommended age at vaccination, and another peak at 19 to 28 years, corresponding to a catch-up programme targeting young women. Compared with 163,910 controls, cases had increased care-seeking in the two years before receiving the first HPV vaccine. A multivariable model showed higher use of telephone/email consultations (OR 1.9; 95% CI 1.2-3.2), physiotherapy (OR 2.1; 95% CI 1.6-2.8) and psychologist/psychiatrist (OR 1.9; 95% CI 1.3-2.7). Cases were more likely to have a diagnosis in the ICD-10 chapters of diseases of the digestive system (OR 1.6; 95% CI 1.0-2.4), of the musculoskeletal system (OR 1.6; 95% CI 1.1-2.2), symptoms or signs not classified elsewhere (OR 1.8; 95% CI 1.3-2.5) as well as injuries (OR 1.5; 95% CI 1.2-1.9). Before receiving the first HPV

  17. Determinants of delayed care seeking for TB suggestive symptoms in Seru district, Oromiya region, Ethiopia: a community based unmatched case-control study.

    PubMed

    Yirgu, Robel; Lemessa, Firaol; Hirpa, Selamawit; Alemayehu, Abraham; Klinkenberg, Eveline

    2017-04-20

    Early tuberculosis (TB) case finding and adequate chemotherapy are essential for interrupting disease transmission and preventing complications due to delayed care seeking. This study was undertaken in order to provide insights into the magnitude and determinants of patient delay. The study was conducted in rural Seru district, employing a population based unmatched case-control study design. The WHO standardized TB screening tool was used to identify presumptive TB cases among the district population ages > 15 years. Presumptive TB cases who sought care in a health facility more than 14 days after the onset of symptoms were considered cases while those who sought care within the first 14 days were classified as controls. A structured interview questionnaire was used to capture socio demographic characteristics and health care service utilization related data from the study participants. A multiple binary logistic regression model was used to identify any factor associated with patient care seeking delay. A total of 9,782 individuals were screened, of which 980 (10%, 95% CI; 9.4-10.5%) presumptive TB cases were identified. From these cases 358 (76%, 95% CI; 75.6%-76.4%) sought care within the first 14 days of the onset of symptoms with a median patient delay of 15 days, IQR (5-30 days). The most common TB suggestive symptom mentioned by the participants was night sweat 754 (76.4%) while the least common was a history of contact with a confirmed TB case in the past one year 207 (21.1%). Individuals in the 45-54 age range had lower odds of delay (AOR 0.31, 95%CI 0.15, 0.61) as compared to those 15-24 years old. First TB treatment episode (AOR16.2, 95% CI 9.94, 26.26) and limited access to either traditional or modern modes of transportation (AOR 2.62, 95% CI 1.25, 5.49) were independently associated with patient care delay. Increasing community awareness about the risks of delayed care seeking and the importance of accessing health services close to the community can

  18. Characteristics of dental care-seeking behavior and related sociodemographic factors in a middle-aged and elderly population in northeast China.

    PubMed

    Liu, Lu; Zhang, Ying; Wu, Wei; Cheng, Ruibo

    2015-06-13

    The etiologies of oral disease are generally progressive and cumulative, such that compared with younger individuals, middle-aged and elderly people are at greater risk of active dental caries and periodontal disease risk. They usually suffer from multiple oral diseases, and obstacles to their use of dental care services are numerous. The objectives of this study were to investigate the characteristics of dental care-seeking behaviors and related sociodemographic factors in a middle-aged and elderly population in northeast China. This was a cross-sectional study of 1188 subjects, including 792 middle-aged (35-44 years-old) and 396 elderly (65-74 years-old) residents of northeast China. Information on dental care-seeking behaviors and sociodemographic characteristics was collected during face-to-face structured interviews conducted between May and June 2010. Chi square tests, Ridit scoring, and multivariate logistic regression analysis were employed to characterize dental care-seeking behaviors and their associations with sociodemographic factors. A greater proportion of middle-aged participants reported a need for dental visits compared with the elderly participants (75.8 % vs. 60.9 %; P < 0.01), as did more urban that rural residents (P < 0.05). The majority of individuals in both the middle-aged and elderly groups obtained for dental care at their own expense, and they predominantly chose private dental clinics. Ridit analyses showed that education level and income were significantly associated with oral care in both middle-aged and elderly people (Ps < 0.05). In addition, logistic regression analysis indicated that rural residence was negatively associated with dental visits in both middle-aged (odds ratio = 0.649, 95 % confidence interval: 0.447-0.884) and elderly (odds ratio = 0.604, 95 % confidence interval: 0.394-0.924) individuals. The rate of dental care visits is low in the middle-aged and elderly populations of northeast China. Among sociodemographic

  19. Women’s experiences and health care-seeking practices in relation to uterine prolapse in a hill district of Nepal

    PubMed Central

    2014-01-01

    Background Although uterine prolapse (UP) occurs commonly in Nepal, little is known about the physical health and care-seeking practices of women with UP. This study aimed to explore women’s experiences of UP and its effect on daily life, its perceived causes, and health care-seeking practices. Methods Using a convenience sampling method, we conducted 115 semi-structured and 16 in-depth interviews with UP-affected women during September–December 2012. All interviews occurred in outreach clinics in villages of the Dhading district. Results Study participants were 23–82 years of age. Twenty-four percent were literate, 47.2% had experienced a teenage pregnancy, and 29% had autonomy to make healthcare decisions. Most participants (>85%) described the major physical discomforts of UP as difficulty with walking, standing, working, sitting, and lifting. They also reported urinary incontinence (68%) bowel symptoms (42%), and difficulty with sexual activity (73.9%). Due to inability to perform household chores or fulfill their husband’s sexual desires, participants endured humiliation, harassment, and torture by their husbands and other family members, causing severe emotional stress. Following disclosure of UP, 24% of spouses remarried and 6% separated from the marital relationship. Women perceived the causes of UP as unsafe childbirth, heavy work during the postpartum period, and gender discrimination. Prior to visiting these camps some women (42%) hid UP for more than 10 years. Almost half (48%) of participants sought no health care; 42% ingested a herb and ate nutritious food. Perceived barriers to accessing health care included shame (48%) and feeling that care was unnecessary (12.5%). Multiple responses (29%) included shame, inability to share, male service provider, fear of stigma and discrimination, and perceiving UP as normal for childbearing women. Conclusions UP adversely affects women’s daily life and negatively influences their physical, mental, and

  20. “Money talks. And the society we live in is very harsh.” Cancer Care-Seeking from the Perspectives of Guam's Chamorros

    PubMed Central

    Moss, John

    2015-01-01

    Cancer mortality is rising at an astonishing rate on the island of Guam compared to the US. The indigenous people of Guam, the Chamorro, suffer from the highest rates of cancer death compared to other ethnic groups. To better understand some of the factors underlying these mortality rates, in-depth interviews were conducted with 11 self-identified Chamorros of Guam to explore their experiences seeking screening and treatment for cancer. Respondent's care-seeking was significantly influenced by their family's wealth and their health insurance coverage. Informants who did not seek regular cancer screening reported financial barriers along with a lack of awareness of cancer screening. Immediate family members facilitated increased access to cancer care, but extended family members sometimes caused increased stress for participants with cancer. Public awareness campaigns promoting cancer screening need to be tied to structural changes to the health care system to make cancer care financially accessible for care-seekers. PMID:26257999

  1. 'For a mere cough, men must just chew Conjex, gain strength, and continue working': the provider construction and tuberculosis care-seeking implications in Blantyre, Malawi.

    PubMed

    Chikovore, Jeremiah; Hart, Graham; Kumwenda, Moses; Chipungu, Geoffrey A; Corbett, Liz

    2015-01-01

    Background Delay by men in seeking healthcare results in their higher mortality while on HIV or tuberculosis (TB) treatment and contributes to ongoing community-level disease transmission before going on treatment. Objective To understand masculinity's role in delay in healthcare seeking for men, with a focus on TB-suggestive symptoms. Design Data were collected between March 2011 and March 2012 in low-income suburbs in urban Blantyre using focus group discussions with community members (n=8) and health workers (n=2), in-depth interviews with 20 TB patients (female=14) and 20 uninvestigated chronic coughers (female=8), and a 3-day participatory workshop with 27 health stakeholder representatives. The research process drew to a large extent on grounded theory principles in the manner of Strauss and Corbin (1998) and also Charmaz (1995). Results Role descriptions by both men and women in the study universally assigned men as primary material providers for their immediate family, that is, the ones earning and bringing livelihood and additional material needs. In a context where collectivism was valued, men were also expected to lead the provision of support to wider kin. Successful role enactment was considered key to achieving recognition as an adequate man; at the same time, job scarcity and insecurity, and low earnings gravely impeded men. Pressures to generate continuing income then meant constantly looking for jobs, or working continuously to retain insecure jobs or to raise money through self-employment. All this led men to relegate their health considerations. Conclusions Early engagement with formal healthcare is critical to dealing with TB and HIV. However, role constructions as portrayed for men in this study, along with the opportunity costs of acknowledging illness seem, in conditions of vulnerability, important barriers to care-seeking. There is a need to address hidden care-seeking costs and to consider more complex interventions, including reducing

  2. Health-care seeking behaviour and the use of traditional medicine among persons with type 2 diabetes in south-western Uganda: a study of focus group interviews

    PubMed Central

    Atwine, Fortunate; Hultsjö, Sally; Albin, Björn; Hjelm, Katarina

    2015-01-01

    Introduction Health-care seeking behaviour is important as it determines acceptance of health care and outcomes of chronic conditions but it has been investigated to a limited extent among persons with diabetes in developing countries. The aim of the study was to explore health-care seeking behaviour among persons with type 2 diabetes to understand reasons for using therapies offered by traditional healers. Methods Descriptive study using focus-group interviews. Three purposive focus-groups were conducted in 2011 of 10 women and 7 men aged 39–72 years in Uganda. Data were collected through semi-structured interviews and qualitatively analysed according to a method described for focus-groups. Results Reasons for seeking help from traditional healers were symptoms related to diabetes such as polydipsia, fatigue and decreased sensitivity in lower limbs. Failure of effect from western medicine was also reported. Treatment was described to be unknown extracts, of locally made products taken as herbs or food, and participants had sought help from different health facilities with the help of relatives and friends. Conclusion The pattern of seeking care was inconsistent, with a switch between different health care providers under the influence of the popular and folk sectors. Despite beliefs in using different healthcare providers seeking complementary and alternative medicine, participants still experienced many physical health problems related to diabetes complications. Health professionals need to be aware of the risk of switches between different health care providers, and develop strategies to initiate health promotion interventions to include in the care actors of significance to the patient from the popular, folk and professional sectors, to maintain continuity of effective diabetes care. PMID:26090034

  3. ‘For a mere cough, men must just chew Conjex, gain strength, and continue working’: the provider construction and tuberculosis care-seeking implications in Blantyre, Malawi

    PubMed Central

    Chikovore, Jeremiah; Hart, Graham; Kumwenda, Moses; Chipungu, Geoffrey A.; Corbett, Liz

    2015-01-01

    Background Delay by men in seeking healthcare results in their higher mortality while on HIV or tuberculosis (TB) treatment and contributes to ongoing community-level disease transmission before going on treatment. Objective To understand masculinity's role in delay in healthcare seeking for men, with a focus on TB-suggestive symptoms. Design Data were collected between March 2011 and March 2012 in low-income suburbs in urban Blantyre using focus group discussions with community members (n=8) and health workers (n=2), in-depth interviews with 20 TB patients (female=14) and 20 uninvestigated chronic coughers (female=8), and a 3-day participatory workshop with 27 health stakeholder representatives. The research process drew to a large extent on grounded theory principles in the manner of Strauss and Corbin (1998) and also Charmaz (1995). Results Role descriptions by both men and women in the study universally assigned men as primary material providers for their immediate family, that is, the ones earning and bringing livelihood and additional material needs. In a context where collectivism was valued, men were also expected to lead the provision of support to wider kin. Successful role enactment was considered key to achieving recognition as an adequate man; at the same time, job scarcity and insecurity, and low earnings gravely impeded men. Pressures to generate continuing income then meant constantly looking for jobs, or working continuously to retain insecure jobs or to raise money through self-employment. All this led men to relegate their health considerations. Conclusions Early engagement with formal healthcare is critical to dealing with TB and HIV. However, role constructions as portrayed for men in this study, along with the opportunity costs of acknowledging illness seem, in conditions of vulnerability, important barriers to care-seeking. There is a need to address hidden care-seeking costs and to consider more complex interventions, including reducing

  4. Local barriers and solutions to improve care-seeking for childhood pneumonia, diarrhoea and malaria in Kenya, Nigeria and Niger: a qualitative study.

    PubMed

    Bedford, K Juliet A; Sharkey, Alyssa B

    2014-01-01

    We present qualitative research findings on care-seeking and treatment uptake for pneumonia, diarrhoea and malaria among children under 5 in Kenya, Nigeria and Niger. The study aimed to determine the barriers caregivers face in accessing treatment for these conditions; to identify local solutions that facilitate more timely access to treatment; and to present these findings as a platform from which to develop context-specific strategies to improve care-seeking for childhood illness. Kenya, Nigeria and Niger are three high burden countries with low rates of related treatment coverage, particularly in underserved areas. Data were collected in Homa Bay County in Nyanza Province, Kenya; in Kebbi and Cross River States, Nigeria; and in the Maradi and Tillabéri regions of Niger. Primary caregivers of children under 5 who did not regularly engage with health services or present their child at a health facility during illness episodes were purposively selected for interview. Data underwent rigorous thematic analysis. We organise the identified barriers and related solutions by theme: financial barriers; distance/location of health facilities; socio-cultural barriers and gender dynamics; knowledge and information barriers; and health facility deterrents. The relative importance of each differed by locality. Participant suggested solutions ranged from community-level actions to facility-level and more policy-oriented actions, plus actions to change underlying problems such as social perceptions and practices and gender dynamics. We discuss the feasibility and implications of these suggested solutions. Given the high burden of childhood morbidity and mortality due to pneumonia, diarrhoea and malaria in Kenya, Nigeria and Niger, this study provides important insights relating to demand-side barriers and locally proposed solutions. Significant advancements are possible when communities participate in both problem identification and resolution, and are engaged as important

  5. Beyond antimalarial stock-outs: implications of health provider compliance on out-of-pocket expenditure during care-seeking for fever in South East Tanzania

    PubMed Central

    2013-01-01

    Background To better understand how stock-outs of the first line antimalarial, Artemisinin-based Combination Therapy (ACT) and other non-compliant health worker behaviour, influence household expenditures during care-seeking for fever in the Ulanga District in Tanzania. Methods We combined weekly ACT stock data for the period 2009-2011 from six health facilities in the Ulanga District in Tanzania, together with household data from 333 respondents on the cost of fever care-seeking in Ulanga during the same time period to establish how health seeking behaviour and expenditure might vary depending on ACT availability in their nearest health facility. Results Irrespective of ACT stock-outs, more than half (58%) of respondents sought initial care in the public sector, the remainder seeking care in the private sector where expenditure was higher by 19%. Over half (54%) of respondents who went to the public sector reported incidences of non-compliant behaviour by the attending health worker (e.g. charging those who were eligible for free service or referring patients to the private sector despite ACT stock), which increased household expenditure per fever episode from USD0.14 to USD1.76. ACT stock-outs were considered to be the result of non-compliant behaviour of others in the health system and increased household expenditure by 21%; however we lacked sufficient statistical power to confirm this finding. Conclusion System design and governance challenges in the Tanzanian health system have resulted in numerous ACT stock-outs and frequent non-compliant public sector health worker behaviour, both of which increase out-of-pocket health expenditure. Interventions are urgently needed to ensure a stable supply of ACT in the public sector and increase health worker accountability. PMID:24161029

  6. Beyond antimalarial stock-outs: implications of health provider compliance on out-of-pocket expenditure during care-seeking for fever in South East Tanzania.

    PubMed

    Mikkelsen-Lopez, Inez; Tediosi, Fabrizio; Abdallah, Gumi; Njozi, Mustafa; Amuri, Baraka; Khatib, Rashid; Manzi, Fatuma; de Savigny, Don

    2013-10-27

    To better understand how stock-outs of the first line antimalarial, Artemisinin-based Combination Therapy (ACT) and other non-compliant health worker behaviour, influence household expenditures during care-seeking for fever in the Ulanga District in Tanzania. We combined weekly ACT stock data for the period 2009-2011 from six health facilities in the Ulanga District in Tanzania, together with household data from 333 respondents on the cost of fever care-seeking in Ulanga during the same time period to establish how health seeking behaviour and expenditure might vary depending on ACT availability in their nearest health facility. Irrespective of ACT stock-outs, more than half (58%) of respondents sought initial care in the public sector, the remainder seeking care in the private sector where expenditure was higher by 19%. Over half (54%) of respondents who went to the public sector reported incidences of non-compliant behaviour by the attending health worker (e.g. charging those who were eligible for free service or referring patients to the private sector despite ACT stock), which increased household expenditure per fever episode from USD0.14 to USD1.76. ACT stock-outs were considered to be the result of non-compliant behaviour of others in the health system and increased household expenditure by 21%; however we lacked sufficient statistical power to confirm this finding. System design and governance challenges in the Tanzanian health system have resulted in numerous ACT stock-outs and frequent non-compliant public sector health worker behaviour, both of which increase out-of-pocket health expenditure. Interventions are urgently needed to ensure a stable supply of ACT in the public sector and increase health worker accountability.

  7. Health-care seeking behaviour and the use of traditional medicine among persons with type 2 diabetes in south-western Uganda: a study of focus group interviews.

    PubMed

    Atwine, Fortunate; Hultsjö, Sally; Albin, Björn; Hjelm, Katarina

    2015-01-01

    Health-care seeking behaviour is important as it determines acceptance of health care and outcomes of chronic conditions but it has been investigated to a limited extent among persons with diabetes in developing countries. The aim of the study was to explore health-care seeking behaviour among persons with type 2 diabetes to understand reasons for using therapies offered by traditional healers. Descriptive study using focus-group interviews. Three purposive focus-groups were conducted in 2011 of 10 women and 7 men aged 39-72 years in Uganda. Data were collected through semi-structured interviews and qualitatively analysed according to a method described for focus-groups. Reasons for seeking help from traditional healers were symptoms related to diabetes such as polydipsia, fatigue and decreased sensitivity in lower limbs. Failure of effect from western medicine was also reported. Treatment was described to be unknown extracts, of locally made products taken as herbs or food, and participants had sought help from different health facilities with the help of relatives and friends. The pattern of seeking care was inconsistent, with a switch between different health care providers under the influence of the popular and folk sectors. Despite beliefs in using different healthcare providers seeking complementary and alternative medicine, participants still experienced many physical health problems related to diabetes complications. Health professionals need to be aware of the risk of switches between different health care providers, and develop strategies to initiate health promotion interventions to include in the care actors of significance to the patient from the popular, folk and professional sectors, to maintain continuity of effective diabetes care.

  8. Local Barriers and Solutions to Improve Care-Seeking for Childhood Pneumonia, Diarrhoea and Malaria in Kenya, Nigeria and Niger: A Qualitative Study

    PubMed Central

    Bedford, K. Juliet A.; Sharkey, Alyssa B.

    2014-01-01

    We present qualitative research findings on care-seeking and treatment uptake for pneumonia, diarrhoea and malaria among children under 5 in Kenya, Nigeria and Niger. The study aimed to determine the barriers caregivers face in accessing treatment for these conditions; to identify local solutions that facilitate more timely access to treatment; and to present these findings as a platform from which to develop context-specific strategies to improve care-seeking for childhood illness. Kenya, Nigeria and Niger are three high burden countries with low rates of related treatment coverage, particularly in underserved areas. Data were collected in Homa Bay County in Nyanza Province, Kenya; in Kebbi and Cross River States, Nigeria; and in the Maradi and Tillabéri regions of Niger. Primary caregivers of children under 5 who did not regularly engage with health services or present their child at a health facility during illness episodes were purposively selected for interview. Data underwent rigorous thematic analysis. We organise the identified barriers and related solutions by theme: financial barriers; distance/location of health facilities; socio-cultural barriers and gender dynamics; knowledge and information barriers; and health facility deterrents. The relative importance of each differed by locality. Participant suggested solutions ranged from community-level actions to facility-level and more policy-oriented actions, plus actions to change underlying problems such as social perceptions and practices and gender dynamics. We discuss the feasibility and implications of these suggested solutions. Given the high burden of childhood morbidity and mortality due to pneumonia, diarrhoea and malaria in Kenya, Nigeria and Niger, this study provides important insights relating to demand-side barriers and locally proposed solutions. Significant advancements are possible when communities participate in both problem identification and resolution, and are engaged as important

  9. Malaria related care-seeking-behaviour and expenditures in urban settings: A household survey in Ouagadougou, Burkina Faso.

    PubMed

    Beogo, Idrissa; Huang, Nicole; Drabo, Maxime K; Yé, Yazoumé

    2016-08-01

    In Sub-Sahara Africa, malaria inflicts a high healthcare expenditure to individuals. However, little is known about healthcare expenditure to individual affected by malaria and determinants of healthcare seeking behaviour in urban settings where private sector is thriving. This study investigated the level and correlates of expenditure among individuals with self-reported malaria episode in Ouagadougou, Burkina Faso. A cross-sectional household survey conducted in August-November 2011 in Ouagadougou covered 8,243 individuals (1,600 households). Using Generalized Estimating Equations, the analysis included 1082 individuals from 715 households, who reported an episode of malaria. Of individuals surveyed, 38.3% sought care from public, 27.4% from private providers, and, 34.2% self-medicated. The median cost for malaria treatment was USD10.1 (4,850.0XOF) with significant different between public, private and self-medication (p<0.001). In public primary care health facilities, the median cost was USD8.4 (4,050.0XOF) for uncomplicated malaria and USD15.2 (7,333.5XOF) for severe malaria. In private-for-profit facilities run by a medical doctor, the median cost was USD30.3 (14,600.0XOF) for uncomplicated malaria and USD 43.0 (20,725.0XOF) for severe malaria. Regardless of the source of care, patients with insurance incurred significantly higher expenditure compared to those without insurance (p<0.001) and medicine accounted for the largest share of the expenditure. The type of provider, having insurance, and the severity of the malaria predict the amount of money spent. The high financial cost of malaria treatment regardless of the providers poses threat to the goal of universal access to malaria interventions, the unique way to achieve elimination goals.

  10. Health care-seeking among Latino immigrants: blocked access, use of traditional medicine, and the role of religion.

    PubMed

    Ransford, H Edward; Carrillo, Frank R; Rivera, Yessenia

    2010-08-01

    Barriers to health care and use of cultural alternatives are studied from open-ended interviews of 96 Latino immigrants, 12 hometown association leaders, and five pastors and health outreach workers. Frequently mentioned barriers to approaching hospitals and clinics included problems in communication, establishing financial eligibility, and extremely long waits for service. We found frequent use of cultural alternatives, such as herbal medications, obtaining care from Mexican doctors, and some use of traditional healers. The role of religiosity is studied: prayer is viewed as fundamental to health, but the church is not perceived as an aid in physical health-seeking. Health care for Latino immigrants often involves a blend of mainstream and traditional medicine; the study discusses examples of respondents who navigate between the two systems within the interplay of culture and structure.

  11. 77 FR 39143 - Executive Branch Qualified Trusts

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-07-02

    ... continues to read as follows: Authority: 5 U.S.C. App. (Ethics in Government Act of 1978); 26 U.S.C. 1043... excess of the diversification standards. (c) Hybrid qualified trust. A qualified trust may contain both a... to this arrangement as a hybrid qualified trust. Sec. 2634.407 Certification of qualified trust...

  12. 7 CFR 1786.154 - Qualified Notes.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 7 Agriculture 12 2011-01-01 2011-01-01 false Qualified Notes. 1786.154 Section 1786.154... Discounted Prepayments on RUS Electric Loans § 1786.154 Qualified Notes. An eligible borrower may prepay Qualified Notes under this subpart at the discounted present value. A Qualified Note is a note evidencing an...

  13. 7 CFR 1786.154 - Qualified Notes.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 7 Agriculture 12 2013-01-01 2013-01-01 false Qualified Notes. 1786.154 Section 1786.154... Discounted Prepayments on RUS Electric Loans § 1786.154 Qualified Notes. An eligible borrower may prepay Qualified Notes under this subpart at the discounted present value. A Qualified Note is a note evidencing an...

  14. 7 CFR 1786.154 - Qualified Notes.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 7 Agriculture 12 2014-01-01 2013-01-01 true Qualified Notes. 1786.154 Section 1786.154 Agriculture... Prepayments on RUS Electric Loans § 1786.154 Qualified Notes. An eligible borrower may prepay Qualified Notes under this subpart at the discounted present value. A Qualified Note is a note evidencing an RUS...

  15. 75 FR 27934 - Qualified Nonpersonal Use Vehicles

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-05-19

    ... driver and all passengers of a qualified nonpersonal use vehicle. However, a working condition fringe... Internal Revenue Service 26 CFR Part 1 RIN 1545-BH65 Qualified Nonpersonal Use Vehicles AGENCY: Internal... regulations relating to qualified nonpersonal use vehicles as defined in section 274(i). Qualified...

  16. 20 CFR 302.3 - Qualifying conditions.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 20 Employees' Benefits 1 2014-04-01 2012-04-01 true Qualifying conditions. 302.3 Section 302.3 Employees' Benefits RAILROAD RETIREMENT BOARD REGULATIONS UNDER THE RAILROAD UNEMPLOYMENT INSURANCE ACT QUALIFIED EMPLOYEE § 302.3 Qualifying conditions. (a) Basic requirements. To qualify for benefits...

  17. 20 CFR 302.3 - Qualifying conditions.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 20 Employees' Benefits 1 2012-04-01 2012-04-01 false Qualifying conditions. 302.3 Section 302.3 Employees' Benefits RAILROAD RETIREMENT BOARD REGULATIONS UNDER THE RAILROAD UNEMPLOYMENT INSURANCE ACT QUALIFIED EMPLOYEE § 302.3 Qualifying conditions. (a) Basic requirements. To qualify for benefits...

  18. 20 CFR 302.3 - Qualifying conditions.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 20 Employees' Benefits 1 2013-04-01 2012-04-01 true Qualifying conditions. 302.3 Section 302.3 Employees' Benefits RAILROAD RETIREMENT BOARD REGULATIONS UNDER THE RAILROAD UNEMPLOYMENT INSURANCE ACT QUALIFIED EMPLOYEE § 302.3 Qualifying conditions. (a) Basic requirements. To qualify for benefits...

  19. 20 CFR 302.3 - Qualifying conditions.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 20 Employees' Benefits 1 2010-04-01 2010-04-01 false Qualifying conditions. 302.3 Section 302.3 Employees' Benefits RAILROAD RETIREMENT BOARD REGULATIONS UNDER THE RAILROAD UNEMPLOYMENT INSURANCE ACT QUALIFIED EMPLOYEE § 302.3 Qualifying conditions. (a) Basic requirements. To qualify for benefits with...

  20. Treating infants with frigg: linking disease aetiologies, medicinal plant use and care-seeking behaviour in southern Morocco.

    PubMed

    Teixidor-Toneu, Irene; Martin, Gary J; Puri, Rajindra K; Ouhammou, Ahmed; Hawkins, Julie A

    2017-01-13

    Although most Moroccans rely to some extent on traditional medicine, the practice of frigg to treat paediatric ailments by elderly women traditional healers known as ferraggat, has not yet been documented. We describe the role of these specialist healers, document the medicinal plants they use, and evaluate how and why their practice is changing. Ethnomedicinal and ethnobotanical data were collected using semi-structured interviews and observations of medical encounters. Information was collected from traditional healers, namely ferraggat, patients, herbalists and public health professionals. Patients' and healers' narratives about traditional medicine were analysed and medicinal plant lists were compiled from healers and herbalists. Plants used were collected, vouchered and deposited in herbaria. Ferragat remain a key health resource to treat infant ailments in the rural High Atlas, because mothers believe only they can treat what are perceived to be illnesses with a supernatural cause. Ferragat possess baraka, or the gift of healing, and treat mainly three folk ailments, taqait, taumist and iqdi, which present symptoms similar to those of ear infections, tonsillitis and gastroenteritis. Seventy plant species were used to treat these ailments, but the emphasis on plants may be a recent substitute for treatments that used primarily wool and blood. This change in materia medica is a shift in the objects of cultural meaningfulness in response to the increasing influence of orthodox Islam and state-sponsored modernisation, including public healthcare and schooling. Religious and other sociocultural changes are impacting the ways in which ferraggat practice. Treatments based on no-longer accepted symbolic elements have been readily abandoned and substituted by licit remedies, namely medicinal plants, which play a legitimisation role for the practice of frigg. However, beliefs in supernatural ailment aetiologies, as well as lack or difficult access to biomedical

  1. 42 CFR 436.121 - Qualified family members.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 42 Public Health 4 2014-10-01 2014-10-01 false Qualified family members. 436.121 Section 436.121 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS ELIGIBILITY IN GUAM, PUERTO RICO, AND THE VIRGIN ISLANDS Mandatory...

  2. 42 CFR 417.412 - Qualifying condition: Administration and management.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ..., COMPETITIVE MEDICAL PLANS, AND HEALTH CARE PREPAYMENT PLANS Qualifying Conditions for Medicare Contracts § 417...) Has sufficient administrative capability to carry out the requirements of the contract; and (b) Does... convicted of criminal offenses related to their involvement in Medicaid, Medicare, or social...

  3. "I never had the money for blood testing" – Caretakers' experiences of care-seeking for fatal childhood fevers in rural Uganda – a mixed methods study

    PubMed Central

    Hildenwall, Helena; Tomson, Göran; Kaija, Judith; Pariyo, George; Peterson, Stefan

    2008-01-01

    Background The main killer diseases of children all manifest as acute febrile illness, yet are curable with timely and adequate management. To avoid a fatal outcome, three essential steps must be completed: caretakers must recognize illness, decide to seek care and reach an appropriate source of care, and then receive appropriate treatment. In a fatal outcome some or all of these steps have failed and it remains to be elucidated to what extent these fatal outcomes are caused by local disease perceptions, inappropriate care-seeking or inadequate resources in the family or health system. This study explores caretakers' experiences of care-seeking for childhood febrile illness with fatal outcome in rural Uganda to elucidate the most influential barriers to adequate care. Methods A mixed methods approach using structured Verbal/Social autopsy interviews and in-depth interviews was employed with 26 caretakers living in Iganga/Mayuge Demographic Surveillance Site who had lost a child 1–59 months old due to acute febrile illness between March and June 2006. In-depth interviews were analysed using content analysis with deductive category application. Results Final categories of barriers to care were: 1) "Illness interpretation barriers" involving children who received delayed or inappropriate care due to caretakers' labelling of the illness, 2) "Barriers to seeking care" with gender roles and household financial constraints hindering adequate care and 3) "Barriers to receiving adequate treatment" revealing discontents with providers and possible deficiencies in quality of care. Resource constraints were identified as the underlying theme for adequate management, both at individual and at health system levels. Conclusion The management of severely ill children in this rural setting has several shortcomings. However, the majority of children were seen by an allopathic health care provider during the final illness. Improvements of basic health care for children suffering

  4. Paralinguistic Qualifiers: Our Many Voices.

    ERIC Educational Resources Information Center

    Poyatos, Fernando

    1991-01-01

    A case is made for the increased study of paralinguistic voice qualifiers, which include variations in breathing, laryngeal, esophageal, pharyngeal, velopharyngeal, lingual, labial, mandibular, articulatory, articulatory tension, and objectual control. It is proposed that attention to these voice qualities has a variety of practical, literary,…

  5. Canada's Highly Qualified Manpower Resources.

    ERIC Educational Resources Information Center

    Atkinson, A. G.; And Others

    The purpose of this report is to assemble basic statistics on highly qualified manpower resources in Canada, especially focusing on scientists and engineers, for the development of policies and research in this field. The economic background contributing to the growth of the white-collar and professional labor force is discussed, and the roles of…

  6. The Influence of Episode Severity on Caregiver Recall, Care-seeking, and Treatment of Diarrhea among Children 2–59 Months of Age in Bihar, Gujarat, and Uttar Pradesh, India

    PubMed Central

    Lamberti, Laura M.; Fischer Walker, Christa L.; Taneja, Sunita; Mazumder, Sarmila; Black, Robert E.

    2015-01-01

    Increased diarrheal episode severity has been linked to better 2-week recall and improved care-seeking and treatment among caregivers of children under five. Using cross-sectional data from three Indian states, we sought to assess the relationship between episode severity and the recall, care-seeking, and treatment of childhood diarrhea. Recall error was higher for episodes with onset 8–14 days (31.2%) versus 1–7 days (4.8%) before the survey, and logistic regression analysis showed a trend toward increased severity of less recent compared with more recent episodes. This finding indicates that data collection with 2-week recall underestimates diarrhea prevalence while overestimating the proportion of severe episodes. There was a strong correlation between care-seeking and dehydration, fever, vomiting, and increased stool frequency and duration. Treatment with oral rehydration salts was associated with dehydration, vomiting, and higher stool frequency, and trends were established between therapeutic zinc supplementation and increased duration and stool frequency. However, state and care-seeking sector were stronger determinants of treatment than episode severity, illustrating the need to address disparities in treatment quality across regions and delivery channels. Our findings are of importance to researchers and diarrhea management program evaluators aiming to produce accurate estimates of diarrheal outcomes and program impact in low- and middle-income countries. PMID:26033018

  7. The Influence of Episode Severity on Caregiver Recall, Care-seeking, and Treatment of Diarrhea Among Children 2-59 Months of Age in Bihar, Gujarat, and Uttar Pradesh, India.

    PubMed

    Lamberti, Laura M; Fischer Walker, Christa L; Taneja, Sunita; Mazumder, Sarmila; Black, Robert E

    2015-08-01

    Increased diarrheal episode severity has been linked to better 2-week recall and improved care-seeking and treatment among caregivers of children under five. Using cross-sectional data from three Indian states, we sought to assess the relationship between episode severity and the recall, care-seeking, and treatment of childhood diarrhea. Recall error was higher for episodes with onset 8-14 days (31.2%) versus 1-7 days (4.8%) before the survey, and logistic regression analysis showed a trend toward increased severity of less recent compared with more recent episodes. This finding indicates that data collection with 2-week recall underestimates diarrhea prevalence while overestimating the proportion of severe episodes. There was a strong correlation between care-seeking and dehydration, fever, vomiting, and increased stool frequency and duration. Treatment with oral rehydration salts was associated with dehydration, vomiting, and higher stool frequency, and trends were established between therapeutic zinc supplementation and increased duration and stool frequency. However, state and care-seeking sector were stronger determinants of treatment than episode severity, illustrating the need to address disparities in treatment quality across regions and delivery channels. Our findings are of importance to researchers and diarrhea management program evaluators aiming to produce accurate estimates of diarrheal outcomes and program impact in low- and middle-income countries.

  8. Providing information to improve body image and care-seeking behavior of women and girls living with female genital mutilation: A systematic review and meta-analysis.

    PubMed

    Esu, Ekpereonne; Okoye, Ifeyinwa; Arikpo, Iwara; Ejemot-Nwadiaro, Regina; Meremikwu, Martin M

    2017-02-01

    Female genital mutilation (FGM) has become recognized worldwide as an extreme form of violation of the human rights of girls and women. Strategies have been employed to curb the practice. To conduct a systematic review of randomized and nonrandomized studies of the effects of providing educational interventions on the body image and care-seeking behavior of girls and women living with FGM with the view to ending the practice. CENTRAL, MEDLINE, and other databases were searched up to August 10, 2015 without any language restrictions. Studies that provided education to women and/or girls living with any type of FGM or residing in countries where FGM is predominantly practiced were included. Two authors independently screened and collected data. We summarized dichotomous outcomes using odds ratios and evidence was assessed using the GRADE system (Grading of Recommendations Assessment, Development, and Evaluation). Educational interventions resulted in fewer women recommending FGM for their daughters and also reduced the incidence of FGM cases among daughters of women who received the educational interventions. These findings need to be validated with large randomized trials. 42015024637. © 2017 International Federation of Gynecology and Obstetrics. The World Health Organization retains copyright and all other rights in the manuscript of this article as submitted for publication.

  9. Care Seeking Behaviour and Barriers to Accessing Services for Sexual Health Problems among Women in Rural Areas of Tamilnadu State in India.

    PubMed

    Puthuchira Ravi, Rejoice; Athimulam Kulasekaran, Ravishankar

    2014-01-01

    Background. Sexually transmitted infections (STIs) may be either asymptomatic or symptomatic. Regardless of the presence or absence of symptoms all STIs can lead to major complications if left untreated. Objective. To assess the care seeking behaviour and barriers to accessing services for sexual health problems among young married women in rural areas of Thiruvarur district of Tamil Nadu state in India. Methods. A community based cross-sectional study was conducted in 28 villages selected using multistage sampling technique for selecting 605 women in the age group of 15-24 years during July 2010-April 2011. Results. The prevalence rate of reproductive tract infections (RTIs) and STIs was observed to be 14.5% and 8.8%, respectively, among the study population. Itching/irritation over vulva, thick white discharge, discharge with unpleasant odor, and frequent and uncomfortable urination were most commonly experienced symptoms of sexual health problems. Around three-fourth of the women received treatment for sexual health problems. Perception of symptoms as normal, feeling shy, lack of female health workers, distance to health facility, and lack of availability of treatment were identified as major barriers for not seeking treatment for RTIs/STIs. Conclusion. Family tradition and poor socioeconomic conditions of the family appear to be the main reasons for not utilizing the health facility for sexual health problems. Integrated approach is strongly suggested for creating awareness to control the spread of sexual health problems among young people.

  10. 42 CFR 495.204 - Incentive payments to qualifying MA organizations for qualifying MA-EPs and qualifying MA...

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... hospitals for which such qualifying organizations received incentive payments were meaningful EHR users in... of EHR incentive payment due the MA organization. (c) Amount payable to qualifying MA organization... for qualifying MA-affiliated eligible hospitals under the Medicare FFS EHR hospital incentive program...

  11. 42 CFR 495.204 - Incentive payments to qualifying MA organizations for qualifying MA-EPs and qualifying MA...

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... hospitals for which such qualifying organizations received incentive payments were meaningful EHR users in... of EHR incentive payment due the MA organization. (c) Amount payable to qualifying MA organization... for qualifying MA-affiliated eligible hospitals under the Medicare FFS EHR hospital incentive program...

  12. 46 CFR 391.5 - Qualified withdrawals.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 46 Shipping 8 2014-10-01 2014-10-01 false Qualified withdrawals. 391.5 Section 391.5 Shipping... TAX ASPECTS OF THE CAPITAL CONSTRUCTION FUND § 391.5 Qualified withdrawals. (a) In general. (1) A qualified withdrawal is one made from the fund during the taxable year which is in accordance with...

  13. 46 CFR 391.5 - Qualified withdrawals.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 46 Shipping 8 2013-10-01 2013-10-01 false Qualified withdrawals. 391.5 Section 391.5 Shipping... TAX ASPECTS OF THE CAPITAL CONSTRUCTION FUND § 391.5 Qualified withdrawals. (a) In general. (1) A qualified withdrawal is one made from the fund during the taxable year which is in accordance with...

  14. 46 CFR 391.5 - Qualified withdrawals.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 46 Shipping 8 2011-10-01 2011-10-01 false Qualified withdrawals. 391.5 Section 391.5 Shipping... TAX ASPECTS OF THE CAPITAL CONSTRUCTION FUND § 391.5 Qualified withdrawals. (a) In general. (1) A qualified withdrawal is one made from the fund during the taxable year which is in accordance with...

  15. 7 CFR 4290.110 - Qualified management.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 7 Agriculture 15 2014-01-01 2014-01-01 false Qualified management. 4290.110 Section 4290.110... Qualifications for the RBIC Program Organizing A Rbic § 4290.110 Qualified management. An Applicant must show, to the satisfaction of the Secretary, that its current or proposed management team is qualified and...

  16. 7 CFR 4290.110 - Qualified management.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 7 Agriculture 15 2012-01-01 2012-01-01 false Qualified management. 4290.110 Section 4290.110... Qualifications for the RBIC Program Organizing A Rbic § 4290.110 Qualified management. Link to an amendment..., that its current or proposed management team is qualified and has the knowledge, experience,...

  17. 28 CFR 549.41 - Voluntary admission and psychotropic medication.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... INSTITUTIONAL MANAGEMENT MEDICAL SERVICES Administrative Safeguards for Psychiatric Treatment and Medication... admitted for psychiatric treatment and medication when, in the professional judgment of qualified...

  18. Community based saving groups: an innovative approach to overcome the financial and social barriers in health care seeking by the women in the rural remote communities of Pakistan.

    PubMed

    Shaikh, Babar Tasneem; Noorani, Qayyum; Abbas, Shazia

    2017-01-01

    In remote rural areas of Pakistan, access to the maternal, newborn and child health (MNCH) care provided by a skilled health provider is quite difficult. There are many reasons such as women's restricted social mobility, lack of education, disenfranchised in decision making and poverty. To overcome these barriers and impediments in district Chitral, which is the largest territory in terms of geography in province Khyber Pakhtunkhwa, local women of reproductive age, were mobilized to form the Community Based Saving Groups (CBSGs) at the village level. In these CBSGs, they pool-in their money, and then provide soft loans to the expecting mothers to meet the expenses of delivery. Simultaneously, young literate women were identified from the local communities; they were trained as Community Midwives (CMWs), using national MNCH curriculum, and later deployed in their respective villages within the district. This study captured their perceptions about the formation of CBSGs to overcome the financial and social barriers, and subsequent use of CMW services. A qualitative enquiry was conducted with the delivered mothers and their husbands through gender specific separate focus group discussions, with CBSG members and with non-members in four different sites of District Chitral. CBSG member women were far more aware on health issues. Information sought from these forums brought a noticeable change in the health seeking practices. Seeking care from a trained birth attendant in the community became easier. Women associated with the CBSGs as members, expressed an increased access to money for utilizing the CMW services, better awareness on MNCH issues, and empowerment to decide for seeking care. CBSG have been an instrumental platform for social networking, helping each other in other household matters. Women have started using the services of CMW and the CBSGs have actually helped them overcome the financial barriers in health care seeking. Moreover, the CBSGs became a medium

  19. Interpretative repertoires that shape low-income African American women's reproductive health care seeking: "don't want to know" and "taking charge of your health".

    PubMed

    Golden, Annis G; Pomerantz, Anita

    2015-01-01

    In the context of reproductive and sexual health, African American women have higher incidence of disease and poorer outcomes on key indicators when compared with White women. In this study, we used discourse analysis to identify and examine the workings of two clusters of interpretive resources ("interpretative repertoires") associated with reproductive/sexual health care seeking among low-income African American women who participated in semistructured interviews as part of a health promotion initiative. Interpretative repertoires are ways of accounting for engaging in or refraining from engaging in actions, which are shared by people in a community. We labeled the two interpretative repertoires "Don't Want to Know," and "Take Charge of Your Health." Within the "Don't Want to Know" repertoire, that testing would lead to threatening findings was assumed, a chain of devastating consequences was imagined, and a preference for uncertainty over certain knowledge was expressed. Conversely, the "Take Charge of Your Health" repertoire valued certainty over uncertainty, though in both interpretive frameworks, knowledge-based and emotion-based decision-making were intertwined. We conclude that health promotion initiatives--if they are to succeed in encouraging women to obtain valuable preventive health care services--must respond, in their choices of language and outreach strategies, to the expressed dilemma of wishing for reassurance but fearing bad news, to the intertwining of emotional reasoning and technorationality in health decision making, and to the particular relational experiences of African American women. Failure to do so will contribute to the continuation of reproductive and sexual health disparities.

  20. The effect of performance-based financing on illness, care-seeking and treatment among children: an impact evaluation in Rwanda.

    PubMed

    Skiles, Martha Priedeman; Curtis, Siân L; Basinga, Paulin; Angeles, Gustavo; Thirumurthy, Harsha

    2015-09-14

    Performance-based financing (PBF) strategies are promoted as a supply-side, results-based financing mechanism to improve primary health care. This study estimated the effects of Rwanda's PBF program on less-incentivized child health services and examined the differential program impact by household poverty. Districts were allocated to intervention and comparison for PBF implementation in Rwanda. Using Demographic Health Survey data from 2005 to 2007-08, a community-level panel dataset of 5781 children less than 5 years of age from intervention and comparison districts was created. The impacts of PBF on reported childhood illness, facility care-seeking, and treatment received were estimated using a difference-in-differences model with community fixed effects. An interaction term between poverty and the program was estimated to identify the differential effect of PBF among children from poorer families. There was no measurable difference in estimated probability of reporting illness with diarrhea, fever or acute respiratory infections between the intervention and comparison groups. Seeking care at a facility for these illnesses increased over time, however no differential effect by PBF was seen. The estimated effect of PBF on receipt of treatment for poor children is 45 percentage points higher (p = 0.047) compared to the non-poor children seeking care for diarrhea or fever. PBF, a supply-side incentive program, improved the quality of treatment received by poor children conditional on patients seeking care, but it did not impact the propensity to seek care. These findings provide additional evidence that PBF incentivizes the critical role staff play in assuring quality services, but does little to influence consumer demand for these services. Efforts to improve child health need to address both supply and demand, with additional attention to barriers due to poverty if equity in service use is a concern.

  1. Social determinants of malaria and health care seeking patterns among rice farming and pastoral communities in Kilosa District in central Tanzania.

    PubMed

    Shayo, Elizabeth H; Rumisha, Susan F; Mlozi, Malongo R S; Bwana, Veneranda M; Mayala, Benjamin K; Malima, Robert C; Mlacha, Tabitha; Mboera, Leonard E G

    2015-04-01

    This study was carried out to understand the role social determinants and health seeking behavior among rice farming and pastoral communities in Kilosa District in central Tanzania. The study involved four villages; two with rice farming communities while the other two with pastoral communities. In each village, heads of households or their spouses were interviewed to seek information on livelihoods activities, knowledge and practices on malaria and its preventions. A total of 471 individuals (males=38.9%; females=61.1%) were interviewed. Only 23.5% of the respondents had adequate knowledge on malaria. Fifty-six percent of the respondents could not associate any livelihood activity with malaria transmission. Majority (79%) of the respondents believed that most of fevers were due to malaria; this was higher among the pastoral (81.7%) than rice farming communities (76.1%) (p=0.038). Cases of fever were significantly higher in households with non-educated (31.2%) than educated respondents (21.5%). Women experienced significantly more episodes of fever than men (p<0.001). Of the total of 2606 individuals living in the households, 26.9% were reported to have had fever in the previous three months. Fever was reported more frequently among pastoral than rice farming communities (p<0.01). Of those who had fever, 36.6% were clinically diagnosed with malaria and 22.9% were confirmed to be infected with malaria. A combination of fever+convulsions or joint pains+headache was most frequently perceived to be malaria. Treatment seeking frequency differed by the size of the household and between rice farming and pastoral communities (p=0.05). In conclusion, education, sex, availability of health care facility and livelihood practices were the major social determinants that influence malaria acquisition and care seeking pattern in central Tanzania. Appropriate public health promotion should be designed to address the links of livelihoods and malaria transmission among rural farming

  2. "It is good to take her early to the doctor" - mothers' understanding of childhood pneumonia symptoms and health care seeking in Kilimanjaro region, Tanzania.

    PubMed

    Muro, Florida; Meta, Judith; Renju, Jenny; Mushi, Adiel; Mbakilwa, Hilda; Olomi, Raimos; Reyburn, Hugh; Hildenwall, Helena

    2017-09-22

    Pneumonia is among the leading causes of avoidable deaths for young children globally. The main burden of mortality falls on children from poor and rural families who are less likely to obtain the treatment they need, highlighting inequities in access to effective care and treatment. Caretakers' illness perceptions and care-seeking practices are of major importance for children with pneumonia to receive adequate care. This study qualitatively explores the caretaker concepts of childhood pneumonia in relation to treatment seeking behaviour and health worker management in Moshi urban district, Tanzania. In May - July 2013 data was gathered through different qualitative data collection techniques including five focus group discussions (FGDs) with mothers of children under-five years of age. The FGDs involved free listing of pneumonia symptoms and video presentations of children with respiratory symptoms done, these were triangulated with ten case narratives with mothers of children admitted with pneumonia and eleven in-depth interviews with hospital health workers. Transcripts were coded and analysed using qualitative content analysis. Mothers demonstrated good awareness of common childhood illnesses including pneumonia, which was often associated with symptoms such as cough, flu, chest tightness, fever, and difficulty in breathing. Mothers had mixed views on causative factors and treatments options but generally preferred modern medicine for persisting and severe symptoms. However, all respondent reported access to health facilities as a barrier to care, associated with transport, personal safety and economic constraints. Local illness concepts and traditional treatment options did not constitute barriers to care for pneumonia symptoms. Poor access to health facilities was the main barrier. Decentralisation of care through community health workers may improve access to care but needs to be combined with strengthened referral systems and accessible hospital care for

  3. Caregiver Recognition of Childhood Diarrhea, Care Seeking Behaviors and Home Treatment Practices in Rural Burkina Faso: A Cross-Sectional Survey

    PubMed Central

    Wilson, Shelby E.; Ouédraogo, Césaire T.; Prince, Lea; Ouédraogo, Amadou; Hess, Sonja Y.; Rouamba, Noël; Ouédraogo, Jean Bosco; Vosti, Stephen A.; Brown, Kenneth H.

    2012-01-01

    Introduction To design effective national diarrhea control programs, including oral rehydration solution (ORS) and therapeutic zinc supplementation, information is needed on local perceptions of illness, external care seeking behaviors, and home treatment practices. Methods A cross-sectional, community-based household survey was conducted in the Orodara Health District, Burkina Faso. Caregivers of 10,490 children <27 months were interviewed to assess child diarrhea prevalence and related care practices. Characteristics of households, caregivers, children, and reported illnesses were compared for those caregivers who did or did not recognize the presence of diarrhea, as defined according to clinical criteria (≥3 liquid or semi-liquid stools/day). Multiple logistic regression models were used to examine factors associated with illness recognition and treatment. Results Clinically defined diarrhea was present in 7.6% (95% CI: 7.1–8.1%) of children during the 24 hours preceding the survey but recognized by only 55% of caregivers. Over half (55%) of the caregivers of 1,067 children with a clinically defined diarrhea episode in the past 14 days sought care outside the home; 78% of those seeking care attended a public sector clinic. Care was sought and treatment provided more frequently for children with fever, vomiting, anorexia, longer illness duration, and those living closer to the health center; and care was sought more frequently for male children. 80% of children with recent diarrhea received some form of treatment; only 24% received ORS, whereas 14% received antibiotics. Zinc was not yet available in the study area. Conclusions Caregivers frequently fail to recognize children's diarrhea, especially among younger infants and when illness signs are less severe. Treatment practices do not correspond with international recommendations in most cases, even when caregivers consult with formal health services. Child caregivers need additional assistance to recognize

  4. HIV prevention and care-seeking behaviour among female sex workers in four cities in India, Kenya, Mozambique and South Africa.

    PubMed

    Lafort, Yves; Greener, Ross; Roy, Anuradha; Greener, Letitia; Ombidi, Wilkister; Lessitala, Faustino; Haghparast-Bidgoli, Hassan; Beksinska, Mags; Gichangi, Peter; Reza-Paul, Sushena; Smit, Jenni A; Chersich, Matthew; Delva, Wim

    2016-10-01

    To identify gaps in the use of HIV prevention and care services and commodities for female sex workers, we conducted a baseline cross-sectional survey in four cities, in the context of an implementation research project aiming to improve use of sexual and reproductive health services. Using respondent-driven sampling, 400 sex workers were recruited in Durban, 308 in Tete, 400 in Mombasa and 458 in Mysore and interviewed face-to-face. RDS-adjusted proportions were estimated by nonparametric bootstrapping and compared across cities using post hoc pairwise comparison. Condom use with last client ranged from 88.3% to 96.8%, ever female condom use from 1.6% to 37.9%, HIV testing within the past 6 months from 40.5% to 70.9%, receiving HIV treatment and care from 35.5% to 92.7%, care seeking for last STI from 74.4% to 87.6% and having had at least 10 contacts with a peer educator in the past year from 5.7% to 98.1%. Many of the differences between cities remained statistically significant (P < 0.05) after adjusting for differences in FSWs' socio-demographic characteristics. The use of HIV prevention and care by FSWs is often insufficient and differed greatly between cities. Differences could not be explained by variations in socio-demographic sex worker characteristics. Models to improve use of condoms and HIV prevention and care services should be tailored to the specific context of each site. Programmes at each site must focus on improving availability and uptake of those services that are currently least used. © 2016 John Wiley & Sons Ltd.

  5. Trends in malaria morbidity among health care-seeking children under age five in Mopti and Sévaré, Mali between 1998 and 2006

    PubMed Central

    2010-01-01

    Background In Mali, malaria is the leading cause of death and the primary cause of outpatient visits for children under five. The twin towns of Mopti and Sévaré have historically had high under-five mortality. This paper investigates the changing malaria burden in children under five in these two towns for the years 1998-2006, and the likely contribution of previous interventions aimed at reducing malaria. Methods A retrospective analysis of daily outpatient consultation records from urban community health centres (CSCOMs) located in Mopti and Sévaré for the years 1998-2006 was conducted. Risk factors for a diagnosis of presumptive malaria, using logistic regression and trends in presumptive malaria diagnostic rates, were assessed using multilevel analysis. Results Between 1998-2006, presumptive malaria accounted for 33.8% of all recorded consultation diagnoses (10,123 out of 29,915). The monthly presumptive malaria diagnostic rate for children under five decreased by 66% (average of 8 diagnoses per month per 1,000 children in 1998 to 2.7 diagnoses per month in 2006). The multi-level analysis related 37% of this decrease to the distribution of bed net treatment kits initiated in May of 2001. Children of the Fulani (Peuhl) ethnicity had significantly lower odds of a presumptive malaria diagnosis when compared to children of other ethnic groups. Conclusions Presumptive malaria diagnostic rates have decreased between 1998-2006 among health care-seeking children under five in Mopti and Sévaré. A bed net treatment kit intervention conducted in 2001 is likely to have contributed to this decline. The results corroborate previous findings that suggest that the Fulani ethnicity is protective against malaria. The findings are useful to encourage dialogue around the urban malaria situation in Mali, particularly in the context of achieving the target of reducing malaria morbidity in children younger than five by 50% by 2011 as compared to levels in 2000. PMID:21067615

  6. Health needs and care seeking behaviours of Yazidis and other minority groups displaced by ISIS into the Kurdistan Region of Iraq.

    PubMed

    Cetorelli, Valeria; Burnham, Gilbert; Shabila, Nazar

    2017-01-01

    During the summer of 2014, ISIS overran Nineveh governorate in Northern Iraq. Yazidis and other religious minorities were subjected to brutal attacks and forced to seek refuge into the neighbouring Kurdistan Region, where they remain living in local communities or in camps. This survey provides a population-based assessment of the health needs and care seeking behaviours of Yazidis and other groups currently residing in camps. The survey covered 13 camps managed by the Kurdish Board of Relief and Humanitarian Affairs. A systematic random sample of 1,300 households with a total of 8,360 members were interviewed between November and December 2015. Participants were asked if any household members had needed care for a health condition in the two weeks preceding the survey, and whether care was obtained from the camp primary health care centre, an outside public hospital or a private clinic. If care was received, the out-of-pocket payment was recorded; otherwise, the reason for not seeking care was queried. In 33.9% (CI: 31.0-37.0) of households one or more members had needed care for a health condition in the two weeks preceding the survey. The most likely to have needed care were older persons (18.5%; CI: 13.6-24.6) and infants (18.0%; CI: 11.6-26.8). The reported health conditions revealed a complex picture of communicable and non-communicable diseases as well as mental health problems and physical injuries. Care was primarily sought from private clinics (41.8%; CI: 36.4-47.4) or public hospitals (27.3%; CI: 22.6-32.7) rather than from the camp primary health care clinics (23.6%; CI: 19.5-28.2). The mean out-of-pocket payment for care received was nearly 3 times higher in public hospitals than in the camp primary health care clinics and nearly 11 times higher in private clinics. Cost was the main perceived barrier to obtaining health services. Demand for health services was high among Yazidis and other minorities living in camps. Private services were preferred in

  7. Maternal health care seeking by rural Tibetan women: characteristics of women delivering at a newly-constructed birth center in western China.

    PubMed

    Gyaltsen, Kunchok; Gipson, Jessica D; Gyal, Lhusham; Kyi, Tsering; Hicks, Andrew L; Pebley, Anne R

    2015-09-22

    Increasing skilled birth attendance at delivery is key to reducing maternal mortality, particularly among marginalized populations. Despite China's successful rollout of a national policy to promote facility deliveries, challenges remain among rural and ethnic minority populations. In response, a Tibetan Birth and Training Center (TBTC) was constructed in 2010 to provide high-quality obstetric care in a home-like environment to a predominantly Tibetan population in Tso-ngon (Qinghai) province in western China to improve maternal care in the region. This study examines if and how first users of the TBTC differ from women in the broader community, and how this information may inform subsequent maternal health care interventions in this area. Trained, Tibetan interviewers administered a face-to-face, quantitative questionnaire to two groups of married, Tibetan women: women who had delivered at the TBTC between June 2011-June 2012 (n = 114) and a non-equivalent comparison group of women from the same communities who had delivered in the last two years, but not at the TBTC (n = 108). Chi-squared and ANOVA tests were conducted to detect differences between the samples. There were no significant differences between the samples in education or income; however, women from the TBTC sample were significantly younger (25.55 vs. 28.16 years; p < 0.001) and had fewer children (1.54 vs. 1.70; p = 0.05). Items measuring maternity health care-seeking and perceived importance of health facility amenities indicated minimal differences between the samples. However, as compared to the community sample, the TBTC sample had a greater proportion of women who reported having the final say regarding where to deliver (26% vs. 14%; p = 0.02) and having a friend or family member who delivered at home (50% vs. 28%; p < 0.001). Findings did not support the hypothesis that the TBTC attracts lower-income, less-educated women. Minimal differences in women's characteristics

  8. Control, struggle, and emergent masculinities: a qualitative study of men's care-seeking determinants for chronic cough and tuberculosis symptoms in Blantyre, Malawi.

    PubMed

    Chikovore, Jeremiah; Hart, Graham; Kumwenda, Moses; Chipungu, Geoffrey A; Desmond, Nicola; Corbett, Liz

    2014-10-09

    Men's healthcare-seeking delay results in higher mortality while on HIV or tuberculosis (TB) treatment, and implies contribution to ongoing community-level TB transmission before initiating treatment. We investigated masculinity's role in healthcare-seeking delay for men with TB-suggestive symptoms, with a view to developing potential interventions for men. Data were collected during March 2011- March 2012 in three high-density suburbs in urban Blantyre. Ten focus group discussions were carried out of which eight (mixed sex = two; female only = three; male only = three) were with 74 ordinary community members, and two (both mixed sex) were with 20 health workers. Individual interviews were done with 20 TB patients (female =14) and 20 un-investigated chronic coughers (female = eight), and a three-day workshop was held with 27 health stakeholder representatives. An expectation to provide for and lead their families, and to control various aspects of their lives while facing limited employment opportunities and small incomes leaves men feeling inadequate, devoid of control, and anxious about being marginalised as men. Men were fearful about being looked at as less than men, and about their wives engaging in extramarital sex without ability to detect or monitor them. Control was a key defining feature of adequate manhood, and efforts to achieve it also led men into side-lining their health. Articulate and consistent concepts of men's bodily strength or appropriate illness responses were absent from the accounts. Facilitating men to seek care early is an urgent public health imperative, given the contexts of high HIV/AIDS prevalence but increasingly available treatment, and the role of care-seeking delay in TB transmission. Men's struggles trying to achieve ideal images seem to influence their engagement with their health. Ambiguous views regarding some key masculinity representations and the embrace of less harmful masculinities raise questions about some common

  9. A Logic for Qualified Syllogisms

    NASA Astrophysics Data System (ADS)

    Schwartz, Daniel G.

    In various works, L.A. Zadeh has introduced fuzzy quantifiers, fuzzy usuality modifiers, and fuzzy likelihood modifiers. This paper provides these notions with a unified semantics and uses this to define a formal logic capable of expressing and validating arguments such as 'Most birds can fly; Tweety is a bird; therefore, it is likely that Tweety can fly'. In effect, these are classical Aristotelean syllogisms that have been "qualified" through the use of fuzzy quantifiers. It is briefly outlined how these, together with some likelihood combination rules, can be used to address some well-known problems in the theory of nonmonotonic reasoning. The work is aimed at future applications in expert systems and robotics, including both hardware and software agents.

  10. 42 CFR 435.116 - Qualified pregnant women and children who are not qualified family members.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 4 2010-10-01 2010-10-01 false Qualified pregnant women and children who are not... Categorically Needy Mandatory Coverage of Pregnant Women, Children Under 8, and Newborn Children § 435.116 Qualified pregnant women and children who are not qualified family members. (a) The agency must...

  11. 42 CFR 435.116 - Qualified pregnant women and children who are not qualified family members.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 42 Public Health 4 2011-10-01 2011-10-01 false Qualified pregnant women and children who are not... Categorically Needy Mandatory Coverage of Pregnant Women, Children Under 8, and Newborn Children § 435.116 Qualified pregnant women and children who are not qualified family members. (a) The agency must provide...

  12. 29 CFR Appendix G to Part 825 - Certification of Qualifying Exigency for Military Family Leave (Form WH-384)

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 29 Labor 3 2012-07-01 2012-07-01 false Certification of Qualifying Exigency for Military Family... HOUR DIVISION, DEPARTMENT OF LABOR OTHER LAWS THE FAMILY AND MEDICAL LEAVE ACT OF 1993 Pt. 825, App. G Appendix G to Part 825—Certification of Qualifying Exigency for Military Family Leave (Form...

  13. 29 CFR Appendix G to Part 825 - Certification of Qualifying Exigency for Military Family Leave (Form WH-384)

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 29 Labor 3 2011-07-01 2011-07-01 false Certification of Qualifying Exigency for Military Family... HOUR DIVISION, DEPARTMENT OF LABOR OTHER LAWS THE FAMILY AND MEDICAL LEAVE ACT OF 1993 Pt. 825, App. G Appendix G to Part 825—Certification of Qualifying Exigency for Military Family Leave (Form...

  14. Comorbidities of HIV infection and health care seeking behavior among HIV infected patients attending public sector healthcare facilities in KwaZulu-Natal: A cross sectional study

    PubMed Central

    Nlooto, Manimbulu

    2017-01-01

    Background HIV-infected people may present with co-infections, comorbidities, and side effects associated with antiretroviral therapy. This study explored the prevalence of comorbid health problems and determined the extent of the use of traditional medicine for treatment of co-infections, comorbidities of HIV infection and side effects. Methods A cross sectional study, using researcher-administered questionnaires, was carried out among HIV-infected patients in eight public sector healthcare facilities in KwaZulu-Natal between April and October 1024. Self-reports of comorbidities, co-infections and side effects were analyzed with respect to factors such as age, gender, race, and health care seeking behavior including the use of traditional medicine. Cross-tabulations were conducted to test the association between factors and the use of traditional medicine, using Pearson chi-squared (χ2) test. Simple and multiple logistic regression models tested the association of the use of traditional medicine with age, gender, race, side effects and comorbidities. Odds ratios with 95% confidence intervals were estimated. Missing values were handled, defined and treated as missing values in the final analysis. Results Overall, 29.5% (n = 516) of the survey participants reported having other comorbidities and or co-infections besides their HIV condition. Same participants reported two or more comorbidities. Almost forty percent of participants (208/531, 39.17%) reported having hypertension as the most noninfectious comorbidity while 21.65% of participants (115/531) had tuberculosis accounting for the most infectious comorbidity. Almost eight percent of participants (142/1748, 8.12%) reported using traditional medicine after starting with cART. Sixty out of 142 participants (60/142, 42.25%) on cART resorted to the use of traditional medicine for the management of comorbidities and or co-infections of their HIV infection. Overall, 311 out of 1748 participants (17.80%) complained

  15. 30 CFR 795.10 - Qualified laboratories.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 30 Mineral Resources 3 2012-07-01 2012-07-01 false Qualified laboratories. 795.10 Section 795.10... laboratories. (a) Basic qualifications. To be designated a qualified laboratory, a firm shall demonstrate that... necessary field samples and making hydrologic field measurements and analytical laboratory determinations...

  16. 7 CFR 802.1 - Qualified laboratories.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 7 Agriculture 7 2012-01-01 2012-01-01 false Qualified laboratories. 802.1 Section 802.1... REQUIREMENTS FOR GRAIN WEIGHING EQUIPMENT AND RELATED GRAIN HANDLING SYSTEMS § 802.1 Qualified laboratories. (a) Metrology laboratories. (1) Any State metrology laboratory currently approved by the NBS...

  17. 30 CFR 795.10 - Qualified laboratories.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 30 Mineral Resources 3 2013-07-01 2013-07-01 false Qualified laboratories. 795.10 Section 795.10... laboratories. (a) Basic qualifications. To be designated a qualified laboratory, a firm shall demonstrate that... necessary field samples and making hydrologic field measurements and analytical laboratory determinations...

  18. 7 CFR 802.1 - Qualified laboratories.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 7 Agriculture 7 2014-01-01 2014-01-01 false Qualified laboratories. 802.1 Section 802.1... REQUIREMENTS FOR GRAIN WEIGHING EQUIPMENT AND RELATED GRAIN HANDLING SYSTEMS § 802.1 Qualified laboratories. (a) Metrology laboratories. (1) Any State metrology laboratory currently approved by the NBS...

  19. 30 CFR 795.10 - Qualified laboratories.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 30 Mineral Resources 3 2014-07-01 2014-07-01 false Qualified laboratories. 795.10 Section 795.10... laboratories. (a) Basic qualifications. To be designated a qualified laboratory, a firm shall demonstrate that... necessary field samples and making hydrologic field measurements and analytical laboratory determinations...

  20. 7 CFR 802.1 - Qualified laboratories.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 7 Agriculture 7 2013-01-01 2013-01-01 false Qualified laboratories. 802.1 Section 802.1... REQUIREMENTS FOR GRAIN WEIGHING EQUIPMENT AND RELATED GRAIN HANDLING SYSTEMS § 802.1 Qualified laboratories. (a) Metrology laboratories. (1) Any State metrology laboratory currently approved by the NBS...

  1. 7 CFR 802.1 - Qualified laboratories.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 7 Agriculture 7 2011-01-01 2011-01-01 false Qualified laboratories. 802.1 Section 802.1... REQUIREMENTS FOR GRAIN WEIGHING EQUIPMENT AND RELATED GRAIN HANDLING SYSTEMS § 802.1 Qualified laboratories. (a) Metrology laboratories. (1) Any State metrology laboratory currently approved by the NBS...

  2. 30 CFR 795.10 - Qualified laboratories.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 30 Mineral Resources 3 2011-07-01 2011-07-01 false Qualified laboratories. 795.10 Section 795.10... laboratories. (a) Basic qualifications. To be designated a qualified laboratory, a firm shall demonstrate that... necessary field samples and making hydrologic field measurements and analytical laboratory determinations...

  3. 46 CFR 390.9 - Qualified withdrawals.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 46 Shipping 8 2010-10-01 2010-10-01 false Qualified withdrawals. 390.9 Section 390.9 Shipping MARITIME ADMINISTRATION, DEPARTMENT OF TRANSPORTATION REGULATIONS UNDER PUBLIC LAW 91-469 CAPITAL CONSTRUCTION FUND § 390.9 Qualified withdrawals. (a) In general—(1) Defined. In accordance with 46 U.S.C....

  4. 46 CFR 391.5 - Qualified withdrawals.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 46 Shipping 8 2010-10-01 2010-10-01 false Qualified withdrawals. 391.5 Section 391.5 Shipping MARITIME ADMINISTRATION, DEPARTMENT OF TRANSPORTATION REGULATIONS UNDER PUBLIC LAW 91-469 FEDERAL INCOME TAX ASPECTS OF THE CAPITAL CONSTRUCTION FUND § 391.5 Qualified withdrawals. (a) In general. (1)...

  5. In Every Core Class, a Qualified Teacher...

    ERIC Educational Resources Information Center

    Keller, Bess

    2006-01-01

    This article reports the teacher-quality plans of putting a highly qualified teacher in every core class which were due to the Education Department in July 7. In the plans, states are required to describe which groups of teachers are not yet highly qualified according to the federal standard, how they would help--and prod--districts to use only…

  6. 12 CFR 1808.200 - Qualified Issuers.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 12 Banks and Banking 10 2014-01-01 2014-01-01 false Qualified Issuers. 1808.200 Section 1808.200 Banks and Banking COMMUNITY DEVELOPMENT FINANCIAL INSTITUTIONS FUND, DEPARTMENT OF THE TREASURY COMMUNITY DEVELOPMENT FINANCIAL INSTITUTIONS BOND GUARANTEE PROGRAM Eligibility § 1808.200 Qualified Issuers...

  7. 13 CFR 108.110 - Qualified management.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 13 Business Credit and Assistance 1 2012-01-01 2012-01-01 false Qualified management. 108.110... management. An Applicant must show, to the satisfaction of SBA, that its current or proposed management team is qualified and has the knowledge, experience, and capability in Community Development Finance...

  8. Learning beyond Graduation: Exploring Newly Qualified Specialists' Entrance into Daily Practice from a Learning Perspective

    ERIC Educational Resources Information Center

    Cuyvers, Katrien; Donche, Vincent; Van den Bossche, Piet

    2016-01-01

    The entrance of newly qualified medical specialists into daily practice is considered to be a stressful period in which curriculum support is absent. Although engaging in both personal and professional learning and development activities is recognized fundamental for lifelong professional competence, research on medical professionals' entrance…

  9. Learning beyond Graduation: Exploring Newly Qualified Specialists' Entrance into Daily Practice from a Learning Perspective

    ERIC Educational Resources Information Center

    Cuyvers, Katrien; Donche, Vincent; Van den Bossche, Piet

    2016-01-01

    The entrance of newly qualified medical specialists into daily practice is considered to be a stressful period in which curriculum support is absent. Although engaging in both personal and professional learning and development activities is recognized fundamental for lifelong professional competence, research on medical professionals' entrance…

  10. The Medical Passport

    ERIC Educational Resources Information Center

    Ineson, Sue; Seeling, Stephen S.

    2005-01-01

    A Working Group on Medical Passports was established in 2002 by the International Association of Medical Regulatory Authorities. The goal of this group was to develop a fast-track registration process for highly qualified medical practitioners wishing to move from one jurisdiction to another. A "medical passport" would be available only to…

  11. Medications

    MedlinePlus

    ... from becoming larger and causing more serious problems. Antiplatelets are medications that stop blood particles called platelets ... an angioplasty procedure. Aspirin is one type of antiplatelet medicine. (See "Aspirin: Take With Caution" ) Beta blockers ...

  12. Flight Qualified Micro Sun Sensor

    NASA Technical Reports Server (NTRS)

    Liebe, Carl Christian; Mobasser, Sohrab; Wrigley, Chris; Schroeder, Jeffrey; Bae, Youngsam; Naegle, James; Katanyoutanant, Sunant; Jerebets, Sergei; Schatzel, Donald; Lee, Choonsup

    2007-01-01

    A prototype small, lightweight micro Sun sensor (MSS) has been flight qualified as part of the attitude-determination system of a spacecraft or for Mars surface operations. The MSS has previously been reported at a very early stage of development in NASA Tech Briefs, Vol. 28, No. 1 (January 2004). An MSS is essentially a miniature multiple-pinhole electronic camera combined with digital processing electronics that functions analogously to a sundial. A micromachined mask containing a number of microscopic pinholes is mounted in front of an active-pixel sensor (APS). Electronic circuits for controlling the operation of the APS, readout from the pixel photodetectors, and analog-to-digital conversion are all integrated onto the same chip along with the APS. The digital processing includes computation of the centroids of the pinhole Sun images on the APS. The spacecraft computer has the task of converting the Sun centroids into Sun angles utilizing a calibration polynomial. The micromachined mask comprises a 500-micron-thick silicon wafer, onto which is deposited a 57-nm-thick chromium adhesion- promotion layer followed by a 200-nm-thick gold light-absorption layer. The pinholes, 50 microns in diameter, are formed in the gold layer by photolithography. The chromium layer is thin enough to be penetrable by an amount of Sunlight adequate to form measurable pinhole images. A spacer frame between the mask and the APS maintains a gap of .1 mm between the pinhole plane and the photodetector plane of the APS. To minimize data volume, mass, and power consumption, the digital processing of the APS readouts takes place in a single field-programmable gate array (FPGA). The particular FPGA is a radiation- tolerant unit that contains .32,000 gates. No external memory is used so the FPGA calculates the centroids in real time as pixels are read off the APS with minimal internal memory. To enable the MSS to fit into a small package, the APS, the FPGA, and other components are mounted

  13. 7 CFR 1150.109 - Qualified program.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... AGREEMENTS AND ORDERS; MILK), DEPARTMENT OF AGRICULTURE DAIRY PROMOTION PROGRAM Dairy Promotion and Research..., research or nutrition education program which is certified as a qualified program pursuant to § 1150.153....

  14. 7 CFR 1150.109 - Qualified program.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... AGREEMENTS AND ORDERS; MILK), DEPARTMENT OF AGRICULTURE DAIRY PROMOTION PROGRAM Dairy Promotion and Research..., research or nutrition education program which is certified as a qualified program pursuant to § 1150.153....

  15. 7 CFR 1150.109 - Qualified program.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... Agreements and Orders; Milk), DEPARTMENT OF AGRICULTURE DAIRY PROMOTION PROGRAM Dairy Promotion and Research..., research or nutrition education program which is certified as a qualified program pursuant to § 1150.153....

  16. Dietary habits of obese patients qualified for bariatric procedures.

    PubMed

    Jastrzebska-Mierzyńska, Marta; Ostrowska, Lucyna; Hady, Hady Razak; Dadan, Jacek

    2014-01-01

    Patients with obesity, including morbid obesity, commit numerous dietary mistakes. They prefer high-energy diets, but of poor nutritional value. Patients qualified for bariatric procedures show deficiencies in vitamins and minerals due to insufficient intake of vegetables, fruit and whole grain products. Analysis of dietary habits in morbidly obese patients prepared for bariatric surgery, including assessment of eating style and frequency of consumption of certain products. The study group contained 39 people aged 18 - 65 years, who were surveyed with a questionnaire elaborated in the Department of Clinical Dietetics and Nutrition, Medical University of Bialystok. The following factors were assessed: number of meals, snacking between meals and eating at night, types of snacks eaten, and frequency of consumption of certain foods. Results were analyzed using Statistica 9.0. The majority of surveyed men (41.7%) ate three meals a day, whereas most women (40.7%) had at least 4 meals a day. Nearly 85% of the respondents admitted snacking between meals, mainly eating fruit, sweets and sandwiches. Whole grain cereal, milk and dairy products, fish, fruit, vegetables and pulses appeared in diet of patients qualified for treatment of obesity very rarely. Dietary habits of obese patients qualified for bariatric procedures are not consistent with recommendations. Therefore, these patients should receive nutritional education in order to foster proper eating habits that will help in the postoperative nutrition.

  17. Experiences of non-UK-qualified doctors working within the UK regulatory framework: a qualitative study

    PubMed Central

    Slowther, A; Lewando Hundt, GA; Purkis, J; Taylor, R

    2012-01-01

    Objective To explore the experience of non-UK-qualified doctors in working within the regulatory framework of the General Medical Council (GMC) document Good Medical Practice. Design Individual interviews and focus groups. Setting United Kingdom. Participants Non-UK-qualified doctors who had registered with the GMC between 1 April 2006 and 31 March 2008, doctors attending training/induction programmes for non-UK-qualified doctors, and key informants involved in training and support for non-UK-qualified doctors. Main outcome measures Themes identified from analysis of interview and focus group transcripts. Results Information and support for non-UK qualified doctors who apply to register to work in the UK has little reference to the ethical and professional standards required of doctors working in the UK. Recognition of the ethical, legal and cultural context of UK healthcare occurs once doctors are working in practice. Non-UK qualified doctors reported clear differences in the ethical and legal framework for practising medicine between the UK and their country of qualification, particularly in the model of the doctor–patient relationship. The degree of support for non-UK-qualified doctors in dealing with ethical concerns is related to the type of post they work in. European doctors describe similar difficulties with working in an unfamiliar regulatory framework to their non-European colleagues. Conclusions Non-UK-qualified doctors experience a number of difficulties related to practising within a different ethical and professional regulatory framework. Provision of information and educational resources before registration, together with in-practice support would help to develop a more effective understanding of GMP and its implications for practice in the UK. PMID:22408082

  18. 30 CFR 75.155 - Qualified hoisting engineer; qualifications.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ...-hoisting engineer; or (2) If a State has no program for qualifying persons as electric-hoisting engineers... 30 Mineral Resources 1 2013-07-01 2013-07-01 false Qualified hoisting engineer; qualifications. 75... Persons § 75.155 Qualified hoisting engineer; qualifications. (a)(1) A person is a qualified hoisting...

  19. 30 CFR 75.155 - Qualified hoisting engineer; qualifications.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ...-hoisting engineer; or (2) If a State has no program for qualifying persons as electric-hoisting engineers... 30 Mineral Resources 1 2011-07-01 2011-07-01 false Qualified hoisting engineer; qualifications. 75... Persons § 75.155 Qualified hoisting engineer; qualifications. (a)(1) A person is a qualified hoisting...

  20. 30 CFR 75.155 - Qualified hoisting engineer; qualifications.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ...-hoisting engineer; or (2) If a State has no program for qualifying persons as electric-hoisting engineers... 30 Mineral Resources 1 2010-07-01 2010-07-01 false Qualified hoisting engineer; qualifications. 75... Persons § 75.155 Qualified hoisting engineer; qualifications. (a)(1) A person is a qualified hoisting...

  1. 30 CFR 75.155 - Qualified hoisting engineer; qualifications.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ...-hoisting engineer; or (2) If a State has no program for qualifying persons as electric-hoisting engineers... 30 Mineral Resources 1 2014-07-01 2014-07-01 false Qualified hoisting engineer; qualifications. 75... Persons § 75.155 Qualified hoisting engineer; qualifications. (a)(1) A person is a qualified hoisting...

  2. 30 CFR 75.155 - Qualified hoisting engineer; qualifications.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ...-hoisting engineer; or (2) If a State has no program for qualifying persons as electric-hoisting engineers... 30 Mineral Resources 1 2012-07-01 2012-07-01 false Qualified hoisting engineer; qualifications. 75... Persons § 75.155 Qualified hoisting engineer; qualifications. (a)(1) A person is a qualified hoisting...

  3. 7 CFR 701.110 - Qualifying minimum cost of restoration.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 7 Agriculture 7 2011-01-01 2011-01-01 false Qualifying minimum cost of restoration. 701.110... Conservation Program § 701.110 Qualifying minimum cost of restoration. (a) To qualify for assistance under... Deputy Administrator shall establish the minimum qualifying cost of restoration. Each affected State may...

  4. 5 CFR 847.202 - Definition of qualifying move.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 5 Administrative Personnel 2 2010-01-01 2010-01-01 false Definition of qualifying move. 847.202... FUND INSTRUMENTALITIES Elections To Continue Retirement Coverage After a Qualifying Move § 847.202 Definition of qualifying move. (a) A qualifying move occurring on or after December 28, 2001, that...

  5. 5 CFR 847.202 - Definition of qualifying move.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 5 Administrative Personnel 2 2011-01-01 2011-01-01 false Definition of qualifying move. 847.202... FUND INSTRUMENTALITIES Elections To Continue Retirement Coverage After a Qualifying Move § 847.202 Definition of qualifying move. (a) A qualifying move occurring on or after December 28, 2001, that...

  6. 5 CFR 847.202 - Definition of qualifying move.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 5 Administrative Personnel 2 2013-01-01 2013-01-01 false Definition of qualifying move. 847.202... FUND INSTRUMENTALITIES Elections To Continue Retirement Coverage After a Qualifying Move § 847.202 Definition of qualifying move. (a) A qualifying move occurring on or after December 28, 2001, that...

  7. 5 CFR 847.202 - Definition of qualifying move.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 5 Administrative Personnel 2 2012-01-01 2012-01-01 false Definition of qualifying move. 847.202... FUND INSTRUMENTALITIES Elections To Continue Retirement Coverage After a Qualifying Move § 847.202 Definition of qualifying move. (a) A qualifying move occurring on or after December 28, 2001, that...

  8. 5 CFR 847.202 - Definition of qualifying move.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 5 Administrative Personnel 2 2014-01-01 2014-01-01 false Definition of qualifying move. 847.202... FUND INSTRUMENTALITIES Elections To Continue Retirement Coverage After a Qualifying Move § 847.202 Definition of qualifying move. (a) A qualifying move occurring on or after December 28, 2001, that...

  9. 12 CFR 1806.201 - Measuring and reporting Qualified Activities.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 12 Banks and Banking 7 2011-01-01 2011-01-01 false Measuring and reporting Qualified Activities..., DEPARTMENT OF THE TREASURY BANK ENTERPRISE AWARD PROGRAM Awards § 1806.201 Measuring and reporting Qualified... applicable BEA NOFA for current limitations on Qualified Activities. (e) Measuring the Value of Qualified...

  10. 26 CFR 1.30-1 - Definition of qualified electric vehicle and recapture of credit for qualified electric vehicle.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 26 Internal Revenue 1 2011-04-01 2009-04-01 true Definition of qualified electric vehicle and recapture of credit for qualified electric vehicle. 1.30-1 Section 1.30-1 Internal Revenue INTERNAL REVENUE... qualified electric vehicle and recapture of credit for qualified electric vehicle. (a) Definition...

  11. 26 CFR 1.30-1 - Definition of qualified electric vehicle and recapture of credit for qualified electric vehicle.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 26 Internal Revenue 1 2014-04-01 2013-04-01 true Definition of qualified electric vehicle and recapture of credit for qualified electric vehicle. 1.30-1 Section 1.30-1 Internal Revenue INTERNAL REVENUE... qualified electric vehicle and recapture of credit for qualified electric vehicle. (a) Definition...

  12. 26 CFR 1.30-1 - Definition of qualified electric vehicle and recapture of credit for qualified electric vehicle.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 26 Internal Revenue 1 2010-04-01 2010-04-01 true Definition of qualified electric vehicle and recapture of credit for qualified electric vehicle. 1.30-1 Section 1.30-1 Internal Revenue INTERNAL REVENUE... qualified electric vehicle and recapture of credit for qualified electric vehicle. (a) Definition...

  13. 26 CFR 1.30-1 - Definition of qualified electric vehicle and recapture of credit for qualified electric vehicle.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 26 Internal Revenue 1 2013-04-01 2013-04-01 false Definition of qualified electric vehicle and recapture of credit for qualified electric vehicle. 1.30-1 Section 1.30-1 Internal Revenue INTERNAL REVENUE... qualified electric vehicle and recapture of credit for qualified electric vehicle. (a) Definition...

  14. 26 CFR 1.30-1 - Definition of qualified electric vehicle and recapture of credit for qualified electric vehicle.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 26 Internal Revenue 1 2012-04-01 2012-04-01 false Definition of qualified electric vehicle and recapture of credit for qualified electric vehicle. 1.30-1 Section 1.30-1 Internal Revenue INTERNAL REVENUE... qualified electric vehicle and recapture of credit for qualified electric vehicle. (a) Definition...

  15. 26 CFR 1.401(a)-1 - Post-ERISA qualified plans and qualified trusts; in general.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 26 Internal Revenue 5 2013-04-01 2013-04-01 false Post-ERISA qualified plans and qualified trusts..., Stock Bonus Plans, Etc. § 1.401(a)-1 Post-ERISA qualified plans and qualified trusts; in general. (a...-406) (“ERISA”). (2) (b) Requirements for pension plans—(1) Definitely determinable benefits. (i)...

  16. 26 CFR 1.401(a)-1 - Post-ERISA qualified plans and qualified trusts; in general.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 26 Internal Revenue 5 2012-04-01 2011-04-01 true Post-ERISA qualified plans and qualified trusts..., Stock Bonus Plans, Etc. § 1.401(a)-1 Post-ERISA qualified plans and qualified trusts; in general. (a...-406) (“ERISA”). (2) (b) Requirements for pension plans—(1) Definitely determinable benefits. (i)...

  17. 26 CFR 1.401(a)-1 - Post-ERISA qualified plans and qualified trusts; in general.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 26 Internal Revenue 5 2011-04-01 2011-04-01 false Post-ERISA qualified plans and qualified trusts..., Stock Bonus Plans, Etc. § 1.401(a)-1 Post-ERISA qualified plans and qualified trusts; in general. (a...-406) (“ERISA”). (2) (b) Requirements for pension plans—(1) Definitely determinable benefits. (i)...

  18. 26 CFR 1.401(a)-1 - Post-ERISA qualified plans and qualified trusts; in general.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 26 Internal Revenue 5 2014-04-01 2014-04-01 false Post-ERISA qualified plans and qualified trusts..., Stock Bonus Plans, Etc. § 1.401(a)-1 Post-ERISA qualified plans and qualified trusts; in general. (a...-406) (“ERISA”). (2) (b) Requirements for pension plans—(1) Definitely determinable benefits. (i)...

  19. Newly qualified midwives' transition to qualified status and role: assimilating the 'habitus' or reshaping it?

    PubMed

    Hobbs, Julie A

    2012-06-01

    to ascribe meaning to the everyday experiences of midwives during their first year of practice as they interact with their social environment. a qualitative, ethnographic study. a major maternity department located in the West Country, UK. seven newly qualified midwives working in the chosen setting. as befits an ethnographic approach, observant participation and interviews in the field were the selected data collection tools. Reflexivity was at the hub of the research process. A field diary was kept in order to ensure that the researcher took into account both her own perceptions and the interactions with participants and significant others. This paper draws on data that illustrates some of the predispositions that may constitute the midwifery habitus. the main themes that emerged from the data were in relation to the culture of midwifery, fitting into the culture and determining what type of midwife the neophytes wanted to be ('what is a midwife?'). To enhance transparency, the latter theme is focused upon in this paper using a model that is a synthesis of some of the findings and Bourdieu's notion of habitus. this research provides insight into the professional and cultural experiences of newly qualified midwives, especially how cultural interactions, education and expectations may shape the midwifery habitus. It would seem that midwives who take a critical and reflective approach to practice are key players in the cultural re-creation of midwifery. Accordingly, to enable the aforementioned approach to practice, it is important that reflective and reflexive practices are an integral part of midwifery education. Nevertheless, the implications for practice are not merely one-dimensional. Observations in the field suggest the importance of making the quality of midwives' working lives a priority by facilitating a more supportive working environment. Moreover, midwives should not be marginalised for preferring to work in the community, the birth centre or the high

  20. 29 CFR 2590.606-3 - Notice requirements for covered employees and qualified beneficiaries.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... PLANS Continuation Coverage, Qualified Medical Child Support Orders, Coverage for Adopted Children... ceasing to be covered under a plan as a dependent child of a participant; (3) Notice of the occurrence of... employer contributes, or which is established or maintained by an employee organization, either the...

  1. Influence of awareness and availability of medical alternatives on parents seeking paediatric emergency care.

    PubMed

    Ellbrant, Julia A; Åkeson, S Jonas; Karlsland Åkeson, Pia M

    2017-10-01

    Direct seeking of care at paediatric emergency departments may result from an inadequate awareness or a short supply of medical alternatives. We therefore evaluated the care-seeking patterns, availability of medical options and initial medical assessments - with overall reference to socioeconomic status - of parents at an urban paediatric emergency department in a Scandinavian country providing free paediatric healthcare. The parents of children assessed by paediatric emergency department physicians at a Swedish university hospital over a 25-day winter period completed a questionnaire on recent medical contacts and their reasons for attendance. Additional information was obtained from ledgers, patient records and population demographics. In total, 657 of 713 eligible patients (92%) were included. Seventy-nine per cent of their parents either failed to or managed to establish medical contact before the emergency department visit, whereas 21% sought care with no attempt at recent medical contact. Visits with a failed telephone or primary care contact (18%) were more common outside office hours ( p=0.014) and were scored as less urgent ( p=0.014). A perceived emergency was the main reason for no attempt at medical contact before the visit. Direct emergency department care-seeking was more common from the city district with the lowest socioeconomic status ( p=0.027). Although most parents in this Swedish study tried to seek medical advice before attending a paediatric emergency department, perceived emergency, a short supply of telephone health line or primary care facilities and lower socioeconomic status contributed to direct care-seeking by almost 40% of parents. Pre-hospital awareness and the availability of medical alternatives with an emphasis on major differences in socioeconomic status should therefore be considered to further optimize care-seeking in paediatric emergency departments.

  2. 7 CFR 3431.15 - Qualifying loans.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... SERVICE, DEPARTMENT OF AGRICULTURE VETERINARY MEDICINE LOAN REPAYMENT PROGRAM Administration of the Veterinary Medicine Loan Repayment Program § 3431.15 Qualifying loans. (a) General. Loan repayments provided... accredited college of veterinary medicine resulting in a degree of Doctor of Veterinary Medicine, or...

  3. 30 CFR 795.10 - Qualified laboratories.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ...) Meets applicable Federal or State safety and health requirements; (4) Has analytical, monitoring and... acceptable hydrologic, geologic, or analytical methods in accordance with the requirements of §§ 780.21, 780... identified at the time a determination is made that a firm is qualified and they meet requirements specified...

  4. 34 CFR 303.22 - Qualified.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... REHABILITATIVE SERVICES, DEPARTMENT OF EDUCATION EARLY INTERVENTION PROGRAM FOR INFANTS AND TODDLERS WITH... intervention services. (Authority: 20 U.S.C. 1432(4)) Note: These regulations contain the following provisions relating to a State's responsibility to ensure that personnel are qualified to provide early intervention...

  5. 40 CFR 1400.12 - Qualified researchers.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 40 Protection of Environment 32 2010-07-01 2010-07-01 false Qualified researchers. 1400.12 Section 1400.12 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY AND DEPARTMENT OF JUSTICE ACCIDENTAL RELEASE PREVENTION REQUIREMENTS; RISK MANAGEMENT PROGRAMS UNDER THE CLEAN AIR ACT SECTION 112(r)(7...

  6. 14 CFR 314.6 - Qualifying dislocation.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 14 Aeronautics and Space 4 2010-01-01 2010-01-01 false Qualifying dislocation. 314.6 Section 314.6 Aeronautics and Space OFFICE OF THE SECRETARY, DEPARTMENT OF TRANSPORTATION (AVIATION PROCEEDINGS) PROCEDURAL... provided by the Airline Deregulation Act of 1978. ...

  7. 27 CFR 479.68 - Qualified manufacturer.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 27 Alcohol, Tobacco Products and Firearms 3 2014-04-01 2014-04-01 false Qualified manufacturer. 479.68 Section 479.68 Alcohol, Tobacco Products, and Firearms BUREAU OF ALCOHOL, TOBACCO, FIREARMS, AND EXPLOSIVES, DEPARTMENT OF JUSTICE FIREARMS AND AMMUNITION MACHINE GUNS, DESTRUCTIVE DEVICES, AND...

  8. 27 CFR 479.68 - Qualified manufacturer.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 27 Alcohol, Tobacco Products and Firearms 3 2012-04-01 2010-04-01 true Qualified manufacturer. 479.68 Section 479.68 Alcohol, Tobacco Products, and Firearms BUREAU OF ALCOHOL, TOBACCO, FIREARMS, AND EXPLOSIVES, DEPARTMENT OF JUSTICE FIREARMS AND AMMUNITION MACHINE GUNS, DESTRUCTIVE DEVICES, AND CERTAIN...

  9. 27 CFR 479.68 - Qualified manufacturer.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 27 Alcohol, Tobacco Products and Firearms 3 2010-04-01 2010-04-01 false Qualified manufacturer. 479.68 Section 479.68 Alcohol, Tobacco Products, and Firearms BUREAU OF ALCOHOL, TOBACCO, FIREARMS, AND EXPLOSIVES, DEPARTMENT OF JUSTICE FIREARMS AND AMMUNITION MACHINE GUNS, DESTRUCTIVE DEVICES, AND...

  10. 27 CFR 479.68 - Qualified manufacturer.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 27 Alcohol, Tobacco Products and Firearms 3 2011-04-01 2010-04-01 true Qualified manufacturer. 479.68 Section 479.68 Alcohol, Tobacco Products, and Firearms BUREAU OF ALCOHOL, TOBACCO, FIREARMS, AND EXPLOSIVES, DEPARTMENT OF JUSTICE FIREARMS AND AMMUNITION MACHINE GUNS, DESTRUCTIVE DEVICES, AND CERTAIN...

  11. 27 CFR 479.68 - Qualified manufacturer.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 27 Alcohol, Tobacco Products and Firearms 3 2013-04-01 2013-04-01 false Qualified manufacturer. 479.68 Section 479.68 Alcohol, Tobacco Products, and Firearms BUREAU OF ALCOHOL, TOBACCO, FIREARMS, AND EXPLOSIVES, DEPARTMENT OF JUSTICE FIREARMS AND AMMUNITION MACHINE GUNS, DESTRUCTIVE DEVICES, AND...

  12. 13 CFR 108.110 - Qualified management.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 13 Business Credit and Assistance 1 2013-01-01 2013-01-01 false Qualified management. 108.110... management. An Applicant must show, to the satisfaction of SBA, that its current or proposed management team... or proposed management team has sufficient qualifications, SBA will consider information provided...

  13. 13 CFR 108.110 - Qualified management.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 13 Business Credit and Assistance 1 2014-01-01 2014-01-01 false Qualified management. 108.110... management. An Applicant must show, to the satisfaction of SBA, that its current or proposed management team... or proposed management team has sufficient qualifications, SBA will consider information provided...

  14. 13 CFR 108.110 - Qualified management.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 13 Business Credit and Assistance 1 2010-01-01 2010-01-01 false Qualified management. 108.110... management. An Applicant must show, to the satisfaction of SBA, that its current or proposed management team... or proposed management team has sufficient qualifications, SBA will consider information provided by...

  15. 24 CFR 236.710 - Qualified tenant.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 24 Housing and Urban Development 2 2011-04-01 2011-04-01 false Qualified tenant. 236.710 Section 236.710 Housing and Urban Development Regulations Relating to Housing and Urban Development (Continued... DEVELOPMENT MORTGAGE AND LOAN INSURANCE PROGRAMS UNDER NATIONAL HOUSING ACT AND OTHER AUTHORITIES...

  16. 13 CFR 108.110 - Qualified management.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... Act, the regulations in this part and its business plan. In determining whether an Applicant's current... 13 Business Credit and Assistance 1 2011-01-01 2011-01-01 false Qualified management. 108.110 Section 108.110 Business Credit and Assistance SMALL BUSINESS ADMINISTRATION NEW MARKETS VENTURE...

  17. Hiring a Qualified Interpreter. NETAC Teacher Tipsheet

    ERIC Educational Resources Information Center

    Downs, Sharon; West, John; Mile, Shana Kirksey

    2000-01-01

    Finding good help is difficult enough these days, but trying to hire a qualified sign language interpreter can be especially difficult if you don't know what to look for. This paper provides some ideas that may help in your search. These include such considerations as using an interpreter referral agency versus direct hiring and certification and…

  18. 40 CFR 1400.12 - Qualified researchers.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 40 Protection of Environment 33 2014-07-01 2014-07-01 false Qualified researchers. 1400.12 Section 1400.12 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY AND DEPARTMENT OF JUSTICE ACCIDENTAL RELEASE PREVENTION REQUIREMENTS; RISK MANAGEMENT PROGRAMS UNDER THE CLEAN AIR ACT SECTION...

  19. 40 CFR 1400.12 - Qualified researchers.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 40 Protection of Environment 34 2013-07-01 2013-07-01 false Qualified researchers. 1400.12 Section 1400.12 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY AND DEPARTMENT OF JUSTICE ACCIDENTAL RELEASE PREVENTION REQUIREMENTS; RISK MANAGEMENT PROGRAMS UNDER THE CLEAN AIR ACT SECTION...

  20. 40 CFR 1400.12 - Qualified researchers.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 40 Protection of Environment 33 2011-07-01 2011-07-01 false Qualified researchers. 1400.12 Section 1400.12 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY AND DEPARTMENT OF JUSTICE ACCIDENTAL RELEASE PREVENTION REQUIREMENTS; RISK MANAGEMENT PROGRAMS UNDER THE CLEAN AIR ACT SECTION...

  1. 40 CFR 1400.12 - Qualified researchers.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 40 Protection of Environment 34 2012-07-01 2012-07-01 false Qualified researchers. 1400.12 Section 1400.12 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY AND DEPARTMENT OF JUSTICE ACCIDENTAL RELEASE PREVENTION REQUIREMENTS; RISK MANAGEMENT PROGRAMS UNDER THE CLEAN AIR ACT SECTION...

  2. 46 CFR 390.9 - Qualified withdrawals.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 46 Shipping 8 2011-10-01 2011-10-01 false Qualified withdrawals. 390.9 Section 390.9 Shipping MARITIME ADMINISTRATION, DEPARTMENT OF TRANSPORTATION REGULATIONS UNDER PUBLIC LAW 91-469 CAPITAL..., including a corporate merger, where the party obtains a proprietary interest in an existing vessel and...

  3. 34 CFR 303.22 - Qualified.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 34 Education 2 2011-07-01 2010-07-01 true Qualified. 303.22 Section 303.22 Education Regulations of the Offices of the Department of Education (Continued) OFFICE OF SPECIAL EDUCATION AND REHABILITATIVE SERVICES, DEPARTMENT OF EDUCATION EARLY INTERVENTION PROGRAM FOR INFANTS AND TODDLERS WITH...

  4. Factors influencing health care access perceptions and care-seeking behaviors of immigrant Latino sexual minority men and transgender individuals: baseline findings from the HOLA intervention study.

    PubMed

    Tanner, Amanda E; Reboussin, Beth A; Mann, Lilli; Ma, Alice; Song, Eunyoung; Alonzo, Jorge; Rhodes, Scott D

    2014-11-01

    Little is known about immigrant Latino sexual minorities’ health seeking behaviors. This study examined factors associated with perceptions of access and actual care behaviors among this population in North Carolina. A community-based participatory research partnership recruited 180 Latino sexual minority men and transgender individuals within preexisting social networks to participate in a sexual health intervention. Mixed-effects logistic regression models and GIS mapping examined factors influencing health care access perceptions and use of services (HIV testing and routine check-ups). Results indicate that perceptions of access and actual care behaviors are low and affected by individual and structural factors, including: years living in NC, reported poor general health, perceptions of discrimination, micro-, meso-, and macro-level barriers, and residence in a Medically Underserved Area. To improve Latino sexual minority health, focus must be placed on multiple levels, including: individual characteristics (e.g., demographics), clinic factors (e.g., provider competence and clinic environment), and structural factors (e.g., discrimination).

  5. Factors influencing health care access perceptions and care-seeking behaviors of immigrant Latino sexual minority men and transgender individuals: Baseline findings from the HOLA intervention study

    PubMed Central

    Tanner, AE; Reboussin, BA; Mann, L; Ma, A; Song, E; Alonzo, J; Rhodes, SD

    2014-01-01

    Little is known about immigrant Latino sexual minorities' health seeking behaviors. This study examined factors associated with perceptions of access and actual care behaviors among this population in North Carolina. Methods A community-based participatory research partnership recruited 180 Latino sexual minority men and transgender individuals within preexisting social networks to participate in a sexual health intervention. Mixed-effects logistic regression models examined factors influencing health care access perceptions and use of services (HIV testing and routine check-ups). Results Results indicate that perceptions of access and actual care behaviors are low and affected by individual and structural factors, including: years living in NC, reported poor general health, perceptions of discrimination, micro-, meso-, and macro-level barriers, and residence in a Medically Underserved Area. Discussion To improve Latino sexual minority health, focus must be placed on multiple levels, individual characteristics (e.g., demographics), clinic factors (e.g., provider competence and clinic environment), and structural factors (e.g., discrimination). PMID:25418235

  6. Variation in Networks and Forms of Support for Care-Seeking Across the HIV Care Continuum in the Rural Southeastern United States.

    PubMed

    Hill, Miranda; Huff, Amber; Chumbler, Neale

    2017-03-14

    In spite of progress in understanding the importance of social support for health outcomes in Persons Living with HIV (PLWH), more remains to be known about mechanisms of support most beneficial at each stage of HIV treatment. In this study, we use a qualitative analytic approach to investigate the forms and sources of social support deemed most integral to the diagnosis, care engagement, and medication adherence behaviors of a diverse sample of PLWH in a mostly rural health district in the Southeastern United States. In-depth interviews (N = 18) were collected during the qualitative phase of a larger mixed methods needs assessment for the Northeast Georgia Health District. A deductive-inductive analysis of participant narratives revealed variation in the perceived importance of particular forms and sources of social support during the initial versus advanced stages of HIV care. PLWH identified the emotional, informational, and appraisal support provided by family as especially critical for emotional stability, coping, and care linkage during the initial stages of diagnosis and treatment. However, once in care, PLWH emphasized informational and instrumental forms of support from care providers and appraisal support from peers as key influences in care engagement and retention behaviors. Increased understanding of the social support mechanisms that contribute to the HIV treatment behaviors of PLWH can fill knowledge gaps in research and inform the efforts of health care providers seeking to leverage various aspects of the social support toward improving the care retention, health, and wellness outcomes of PLWH. © 2017 National Rural Health Association.

  7. Development and validation of an instrument to assess patients' appraisal, emotions and action tendencies preceding care-seeking in acute myocardial infarction: The PA-AMI questionnaire.

    PubMed

    Nymark, C; Saboonchi, F; Mattiasson, A-C; Henriksson, P; Kiessling, A

    2017-03-01

    Reducing patient delay for patients afflicted by an acute myocardial infarction is a task of great complexity, which might be alleviated if more factors that influence this delay could be identified. Although a number of self-reported instruments associated with patient delay exist, none of these taps the content of the appraisal process related to patients' subjective emotions. The aim of this study was to develop and validate a questionnaire aimed at assessing patients' appraisal, emotions and action tendencies when afflicted by an acute myocardial infarction. An item pool was generated based on themes conceptualized in a recent qualitative study of acute myocardial infarction patients' thoughts, feelings and actions preceding the decision to seek medical care. The 'Think-Aloud Protocol' and test-retest analysis at item level were performed. The modified item pool was administered to 96 patients when treated for acute myocardial infarction. Explorative factor analysis and principal component analysis with the non-linear iterative partial least squares algorithm were performed to examine the underlying factor structure of the items. The findings indicated three core dimensions corresponding to three subscales, namely, 'symptom appraisal'; 'perceived inability to act'; 'autonomy preservation'. The results demonstrated acceptable measures of reliability and validity Conclusions: The PA-AMI questionnaire demonstrated satisfactory psychometric properties. Assessment of the included core dimensions may contribute to greater understanding of the appraisal processes for patients afflicted by an acute myocardial infarction.

  8. 33 CFR 155.1026 - Qualified individual and alternate qualified individual.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... must be available on a 24-hour basis. (b) The qualified individual and alternate must— (1) Speak fluent English; (2) Except as set out in paragraph (c) of this section, be located in the United States; (3)...

  9. 33 CFR 155.1026 - Qualified individual and alternate qualified individual.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... must be available on a 24-hour basis. (b) The qualified individual and alternate must— (1) Speak fluent English; (2) Except as set out in paragraph (c) of this section, be located in the United States; (3)...

  10. 33 CFR 155.1026 - Qualified individual and alternate qualified individual.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... must be available on a 24-hour basis. (b) The qualified individual and alternate must— (1) Speak fluent English; (2) Except as set out in paragraph (c) of this section, be located in the United States; (3)...

  11. 33 CFR 155.1026 - Qualified individual and alternate qualified individual.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... must be available on a 24-hour basis. (b) The qualified individual and alternate must— (1) Speak fluent English; (2) Except as set out in paragraph (c) of this section, be located in the United States; (3)...

  12. 33 CFR 155.1026 - Qualified individual and alternate qualified individual.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... must be available on a 24-hour basis. (b) The qualified individual and alternate must— (1) Speak fluent English; (2) Except as set out in paragraph (c) of this section, be located in the United States; (3)...

  13. Antenatal and delivery services in Kinshasa, Democratic Republic of Congo: care-seeking and experiences reported by women in a household-based survey.

    PubMed

    Feinstein, Lydia; Dimomfu, Bruno Lapika; Mupenda, Bavon; Duvall, Sandra; Chalachala, Jean Lambert; Edmonds, Andrew; Behets, Frieda

    2013-10-01

    Increasing coverage of quality reproductive health services, including prevention of mother-to-child transmission services, requires understanding where and how these services are provided. To inform scale-up, we conducted a population-based survey in Kinshasa, Democratic Republic of Congo. Stratified two-stage cluster sampling was used to select women ≥18 years old who had been pregnant within the prior three years. Participants were interviewed about their reproductive healthcare utilization and impressions of services received. We interviewed 1221 women, 98% of whom sought antenatal care (ANC). 78% of women began ANC after the first trimester and 22% reported <4 visits. Reasons for choosing an ANC facility included reputation (51%), friendly/accessible staff (39%), availability of comprehensive services (29%), medication access (26%), location (26%), and cost (21%). Most women reported satisfactory treatment by staff, but 47% reported that the ANC provider ignored their complaints, 23% had difficulty understanding responses to their questions, 22% wanted more time with the provider, 21% wanted more privacy, and 12% felt uncomfortable asking questions. Only 56% reported someone talked to them about HIV/AIDS. Strongest predictors of seeking inadequate ANC included low participant and partner education and lack of certain assets. Only 32% of women sought postnatal care. Some results varied by health zone. Scaling-up interventions to improve reproductive health services should include broad-based health systems strengthening and promote equitable access to quality ANC, delivery, and postnatal services. Personal and structural-level barriers to seeking ANC need to be addressed, with consideration given to local contexts. © 2013 John Wiley & Sons Ltd.

  14. Debt and foregone medical care.

    PubMed

    Kalousova, Lucie; Burgard, Sarah A

    2013-06-01

    Most American households carry debt, yet we have little understanding of how debt influences health behavior, especially health care seeking. We examined associations between foregone medical care and debt using a population-based sample of 914 southeastern Michigan residents surveyed in the wake of the late-2000s recession. Overall debt and ratios of debt to income and debt to assets were positively associated with foregoing medical or dental care in the past 12 months, even after adjusting for the poorer socioeconomic and health characteristics of those foregoing care and for respondents' household incomes and net worth. These overall associations were driven largely by credit card and medical debt, while housing debt and automobile and student loans were not associated with foregoing care. These results suggest that debt is an understudied aspect of health stratification.

  15. 24 CFR 236.710 - Qualified tenant.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... Qualified Tenant found in § 236.2 of subpart A (contained in the April 1, 1995 edition of 24 CFR, parts 220... Income, as defined in § 236.2 of subpart A (contained in the April 1, 1995 edition of 24 CFR, parts 220...” in 24 CFR 236.2 (contained in the April 1, 1995 edition of 24 CFR, parts 220 to 499; see the Savings...

  16. 24 CFR 236.710 - Qualified tenant.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... Qualified Tenant found in § 236.2 of subpart A (contained in the April 1, 1995 edition of 24 CFR, parts 220... Income, as defined in § 236.2 of subpart A (contained in the April 1, 1995 edition of 24 CFR, parts 220...” in 24 CFR 236.2 (contained in the April 1, 1995 edition of 24 CFR, parts 220 to 499; see the Savings...

  17. The practical skills of newly qualified nurses.

    PubMed

    Danbjørg, Dorthe Boe; Birkelund, Regner

    2011-02-01

    This paper reports the findings from a study of newly qualified nurses and which subjects the nurses regarded as the most important in order to be able to live up to the requirements of clinical practice, and how they experience their potential for developing practical and moral skills, after the decrease in practical training. A qualitative approach guided the research process and the analysis of the data. The data was collected by participant observation and qualitative interviews with four nurses as informants. The conclusions made in this study are based on the statements and the observations of the newly qualified nurses. Our findings are discussed in relation to the Aristotelian concept and other relevant literature. The main message is that the newly qualified nurses did not feel equipped when they finished their training. This could be interpreted as a direct consequence of the decrease in practical training. Our study also underlines that the way nursing theory is perceived and taught is problematic. The interviews revealed that the nurses think that nursing theories should be applied directly in practice. This misunderstanding is probably also applicable to the teachers of the theories.

  18. Receptivity to Bariatric Surgery in Qualified Patients

    PubMed Central

    Fung, Michael; Wharton, Sean; Macpherson, Alison

    2016-01-01

    Objectives. Bariatric surgery has been shown to be an effective intervention for weight loss and diabetes management. Despite this, many patients qualified for bariatric surgery are not interested in undergoing the procedure. The objective of this study is to determine the factors influencing receptivity to bariatric surgery among those who qualify for the procedure. Methods. Patients attending a publicly funded weight management clinic who qualified for bariatric surgery were asked to complete an elective questionnaire between February 2013 and April 2014. Results. A total of 371 patients (72% female) completed the questionnaire. Only 87 of 371 (23%) participants were interested in bariatric surgery. Individuals interested in bariatric surgery had a higher BMI (48.0 versus 46.2 kg/m2, P = 0.03) and believed that they would lose more weight with surgery (51 versus 44 kg, P = 0.0069). Those who scored highly on past weight loss success and financial concerns were less likely to be interested in bariatric surgery, whereas those who scored highly on high receptivity to surgery and positive social support were more likely to be interested in bariatric surgery. Conclusion. Although participants overestimated the effect of bariatric surgery on weight loss, most were still not interested in bariatric surgery. PMID:27516900

  19. 30 CFR 75.153 - Electrical work; qualified person.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 30 Mineral Resources 1 2012-07-01 2012-07-01 false Electrical work; qualified person. 75.153....153 Electrical work; qualified person. (a) Except as provided in paragraph (f) of this section, an individual is a qualified person within the meaning of §§ 75.511 and 75.512 to perform electrical work (other...

  20. 30 CFR 77.103 - Electrical work; qualified person.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 30 Mineral Resources 1 2013-07-01 2013-07-01 false Electrical work; qualified person. 77.103... SAFETY AND HEALTH MANDATORY SAFETY STANDARDS, SURFACE COAL MINES AND SURFACE WORK AREAS OF UNDERGROUND COAL MINES Qualified and Certified Persons § 77.103 Electrical work; qualified person. (a) Except as...

  1. 30 CFR 77.103 - Electrical work; qualified person.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 30 Mineral Resources 1 2012-07-01 2012-07-01 false Electrical work; qualified person. 77.103... SAFETY AND HEALTH MANDATORY SAFETY STANDARDS, SURFACE COAL MINES AND SURFACE WORK AREAS OF UNDERGROUND COAL MINES Qualified and Certified Persons § 77.103 Electrical work; qualified person. (a) Except as...

  2. 30 CFR 75.153 - Electrical work; qualified person.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 30 Mineral Resources 1 2013-07-01 2013-07-01 false Electrical work; qualified person. 75.153....153 Electrical work; qualified person. (a) Except as provided in paragraph (f) of this section, an individual is a qualified person within the meaning of §§ 75.511 and 75.512 to perform electrical work (other...

  3. 9 CFR 201.73 - Scale operators to be qualified.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 9 Animals and Animal Products 2 2014-01-01 2014-01-01 false Scale operators to be qualified. 201... ACT Services § 201.73 Scale operators to be qualified. Stockyard owners, market agencies, dealers, packers, and live poultry dealers shall employ qualified persons to operate scales for weighing livestock...

  4. 9 CFR 201.73 - Scale operators to be qualified.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 9 Animals and Animal Products 2 2012-01-01 2012-01-01 false Scale operators to be qualified. 201... ACT Services § 201.73 Scale operators to be qualified. Stockyard owners, market agencies, dealers, packers, and live poultry dealers shall employ qualified persons to operate scales for weighing livestock...

  5. 9 CFR 201.73 - Scale operators to be qualified.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 9 Animals and Animal Products 2 2013-01-01 2013-01-01 false Scale operators to be qualified. 201... ACT Services § 201.73 Scale operators to be qualified. Stockyard owners, market agencies, dealers, packers, and live poultry dealers shall employ qualified persons to operate scales for weighing livestock...

  6. 9 CFR 201.73 - Scale operators to be qualified.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 9 Animals and Animal Products 2 2010-01-01 2010-01-01 false Scale operators to be qualified. 201... ACT Services § 201.73 Scale operators to be qualified. Stockyard owners, market agencies, dealers, packers, and live poultry dealers shall employ qualified persons to operate scales for weighing livestock...

  7. 9 CFR 201.73 - Scale operators to be qualified.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 9 Animals and Animal Products 2 2011-01-01 2011-01-01 false Scale operators to be qualified. 201... ACT Services § 201.73 Scale operators to be qualified. Stockyard owners, market agencies, dealers, packers, and live poultry dealers shall employ qualified persons to operate scales for weighing livestock...

  8. 26 CFR 54.4980B-4 - Qualifying events.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 26 Internal Revenue 17 2014-04-01 2014-04-01 false Qualifying events. 54.4980B-4 Section 54.4980B... EXCISE TAXES (CONTINUED) PENSION EXCISE TAXES § 54.4980B-4 Qualifying events. The determination of what constitutes a qualifying event is addressed in the following questions and answers: Q-1: What is a...

  9. 26 CFR 54.4980B-4 - Qualifying events.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 26 Internal Revenue 17 2011-04-01 2011-04-01 false Qualifying events. 54.4980B-4 Section 54.4980B... EXCISE TAXES (CONTINUED) PENSION EXCISE TAXES § 54.4980B-4 Qualifying events. The determination of what constitutes a qualifying event is addressed in the following questions and answers: Q-1: What is a...

  10. 26 CFR 54.4980B-4 - Qualifying events.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 26 Internal Revenue 17 2012-04-01 2012-04-01 false Qualifying events. 54.4980B-4 Section 54.4980B... EXCISE TAXES (CONTINUED) PENSION EXCISE TAXES § 54.4980B-4 Qualifying events. The determination of what constitutes a qualifying event is addressed in the following questions and answers: Q-1: What is a...

  11. 26 CFR 54.4980B-4 - Qualifying events.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 26 Internal Revenue 17 2013-04-01 2013-04-01 false Qualifying events. 54.4980B-4 Section 54.4980B... EXCISE TAXES (CONTINUED) PENSION EXCISE TAXES § 54.4980B-4 Qualifying events. The determination of what constitutes a qualifying event is addressed in the following questions and answers: Q-1: What is a...

  12. 26 CFR 1.25-3 - Qualified mortgage credit certificate.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 26 Internal Revenue 1 2011-04-01 2009-04-01 true Qualified mortgage credit certificate. 1.25-3... TAXES Changes in Rates During A Taxable Year § 1.25-3 Qualified mortgage credit certificate. (a)-(g)(1... certificates for certain refinancings—(1) In general. If the issuer of a qualified mortgage credit...

  13. 49 CFR 604.7 - Qualified human service organizations.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 49 Transportation 7 2010-10-01 2010-10-01 false Qualified human service organizations. 604.7... ADMINISTRATION, DEPARTMENT OF TRANSPORTATION CHARTER SERVICE Exceptions § 604.7 Qualified human service organizations. (a) A recipient may provide charter service to a qualified human service organization (QHSO)...

  14. 49 CFR 604.7 - Qualified human service organizations.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 49 Transportation 7 2011-10-01 2011-10-01 false Qualified human service organizations. 604.7... ADMINISTRATION, DEPARTMENT OF TRANSPORTATION CHARTER SERVICE Exceptions § 604.7 Qualified human service organizations. (a) A recipient may provide charter service to a qualified human service organization (QHSO)...

  15. 26 CFR 1.884-5 - Qualified resident.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 26 Internal Revenue 9 2010-04-01 2010-04-01 false Qualified resident. 1.884-5 Section 1.884-5...) INCOME TAXES Foreign Corporations § 1.884-5 Qualified resident. (a) Definition of qualified resident. A... country (within the meaning of such treaty) and either— (1) Meets the requirements of paragraphs (b)...

  16. 42 CFR 435.119 - Qualified family members.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 4 2010-10-01 2010-10-01 false Qualified family members. 435.119 Section 435.119... Family Members § 435.119 Qualified family members. (a) Definition. A qualified family member is any member of a family, including pregnant women and children eligible for Medicaid under § 435.116 of...

  17. 42 CFR 436.121 - Qualified family members.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 4 2010-10-01 2010-10-01 false Qualified family members. 436.121 Section 436.121... Coverage of the Categorically Needy § 436.121 Qualified family members. (a) Definition. A qualified family member is any member of a family, including pregnant women and children eligible for Medicaid under §...

  18. 30 CFR 77.103 - Electrical work; qualified person.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 30 Mineral Resources 1 2010-07-01 2010-07-01 false Electrical work; qualified person. 77.103... COAL MINES Qualified and Certified Persons § 77.103 Electrical work; qualified person. (a) Except as... Subparts F, G, H, I, and J of this Part 77 to perform electrical work (other than work on energized surface...

  19. 30 CFR 75.153 - Electrical work; qualified person.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 30 Mineral Resources 1 2011-07-01 2011-07-01 false Electrical work; qualified person. 75.153....153 Electrical work; qualified person. (a) Except as provided in paragraph (f) of this section, an individual is a qualified person within the meaning of §§ 75.511 and 75.512 to perform electrical work (other...

  20. 30 CFR 77.103 - Electrical work; qualified person.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 30 Mineral Resources 1 2011-07-01 2011-07-01 false Electrical work; qualified person. 77.103... COAL MINES Qualified and Certified Persons § 77.103 Electrical work; qualified person. (a) Except as... Subparts F, G, H, I, and J of this Part 77 to perform electrical work (other than work on energized surface...

  1. 30 CFR 75.153 - Electrical work; qualified person.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 30 Mineral Resources 1 2010-07-01 2010-07-01 false Electrical work; qualified person. 75.153....153 Electrical work; qualified person. (a) Except as provided in paragraph (f) of this section, an individual is a qualified person within the meaning of §§ 75.511 and 75.512 to perform electrical work (other...

  2. 49 CFR 604.7 - Qualified human service organizations.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 49 Transportation 7 2012-10-01 2012-10-01 false Qualified human service organizations. 604.7... ADMINISTRATION, DEPARTMENT OF TRANSPORTATION CHARTER SERVICE Exceptions § 604.7 Qualified human service organizations. (a) A recipient may provide charter service to a qualified human service organization (QHSO) for...

  3. 49 CFR 604.7 - Qualified human service organizations.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 49 Transportation 7 2014-10-01 2014-10-01 false Qualified human service organizations. 604.7... ADMINISTRATION, DEPARTMENT OF TRANSPORTATION CHARTER SERVICE Exceptions § 604.7 Qualified human service organizations. (a) A recipient may provide charter service to a qualified human service organization (QHSO) for...

  4. 49 CFR 604.7 - Qualified human service organizations.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 49 Transportation 7 2013-10-01 2013-10-01 false Qualified human service organizations. 604.7... ADMINISTRATION, DEPARTMENT OF TRANSPORTATION CHARTER SERVICE Exceptions § 604.7 Qualified human service organizations. (a) A recipient may provide charter service to a qualified human service organization (QHSO) for...

  5. 26 CFR 1.884-5 - Qualified resident.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 26 Internal Revenue 9 2011-04-01 2011-04-01 false Qualified resident. 1.884-5 Section 1.884-5 Internal Revenue INTERNAL REVENUE SERVICE, DEPARTMENT OF THE TREASURY (CONTINUED) INCOME TAX (CONTINUED) INCOME TAXES (CONTINUED) Foreign Corporations § 1.884-5 Qualified resident. (a) Definition of qualified resident. A foreign corporation is a...

  6. 12 CFR 621.4 - Audit by qualified public accountant.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 12 Banks and Banking 6 2011-01-01 2011-01-01 false Audit by qualified public accountant. 621.4... REQUIREMENTS General Rules § 621.4 Audit by qualified public accountant. (a) Each institution shall, at least annually, have its financial statements audited by a qualified public accountant in accordance...

  7. 30 CFR 77.103 - Electrical work; qualified person.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 30 Mineral Resources 1 2014-07-01 2014-07-01 false Electrical work; qualified person. 77.103... COAL MINES Qualified and Certified Persons § 77.103 Electrical work; qualified person. (a) Except as... Subparts F, G, H, I, and J of this Part 77 to perform electrical work (other than work on energized...

  8. 30 CFR 75.153 - Electrical work; qualified person.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 30 Mineral Resources 1 2014-07-01 2014-07-01 false Electrical work; qualified person. 75.153....153 Electrical work; qualified person. (a) Except as provided in paragraph (f) of this section, an individual is a qualified person within the meaning of §§ 75.511 and 75.512 to perform electrical work...

  9. 26 CFR 1.132-9 - Qualified transportation fringes.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... compensation at a specified future date or a fixed amount of qualified transportation fringes to be provided for a specified future period (such as qualified parking to be used during a future calendar month... that is not used for qualified transportation fringes is not refunded to the employee at any...

  10. 26 CFR 1.132-9 - Qualified transportation fringes.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... compensation at a specified future date or a fixed amount of qualified transportation fringes to be provided for a specified future period (such as qualified parking to be used during a future calendar month... that is not used for qualified transportation fringes is not refunded to the employee at any...

  11. 7 CFR 1221.24 - Qualified sorghum producer organization.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 7 Agriculture 10 2013-01-01 2013-01-01 false Qualified sorghum producer organization. 1221.24... SORGHUM PROMOTION, RESEARCH, AND INFORMATION ORDER Sorghum Promotion, Research, and Information Order Definitions § 1221.24 Qualified sorghum producer organization. Qualified sorghum producer organization means...

  12. 7 CFR 1221.24 - Qualified sorghum producer organization.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 7 Agriculture 10 2011-01-01 2011-01-01 false Qualified sorghum producer organization. 1221.24... SORGHUM PROMOTION, RESEARCH, AND INFORMATION ORDER Sorghum Promotion, Research, and Information Order Definitions § 1221.24 Qualified sorghum producer organization. Qualified sorghum producer organization means...

  13. 7 CFR 1221.24 - Qualified sorghum producer organization.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 7 Agriculture 10 2012-01-01 2012-01-01 false Qualified sorghum producer organization. 1221.24... SORGHUM PROMOTION, RESEARCH, AND INFORMATION ORDER Sorghum Promotion, Research, and Information Order Definitions § 1221.24 Qualified sorghum producer organization. Qualified sorghum producer organization means...

  14. 7 CFR 1221.24 - Qualified sorghum producer organization.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 7 Agriculture 10 2014-01-01 2014-01-01 false Qualified sorghum producer organization. 1221.24... SORGHUM PROMOTION, RESEARCH, AND INFORMATION ORDER Sorghum Promotion, Research, and Information Order Definitions § 1221.24 Qualified sorghum producer organization. Qualified sorghum producer organization means...

  15. 41 CFR 101-29.207 - Qualified products list (QPL).

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 41 Public Contracts and Property Management 2 2011-07-01 2007-07-01 true Qualified products list (QPL). 101-29.207 Section 101-29.207 Public Contracts and Property Management Federal Property... PRODUCT DESCRIPTIONS 29.2-Definitions § 101-29.207 Qualified products list (QPL). A qualified products...

  16. 41 CFR 101-29.207 - Qualified products list (QPL).

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 41 Public Contracts and Property Management 2 2010-07-01 2010-07-01 true Qualified products list (QPL). 101-29.207 Section 101-29.207 Public Contracts and Property Management Federal Property... PRODUCT DESCRIPTIONS 29.2-Definitions § 101-29.207 Qualified products list (QPL). A qualified products...

  17. 7 CFR 701.210 - Qualifying minimum cost of restoration.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 7 Agriculture 7 2011-01-01 2011-01-01 false Qualifying minimum cost of restoration. 701.210... Restoration Program § 701.210 Qualifying minimum cost of restoration. (a) FSA will establish the minimum qualifying cost of restoration, which may vary by State or region. (b) An applicant may request a waiver of...

  18. 11 CFR 9002.11 - Qualified campaign expense.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 11 Federal Elections 1 2010-01-01 2010-01-01 false Qualified campaign expense. 9002.11 Section 9002.11 Federal Elections FEDERAL ELECTION COMMISSION PRESIDENTIAL ELECTION CAMPAIGN FUND: GENERAL ELECTION FINANCING DEFINITIONS § 9002.11 Qualified campaign expense. (a) Qualified campaign expense...

  19. 31 CFR 321.4 - Paying agents previously qualified.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 31 Money and Finance: Treasury 2 2010-07-01 2010-07-01 false Paying agents previously qualified...) Procedures for Qualification § 321.4 Paying agents previously qualified. Institutions qualified as paying agents under previous revisions of this part are authorized to continue to act in that capacity without...

  20. 31 CFR 317.4 - Issuing agents currently qualified.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 31 Money and Finance: Treasury 2 2010-07-01 2010-07-01 false Issuing agents currently qualified... ISSUE OF UNITED STATES SAVINGS BONDS § 317.4 Issuing agents currently qualified. Each organization, qualified as an issuing agent under a trust agreement currently in effect, is authorized to continue to act...

  1. 31 CFR 321.4 - Paying agents previously qualified.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 31 Money and Finance: Treasury 2 2014-07-01 2014-07-01 false Paying agents previously qualified... SHARES) Procedures for Qualification § 321.4 Paying agents previously qualified. Institutions qualified as paying agents under previous revisions of this part are authorized to continue to act in that...

  2. 31 CFR 321.4 - Paying agents previously qualified.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 31 Money and Finance:Treasury 2 2011-07-01 2011-07-01 false Paying agents previously qualified...) Procedures for Qualification § 321.4 Paying agents previously qualified. Institutions qualified as paying agents under previous revisions of this part are authorized to continue to act in that capacity without...

  3. 31 CFR 317.4 - Issuing agents currently qualified.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 31 Money and Finance:Treasury 2 2012-07-01 2012-07-01 false Issuing agents currently qualified... ISSUE OF UNITED STATES SAVINGS BONDS § 317.4 Issuing agents currently qualified. Each organization, qualified as an issuing agent under a trust agreement currently in effect, is authorized to continue to act...

  4. 31 CFR 317.4 - Issuing agents currently qualified.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 31 Money and Finance:Treasury 2 2013-07-01 2013-07-01 false Issuing agents currently qualified... ISSUE OF UNITED STATES SAVINGS BONDS § 317.4 Issuing agents currently qualified. Each organization, qualified as an issuing agent under a trust agreement currently in effect, is authorized to continue to act...

  5. 31 CFR 321.4 - Paying agents previously qualified.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 31 Money and Finance:Treasury 2 2012-07-01 2012-07-01 false Paying agents previously qualified... SHARES) Procedures for Qualification § 321.4 Paying agents previously qualified. Institutions qualified as paying agents under previous revisions of this part are authorized to continue to act in that...

  6. 31 CFR 321.4 - Paying agents previously qualified.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 31 Money and Finance:Treasury 2 2013-07-01 2013-07-01 false Paying agents previously qualified... SHARES) Procedures for Qualification § 321.4 Paying agents previously qualified. Institutions qualified as paying agents under previous revisions of this part are authorized to continue to act in that...

  7. 31 CFR 317.4 - Issuing agents currently qualified.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 31 Money and Finance:Treasury 2 2011-07-01 2011-07-01 false Issuing agents currently qualified... ISSUE OF UNITED STATES SAVINGS BONDS § 317.4 Issuing agents currently qualified. Each organization, qualified as an issuing agent under a trust agreement currently in effect, is authorized to continue to act...

  8. 31 CFR 317.4 - Issuing agents currently qualified.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 31 Money and Finance: Treasury 2 2014-07-01 2014-07-01 false Issuing agents currently qualified... FOR ISSUE OF UNITED STATES SAVINGS BONDS § 317.4 Issuing agents currently qualified. Each organization, qualified as an issuing agent under a trust agreement currently in effect, is authorized to continue to act...

  9. 28 CFR 41.32 - Qualified handicapped person.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 28 Judicial Administration 1 2010-07-01 2010-07-01 false Qualified handicapped person. 41.32..., NONDISCRIMINATION ON THE BASIS OF HANDICAP IN FEDERALLY ASSISTED PROGRAMS Standards for Determining Who Are Handicapped Persons § 41.32 Qualified handicapped person. Qualified handicapped person means: (a) With respect...

  10. 45 CFR 1151.12 - Qualified handicapped person.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 45 Public Welfare 3 2010-10-01 2010-10-01 false Qualified handicapped person. 1151.12 Section 1151... AND THE HUMANITIES NATIONAL ENDOWMENT FOR THE ARTS NONDISCRIMINATION ON THE BASIS OF HANDICAP Standards for Determining Who Are Handicapped Persons § 1151.12 Qualified handicapped person. Qualified...

  11. 42 CFR 436.121 - Qualified family members.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 42 Public Health 4 2011-10-01 2011-10-01 false Qualified family members. 436.121 Section 436.121... Coverage of the Categorically Needy § 436.121 Qualified family members. (a) Definition. A qualified family member is any member of a family, including pregnant women and children eligible for Medicaid under § 436...

  12. 42 CFR 435.119 - Qualified family members.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 42 Public Health 4 2011-10-01 2011-10-01 false Qualified family members. 435.119 Section 435.119... Family Members § 435.119 Qualified family members. (a) Definition. A qualified family member is any member of a family, including pregnant women and children eligible for Medicaid under § 435.116 of this...

  13. 42 CFR 436.121 - Qualified family members.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 42 Public Health 4 2013-10-01 2013-10-01 false Qualified family members. 436.121 Section 436.121... Coverage of the Categorically Needy § 436.121 Qualified family members. (a) Definition. A qualified family member is any member of a family, including pregnant women and children eligible for Medicaid under § 436...

  14. 42 CFR 436.121 - Qualified family members.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 42 Public Health 4 2012-10-01 2012-10-01 false Qualified family members. 436.121 Section 436.121... Coverage of the Categorically Needy § 436.121 Qualified family members. (a) Definition. A qualified family member is any member of a family, including pregnant women and children eligible for Medicaid under § 436...

  15. The Highly Qualified Physical Education Teacher: Traveling the Professional Pathway

    ERIC Educational Resources Information Center

    Van Volkinburg, Pat; Marston, Rip; Napper-Owen, Gloria

    2008-01-01

    Defining the quantifiable elements of a highly qualified physical education teacher is challenging. For the past two years, a task force of the National Association for Sport and Physical Education (NASPE) has worked on describing characteristics associated with highly qualified physical education teachers. Highly qualified teachers are needed to…

  16. 12 CFR 621.4 - Audit by qualified public accountant.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 12 Banks and Banking 7 2014-01-01 2014-01-01 false Audit by qualified public accountant. 621.4... REQUIREMENTS General Rules § 621.4 Audit by qualified public accountant. (a) Each institution shall, at least annually, have its financial statements audited by a qualified public accountant in accordance with...

  17. 12 CFR 621.4 - Audit by qualified public accountant.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 12 Banks and Banking 7 2013-01-01 2013-01-01 false Audit by qualified public accountant. 621.4... REQUIREMENTS General Rules § 621.4 Audit by qualified public accountant. (a) Each institution shall, at least annually, have its financial statements audited by a qualified public accountant in accordance with...

  18. 12 CFR 621.4 - Audit by qualified public accountant.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 12 Banks and Banking 7 2012-01-01 2012-01-01 false Audit by qualified public accountant. 621.4... REQUIREMENTS General Rules § 621.4 Audit by qualified public accountant. (a) Each institution shall, at least annually, have its financial statements audited by a qualified public accountant in accordance with...

  19. 5 CFR 847.402 - Definition of qualifying move.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 5 Administrative Personnel 2 2011-01-01 2011-01-01 false Definition of qualifying move. 847.402....402 Definition of qualifying move. (a) A qualifying move occurring after December 31, 1965, and before... under CSRS or FERS retroactive to the date of the move must meet all the following criteria: (1)(i)...

  20. 5 CFR 847.402 - Definition of qualifying move.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 5 Administrative Personnel 2 2013-01-01 2013-01-01 false Definition of qualifying move. 847.402....402 Definition of qualifying move. (a) A qualifying move occurring after December 31, 1965, and before... under CSRS or FERS retroactive to the date of the move must meet all the following criteria: (1)(i)...

  1. 5 CFR 847.402 - Definition of qualifying move.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 5 Administrative Personnel 2 2012-01-01 2012-01-01 false Definition of qualifying move. 847.402....402 Definition of qualifying move. (a) A qualifying move occurring after December 31, 1965, and before... under CSRS or FERS retroactive to the date of the move must meet all the following criteria: (1)(i)...

  2. 5 CFR 847.402 - Definition of qualifying move.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 5 Administrative Personnel 2 2014-01-01 2014-01-01 false Definition of qualifying move. 847.402....402 Definition of qualifying move. (a) A qualifying move occurring after December 31, 1965, and before... under CSRS or FERS retroactive to the date of the move must meet all the following criteria: (1)(i)...

  3. 10 CFR 436.32 - Qualified contractors lists.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 10 Energy 3 2010-01-01 2010-01-01 false Qualified contractors lists. 436.32 Section 436.32 Energy... Procedures for Energy Savings Performance Contracting § 436.32 Qualified contractors lists. (a) DOE shall... energy savings performance contracts. (c) DOE may remove a firm from DOE's list of qualified...

  4. 9 CFR 77.36 - Interstate movement from qualified herds.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 9 Animals and Animal Products 1 2010-01-01 2010-01-01 false Interstate movement from qualified... TUBERCULOSIS Captive Cervids § 77.36 Interstate movement from qualified herds. (a) Qualifications. To be... and is classified as a qualified herd. (b) Movement allowed. Except as provided in § 77.23 with regard...

  5. 11 CFR 9032.9 - Qualified campaign expense.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 11 Federal Elections 1 2012-01-01 2012-01-01 false Qualified campaign expense. 9032.9 Section 9032.9 Federal Elections FEDERAL ELECTION COMMISSION PRESIDENTIAL ELECTION CAMPAIGN FUND: PRESIDENTIAL PRIMARY MATCHING FUND DEFINITIONS § 9032.9 Qualified campaign expense. (a) Qualified campaign...

  6. 11 CFR 9032.9 - Qualified campaign expense.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 11 Federal Elections 1 2011-01-01 2011-01-01 false Qualified campaign expense. 9032.9 Section 9032.9 Federal Elections FEDERAL ELECTION COMMISSION PRESIDENTIAL ELECTION CAMPAIGN FUND: PRESIDENTIAL PRIMARY MATCHING FUND DEFINITIONS § 9032.9 Qualified campaign expense. (a) Qualified campaign...

  7. 11 CFR 9032.9 - Qualified campaign expense.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 11 Federal Elections 1 2010-01-01 2010-01-01 false Qualified campaign expense. 9032.9 Section 9032.9 Federal Elections FEDERAL ELECTION COMMISSION PRESIDENTIAL ELECTION CAMPAIGN FUND: PRESIDENTIAL PRIMARY MATCHING FUND DEFINITIONS § 9032.9 Qualified campaign expense. (a) Qualified campaign...

  8. 11 CFR 9032.9 - Qualified campaign expense.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 11 Federal Elections 1 2013-01-01 2012-01-01 true Qualified campaign expense. 9032.9 Section 9032.9 Federal Elections FEDERAL ELECTION COMMISSION PRESIDENTIAL ELECTION CAMPAIGN FUND: PRESIDENTIAL PRIMARY MATCHING FUND DEFINITIONS § 9032.9 Qualified campaign expense. (a) Qualified campaign...

  9. 11 CFR 9032.9 - Qualified campaign expense.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 11 Federal Elections 1 2014-01-01 2014-01-01 false Qualified campaign expense. 9032.9 Section 9032.9 Federal Elections FEDERAL ELECTION COMMISSION PRESIDENTIAL ELECTION CAMPAIGN FUND: PRESIDENTIAL PRIMARY MATCHING FUND DEFINITIONS § 9032.9 Qualified campaign expense. (a) Qualified campaign...

  10. 26 CFR 1.132-9 - Qualified transportation fringes.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 26 Internal Revenue 2 2011-04-01 2011-04-01 false Qualified transportation fringes. 1.132-9... Qualified transportation fringes. (a) Table of contents. This section contains a list of the questions and answers in § 1.132-9. (1) General rules. Q-1. What is a qualified transportation fringe? Q-2. What is...

  11. 26 CFR 1.132-9 - Qualified transportation fringes.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 26 Internal Revenue 2 2010-04-01 2010-04-01 false Qualified transportation fringes. 1.132-9... Qualified transportation fringes. (a) Table of contents. This section contains a list of the questions and answers in § 1.132-9. (1) General rules. Q-1. What is a qualified transportation fringe? Q-2. What is...

  12. 26 CFR 301.7430-7 - Qualified offers.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... conference. (5) Remains open. A qualified offer must, by its terms, remain open for acceptance by the United... that would have resulted from the acceptance of E's qualified offer is a reduction in that liability of... 26 Internal Revenue 18 2010-04-01 2010-04-01 false Qualified offers. 301.7430-7 Section...

  13. 26 CFR 1.25-3 - Qualified mortgage credit certificate.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 26 Internal Revenue 1 2010-04-01 2010-04-01 true Qualified mortgage credit certificate. 1.25-3... TAXES Changes in Rates During A Taxable Year § 1.25-3 Qualified mortgage credit certificate. (a)-(g)(1... certificates for certain refinancings—(1) In general. If the issuer of a qualified mortgage credit certificate...

  14. 26 CFR 1.1092(c)-1 - Qualified covered calls.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 26 Internal Revenue 11 2010-04-01 2010-04-01 true Qualified covered calls. 1.1092(c)-1 Section 1... (CONTINUED) INCOME TAXES Wash Sales of Stock Or Securities § 1.1092(c)-1 Qualified covered calls. (a) In...), however, writing a qualified covered call option and owning the optioned stock is not treated as...

  15. Evaluating the relative effectiveness of high-intensity and low-intensity models of behaviour change communication interventions for abortion care-seeking in Bihar and Jharkhand, India: a cross-sectional study

    PubMed Central

    Banerjee, Sushanta K; Andersen, Kathryn; Pearson, Erin; Warvadekar, Janardan; Khan, Danish U; Batra, Sangeeta

    2017-01-01

    Background This study aimed to compare the effectiveness of a high-intensity model (HIM) and a low-intensity model (LIM) of behaviour change communication interventions in Bihar and Jharkhand states of India designed to improve women's knowledge and usage of safe abortion services, as well as the dose effect of intervention exposure. Methods We conducted two cross-sectional household surveys among married women aged 15–49 years in intervention and comparison districts. Difference-in-difference models were used to assess the efficacy of the intervention, adjusting for sociodemographic characteristics. Results Although both intervention types improved abortion knowledge, the HIM intervention was more effective in improving comprehensive knowledge about abortion. In particular, there were improvements in knowledge on legality of abortion (AOR=2.2; 95% CI 1.6 to 2.9) and nearby sources of safe abortion care (AOR=1.7; 95% CI 1.2 to 1.3). Conclusions Higher level of exposure to abortion-related messages was related to more accurate knowledge about abortion within both intervention groups. Evidence was mixed on changes in abortion care-seeking behaviour. More work is needed to ensure that women seek safe abortion services in lieu of informal services that may be more likely to lead to postabortion complications. PMID:28237953

  16. Evaluating the relative effectiveness of high-intensity and low-intensity models of behaviour change communication interventions for abortion care-seeking in Bihar and Jharkhand, India: a cross-sectional study.

    PubMed

    Banerjee, Sushanta K; Andersen, Kathryn; Pearson, Erin; Warvadekar, Janardan; Khan, Danish U; Batra, Sangeeta

    2017-02-24

    This study aimed to compare the effectiveness of a high-intensity model (HIM) and a low-intensity model (LIM) of behaviour change communication interventions in Bihar and Jharkhand states of India designed to improve women's knowledge and usage of safe abortion services, as well as the dose effect of intervention exposure. We conducted two cross-sectional household surveys among married women aged 15-49 years in intervention and comparison districts. Difference-in-difference models were used to assess the efficacy of the intervention, adjusting for sociodemographic characteristics. Although both intervention types improved abortion knowledge, the HIM intervention was more effective in improving comprehensive knowledge about abortion. In particular, there were improvements in knowledge on legality of abortion (AOR=2.2; 95% CI 1.6 to 2.9) and nearby sources of safe abortion care (AOR=1.7; 95% CI 1.2 to 1.3). Higher level of exposure to abortion-related messages was related to more accurate knowledge about abortion within both intervention groups. Evidence was mixed on changes in abortion care-seeking behaviour. More work is needed to ensure that women seek safe abortion services in lieu of informal services that may be more likely to lead to postabortion complications. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

  17. [Qualified and emergency specialized surgical care for those with wounds to the extremities].

    PubMed

    Iurkevich, V V; Fidarov, E Z; Bauér, V A

    1997-06-01

    Experience of organization of the surgical care in the military hospital to 438 wounded in extremities during armed conflict in Republic of Chechnya is generalized. Maximum reduction of stages of medical evacuation of the wounded in extremities, approaching of the qualified and urgent specialized surgical care directly to the region of battle actions, use of opportunities for it one-moment rendering corresponded to principles of the modern military-medical doctrine. Due to realization of the requirements of the doctrine life of many wounded ++ was saved, terms of treatment, medical and social rehabilitation are reduced. Besides lethality, treatment cost and numbers of transferring to the reserve from the Armed Forces were reduced.

  18. Space-Qualified Traveling-Wave Tube

    NASA Technical Reports Server (NTRS)

    Wilson, Jeffrey D.; Krawczyk, Richard; Simons, Rainee N.; Williams, Wallace D.; Robbins, Neal R.; Dibb, Daniel R.; Menninger, William L.; Zhai, Xiaoling; Benton, Robert T.

    2010-01-01

    The L-3 Communications Electron Technologies, Inc. Model 999HA traveling-wave tube (TWT), was developed for use as a high-power microwave amplifier for high-rate transmission of data and video signals from deep space to Earth (see figure). The 999HA is a successor to the 999H a non-space qualified TWT described in High-Power, High-Efficiency Ka-Band Traveling-Wave Tube (LEW-17900-1), NASA Tech Briefs, Vol. 31, No. 2 (February 2007), page 32. Operating in the 31.8-to-32.3 GHz frequency band, the 999HA has been shown to generate 252 W of continuous- wave output power at 62 percent overall power efficiency a 75-percent increase in output power over the 999H. The mass of the 999HA is 35 percent less than that of the 999H. Moreover, taking account of the elimination of a Faraday cage that is necessary for operation of the 999H but is obviated by a redesign of high-voltage feed-throughs for the 999HA, the overall reduction in mass becomes 57 percent with an 82 percent reduction in volume. Through a series of rigorous tests, the 999HA has been qualified for operation aboard spacecraft with a lifetime exceeding seven years. Offspring of the 999HA will fly on the Kepler and Lunar Reconnaissance Orbiter missions.

  19. Professional care seeking for mental health problems among women and men in Europe: the role of socioeconomic, family-related and mental health status factors in explaining gender differences.

    PubMed

    Buffel, V; Van de Velde, S; Bracke, P

    2014-10-01

    This comparative study examines cross-national variation in gender differences in primary and specialized mental health care use in Europe. We investigate to what extent socioeconomic, family-related, and mental health factors explain the gender difference, and how the impact of these groups of determinants on gender differences in mental health care use varies between countries. Data from the Eurobarometer 248 (2005-2006) for 29 European countries is used and country-specific logistic regression analyses are performed. Gender differences in professional care seeking are largely need based. In almost one-third of the countries examined, the gender difference is mainly attributable to women's poorer mental health status. However, in some countries, family and socioeconomic characteristics also have an independent contribution to the gender difference in mental health care use. Women's higher likelihood of a lower socioeconomic position, might partly explain their higher primary care use, while in some countries, it restricts their specialized care use. In addition, some social conditions, as having children and being widowed, seem to function in a few countries as suppressors of women's care use. Our study has shown that the gender difference in mental health care use, with women having a higher care use, is not a consistent European phenomenon and is dependent on the type of care provider, with greater gender inequity in the use of primary health care. The social roles adopted by men and women have in some countries on top of the mental health status a relevant influence on the greater tendency among women to contact a care provider. How the socioeconomic and family characteristics moderate the relation between gender and mental health care use is not straightforward and country dependent.

  20. 49 CFR 109.11 - Assistance of properly qualified personnel.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... MATERIALS SAFETY ADMINISTRATION, DEPARTMENT OF TRANSPORTATION HAZARDOUS MATERIALS AND OIL TRANSPORTATION... properly qualified to perform a function that is essential to the agent's exercise of authority under this...

  1. How a mobile app supports the learning and practice of newly qualified doctors in the UK: an intervention study.

    PubMed

    Bullock, Alison; Dimond, Rebecca; Webb, Katie; Lovatt, Joseph; Hardyman, Wendy; Stacey, Mark

    2015-04-08

    The transition from medical school to the workplace can be demanding, with high expectations placed on newly qualified doctors. The provision of up-to-date and accurate information is essential to support doctors at a time when they are managing increased responsibility for patient care. In August 2012, the Wales Deanery issued the Dr.Companion© software with five key medical textbooks (the iDoc app) to newly qualified doctors (the intervention). The aim of the study was to examine how a smartphone app with key medical texts was used in clinical workplace settings by newly qualified doctors in relation to other information sources and to report changes over time. Participants (newly qualified - Foundation Year 1 - doctors) completed a baseline questionnaire before downloading the iDoc app to their own personal smartphone device. At the end of Foundation Year 1 participants (n = 125) completed exit questionnaires one year later. We used Wilcoxon Signed Rank test to analyse matched quantitative data. We report significant changes in our participants' use of workplace information resources over the year. Respondents reduced their use of hard-copy and electronic versions of texts on PCs but made more use of senior medical staff. There was no significant difference in the use of peers and other staff as information sources. We found a significant difference in how doctors felt about using a mobile device containing textbooks in front of patients and senior medical staff in the workplace. Our study indicates that a mobile app enabling timely, internet-free access to key textbooks supports the learning and practice of newly qualified doctors. Although participants changed their use of other resources in the workplace, they continued to consult with seniors. Rather than over-reliance on technology, these findings suggest that the app was used strategically to complement, not replace discussion with members of the medical team. Participants' uncertainty about using a

  2. 29 CFR Appendix G to Part 825 - Certification of Qualifying Exigency for Military Family Leave (Form WH-384)

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... Leave (Form WH-384) G Appendix G to Part 825 Labor Regulations Relating to Labor (Continued) WAGE AND HOUR DIVISION, DEPARTMENT OF LABOR OTHER LAWS THE FAMILY AND MEDICAL LEAVE ACT OF 1993 Pt. 825, App. G Appendix G to Part 825—Certification of Qualifying Exigency for Military Family Leave (Form WH-384...

  3. Delay in Seeking Medical Help following Transient Ischemic Attack (TIA) or “Mini-Stroke”: A Qualitative Study

    PubMed Central

    Mc Sharry, Jennifer; Baxter, Alison; Wallace, Louise M.; Kenton, Anthony; Turner, Andrew; French, David P.

    2014-01-01

    Background Prompt treatment following Transient Ischemic Attack (TIA) can reduce the risk of subsequent stroke and disability. However, many patients delay in making contact with medical services. This study aimed to explore TIA patients' accounts of delay between symptom onset and contacting medical services including how decisions to contact services were made and the factors discussed in relation to delay. Methods Twenty interviews were conducted with TIA patients in England. Using a previous systematic review as an initial framework, interview data were organised into categories of symptom recognition, presence of others and type of care sought. A thematic analysis was then conducted to explore descriptions of care-seeking relevant to each category. Results Delay in contacting medical services varied from less than an hour to eight days. Awareness of typical stroke symptoms could lead to urgent action when more severe TIA symptoms were present but could lead to delay when experienced symptoms were less severe. The role of friends and family varied widely from deciding on and enacting care-seeking decisions to simply providing transport to the GP practice. When family or friends played a greater role, and both made and enacted care-seeking decisions, delays were often shorter, even when patients themselves failed to identify symptoms. Healthcare professionals also impacted on patients' care-seeking with greater delays in seeking further care for the same episode described when patients perceived a lack of urgency during initial healthcare interactions. Conclusions This study provides new information on patients' decisions to contact medical services following TIA and identifies overlapping factors that can lead to delay in receiving appropriate treatment. While recognition of symptoms may contribute to delay in contacting medical services, additional factors, including full responsibility being taken by others and initial healthcare interactions, can over

  4. Delay in seeking medical help following Transient Ischemic Attack (TIA) or "mini-stroke": a qualitative study.

    PubMed

    Mc Sharry, Jennifer; Baxter, Alison; Wallace, Louise M; Kenton, Anthony; Turner, Andrew; French, David P

    2014-01-01

    Prompt treatment following Transient Ischemic Attack (TIA) can reduce the risk of subsequent stroke and disability. However, many patients delay in making contact with medical services. This study aimed to explore TIA patients' accounts of delay between symptom onset and contacting medical services including how decisions to contact services were made and the factors discussed in relation to delay. Twenty interviews were conducted with TIA patients in England. Using a previous systematic review as an initial framework, interview data were organised into categories of symptom recognition, presence of others and type of care sought. A thematic analysis was then conducted to explore descriptions of care-seeking relevant to each category. Delay in contacting medical services varied from less than an hour to eight days. Awareness of typical stroke symptoms could lead to urgent action when more severe TIA symptoms were present but could lead to delay when experienced symptoms were less severe. The role of friends and family varied widely from deciding on and enacting care-seeking decisions to simply providing transport to the GP practice. When family or friends played a greater role, and both made and enacted care-seeking decisions, delays were often shorter, even when patients themselves failed to identify symptoms. Healthcare professionals also impacted on patients' care-seeking with greater delays in seeking further care for the same episode described when patients perceived a lack of urgency during initial healthcare interactions. This study provides new information on patients' decisions to contact medical services following TIA and identifies overlapping factors that can lead to delay in receiving appropriate treatment. While recognition of symptoms may contribute to delay in contacting medical services, additional factors, including full responsibility being taken by others and initial healthcare interactions, can over-ride or undermine the importance of patients

  5. 26 CFR 1.103A-2 - Qualified mortgage bond.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 26 Internal Revenue 2 2011-04-01 2011-04-01 false Qualified mortgage bond. 1.103A-2 Section 1.103A... mortgage bond. (a)-(j) (k) Information reporting requirement—(1) In general. An issue meets the... requirements of this paragraph apply to qualified veterans' mortgage bonds issued after July 18, 1984, and to...

  6. 77 FR 18651 - Qualifying Urban Areas for the 2010 Census

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-03-27

    ...\\ The Census Bureau delineates urbanized areas \\2\\ and urban clusters \\3\\ primarily on the basis of... provides the list of urbanized areas and urban clusters that qualified based on results of the 2010 Census...'s official announcement of the list of qualifying urbanized areas and urban clusters for...

  7. 42 CFR 436.128 - Coverage for certain qualified aliens.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 42 Public Health 4 2014-10-01 2014-10-01 false Coverage for certain qualified aliens. 436.128... Mandatory Coverage of the Categorically Needy § 436.128 Coverage for certain qualified aliens. The agency... § 440.255(c) of this chapter to those aliens described in § 436.406(c) of this subpart. ...

  8. 42 CFR 436.128 - Coverage for certain qualified aliens.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 42 Public Health 4 2013-10-01 2013-10-01 false Coverage for certain qualified aliens. 436.128... Mandatory Coverage of the Categorically Needy § 436.128 Coverage for certain qualified aliens. The agency... § 440.255(c) of this chapter to those aliens described in § 436.406(c) of this subpart. ...

  9. 42 CFR 436.128 - Coverage for certain qualified aliens.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 42 Public Health 4 2012-10-01 2012-10-01 false Coverage for certain qualified aliens. 436.128... Mandatory Coverage of the Categorically Needy § 436.128 Coverage for certain qualified aliens. The agency... § 440.255(c) of this chapter to those aliens described in § 436.406(c) of this subpart. ...

  10. 49 CFR 599.300 - Requirements for qualifying transactions.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... Requirements for qualifying transactions. (a) In general. To qualify for a credit under the CARS Program, a... history provider evidencing registration for a period of not less than one year immediately prior to the... letters that do not obscure the owner's name, VIN, or other writing as follows: “Junk Automobile,...

  11. 49 CFR 599.300 - Requirements for qualifying transactions.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... Requirements for qualifying transactions. (a) In general. To qualify for a credit under the CARS Program, a... history provider evidencing registration for a period of not less than one year immediately prior to the... letters that do not obscure the owner's name, VIN, or other writing as follows: “Junk Automobile,...

  12. 24 CFR 266.100 - Qualified housing finance agency (HFA).

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 24 Housing and Urban Development 2 2010-04-01 2010-04-01 false Qualified housing finance agency... AUTHORITIES HOUSING FINANCE AGENCY RISK-SHARING PROGRAM FOR INSURED AFFORDABLE MULTIFAMILY PROJECT LOANS Housing Finance Agency Requirements § 266.100 Qualified housing finance agency (HFA). (a) Qualifications...

  13. 7 CFR 1260.181 - Qualified State beef councils.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 7 Agriculture 10 2010-01-01 2010-01-01 false Qualified State beef councils. 1260.181 Section 1260... SERVICE (MARKETING AGREEMENTS AND ORDERS; MISCELLANEOUS COMMODITIES), DEPARTMENT OF AGRICULTURE BEEF PROMOTION AND RESEARCH Beef Promotion and Research Order Assessments § 1260.181 Qualified State beef...

  14. 42 CFR 417.412 - Qualifying condition: Administration and management.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 3 2010-10-01 2010-10-01 false Qualifying condition: Administration and management... Qualifying condition: Administration and management. The HMO or CMP must demonstrate that it— (a) Has... agents or management staff or persons with ownership or control interests who have been convicted...

  15. 7 CFR 1450.101 - Qualified biomass conversion facility.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 7 Agriculture 10 2011-01-01 2011-01-01 false Qualified biomass conversion facility. 1450.101... CORPORATION, DEPARTMENT OF AGRICULTURE LOANS, PURCHASES, AND OTHER OPERATIONS BIOMASS CROP ASSISTANCE PROGRAM (BCAP) Matching Payments § 1450.101 Qualified biomass conversion facility. (a) To be considered a...

  16. 7 CFR 1450.101 - Qualified biomass conversion facility.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 7 Agriculture 10 2013-01-01 2013-01-01 false Qualified biomass conversion facility. 1450.101... CORPORATION, DEPARTMENT OF AGRICULTURE LOANS, PURCHASES, AND OTHER OPERATIONS BIOMASS CROP ASSISTANCE PROGRAM (BCAP) Matching Payments § 1450.101 Qualified biomass conversion facility. (a) To be considered a...

  17. 7 CFR 1450.101 - Qualified biomass conversion facility.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 7 Agriculture 10 2014-01-01 2014-01-01 false Qualified biomass conversion facility. 1450.101... CORPORATION, DEPARTMENT OF AGRICULTURE LOANS, PURCHASES, AND OTHER OPERATIONS BIOMASS CROP ASSISTANCE PROGRAM (BCAP) Matching Payments § 1450.101 Qualified biomass conversion facility. (a) To be considered a...

  18. 7 CFR 1450.101 - Qualified biomass conversion facility.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 7 Agriculture 10 2012-01-01 2012-01-01 false Qualified biomass conversion facility. 1450.101... CORPORATION, DEPARTMENT OF AGRICULTURE LOANS, PURCHASES, AND OTHER OPERATIONS BIOMASS CROP ASSISTANCE PROGRAM (BCAP) Matching Payments § 1450.101 Qualified biomass conversion facility. (a) To be considered a...

  19. 42 CFR 68.9 - What loans qualify for repayment?

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 42 Public Health 1 2013-10-01 2013-10-01 false What loans qualify for repayment? 68.9 Section 68.9 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES FELLOWSHIPS, INTERNSHIPS, TRAINING NATIONAL INSTITUTES OF HEALTH (NIH) LOAN REPAYMENT PROGRAMS (LRPs) § 68.9 What loans qualify...

  20. 42 CFR 68.9 - What loans qualify for repayment?

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 42 Public Health 1 2014-10-01 2014-10-01 false What loans qualify for repayment? 68.9 Section 68.9 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES FELLOWSHIPS, INTERNSHIPS, TRAINING NATIONAL INSTITUTES OF HEALTH (NIH) LOAN REPAYMENT PROGRAMS (LRPs) § 68.9 What loans qualify...

  1. 13 CFR 107.130 - Requirement for qualified management.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... qualified management. When applying for a license, you must show, to the satisfaction of SBA, that your current or proposed management is qualified and has the knowledge, experience, and capability necessary... management. 107.130 Section 107.130 Business Credit and Assistance SMALL BUSINESS ADMINISTRATION...

  2. 48 CFR 837.7002 - List of qualified funeral directors.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 48 Federal Acquisition Regulations System 5 2010-10-01 2010-10-01 false List of qualified funeral... SPECIAL CATEGORIES OF CONTRACTING SERVICE CONTRACTING Mortuary Services 837.7002 List of qualified funeral..., a list of funeral directors capable of performing the burial services specified in 837.7003....

  3. 26 CFR 6a.103A-2 - Qualified mortgage bond.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... treated as part of a qualified mortgage bond issue. (b) Definitions and special rules. For purposes of this section and § 6a.103A-1, the following definitions apply: (1) Qualified mortgage bond. The term... bond proceeds. For example, where a mortgagor purchases a building which is so incomplete that...

  4. 26 CFR 6a.103A-2 - Qualified mortgage bond.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... treated as part of a qualified mortgage bond issue. (b) Definitions and special rules. For purposes of this section and § 6a.103A-1, the following definitions apply: (1) Qualified mortgage bond. The term... bond proceeds. For example, where a mortgagor purchases a building which is so incomplete that...

  5. 26 CFR 301.6362-5 - Qualified nonresident tax.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 26 Internal Revenue 18 2012-04-01 2012-04-01 false Qualified nonresident tax. 301.6362-5 Section... AND ADMINISTRATION PROCEDURE AND ADMINISTRATION Seizure of Property for Collection of Taxes § 301.6362-5 Qualified nonresident tax. (a) In general. A tax meets the requirements of section 6362(d)...

  6. 26 CFR 301.6362-5 - Qualified nonresident tax.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 26 Internal Revenue 18 2013-04-01 2013-04-01 false Qualified nonresident tax. 301.6362-5 Section... AND ADMINISTRATION PROCEDURE AND ADMINISTRATION Seizure of Property for Collection of Taxes § 301.6362-5 Qualified nonresident tax. (a) In general. A tax meets the requirements of section 6362(d)...

  7. 7 CFR 1260.115 - Qualified State beef council.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 7 Agriculture 10 2010-01-01 2010-01-01 false Qualified State beef council. 1260.115 Section 1260... SERVICE (MARKETING AGREEMENTS AND ORDERS; MISCELLANEOUS COMMODITIES), DEPARTMENT OF AGRICULTURE BEEF PROMOTION AND RESEARCH Beef Promotion and Research Order Definitions § 1260.115 Qualified State beef...

  8. 5 CFR 838.1004 - Qualifying court orders.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 5 Administrative Personnel 2 2014-01-01 2014-01-01 false Qualifying court orders. 838.1004 Section... (CONTINUED) COURT ORDERS AFFECTING RETIREMENT BENEFITS Court Orders Affecting Civil Service Retirement Benefits § 838.1004 Qualifying court orders. (a) A former spouse is entitled to a portion of an employee's...

  9. 5 CFR 838.1004 - Qualifying court orders.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 5 Administrative Personnel 2 2013-01-01 2013-01-01 false Qualifying court orders. 838.1004 Section... (CONTINUED) COURT ORDERS AFFECTING RETIREMENT BENEFITS Court Orders Affecting Civil Service Retirement Benefits § 838.1004 Qualifying court orders. (a) A former spouse is entitled to a portion of an employee's...

  10. 20 CFR 404.1018b - Medicare qualified government employment.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 20 Employees' Benefits 2 2014-04-01 2014-04-01 false Medicare qualified government employment. 404... Excluded from Employment § 404.1018b Medicare qualified government employment. (a) General. The work of a Federal, State, or local government employee not otherwise subject to Social Security coverage...

  11. 20 CFR 404.1018b - Medicare qualified government employment.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 20 Employees' Benefits 2 2011-04-01 2011-04-01 false Medicare qualified government employment. 404... Excluded from Employment § 404.1018b Medicare qualified government employment. (a) General. The work of a Federal, State, or local government employee not otherwise subject to Social Security coverage...

  12. 20 CFR 404.1018b - Medicare qualified government employment.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 20 Employees' Benefits 2 2012-04-01 2012-04-01 false Medicare qualified government employment. 404... Excluded from Employment § 404.1018b Medicare qualified government employment. (a) General. The work of a Federal, State, or local government employee not otherwise subject to Social Security coverage...

  13. 42 CFR 436.128 - Coverage for certain qualified aliens.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 4 2010-10-01 2010-10-01 false Coverage for certain qualified aliens. 436.128... Mandatory Coverage of the Categorically Needy § 436.128 Coverage for certain qualified aliens. The agency... § 440.255(c) of this chapter to those aliens described in § 436.406(c) of this subpart....

  14. 42 CFR 436.128 - Coverage for certain qualified aliens.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 42 Public Health 4 2011-10-01 2011-10-01 false Coverage for certain qualified aliens. 436.128... Mandatory Coverage of the Categorically Needy § 436.128 Coverage for certain qualified aliens. The agency... § 440.255(c) of this chapter to those aliens described in § 436.406(c) of this subpart....

  15. Enhancing the Employability of Newly Qualified Nurses: A Pilot Study

    ERIC Educational Resources Information Center

    Dray, Beattie; Burke, Linda; Hurst, Heather M.; Ferguson, Anne; Marks-Maran, Diane

    2011-01-01

    Vocationally based higher education programmes are meant to prepare people for employment in their chosen fields of study. In nursing, historically, employment after qualifying has been almost assured, with sufficient vacancies available for newly qualified nurses. Recently, however, for a number of reasons, primarily related to economic…

  16. 42 CFR 417.414 - Qualifying condition: Range of services.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... HEALTH CARE PREPAYMENT PLANS Qualifying Conditions for Medicare Contracts § 417.414 Qualifying condition... practice to refer patients to sources outside that geographic area. (3) Exception for hospice care. An HMO or CMP is not required to furnish hospice care as described in part 418 of this chapter. However...

  17. 7 CFR 900.356 - Listing of qualified associations.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 7 Agriculture 8 2010-01-01 2010-01-01 false Listing of qualified associations. 900.356 Section 900... REGULATIONS Procedure for Determining the Qualification of Cooperative Milk Marketing Associations § 900.356 Listing of qualified associations. A copy of each determination of qualification is furnished to the...

  18. 24 CFR 3286.303 - Responsibilities of qualified trainers.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ...-Administered States § 3286.303 Responsibilities of qualified trainers. (a) Curriculum and hours. In providing... program, qualified trainers must adequately address the curriculum and instruction-time requirements... compliance with the applicable curriculum and time requirements under subparts C and D of this part....

  19. 20 CFR 404.1018b - Medicare qualified government employment.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... AND DISABILITY INSURANCE (1950- ) Employment, Wages, Self-Employment, and Self-Employment Income Work Excluded from Employment § 404.1018b Medicare qualified government employment. (a) General. The work of a... 20 Employees' Benefits 2 2013-04-01 2013-04-01 false Medicare qualified government employment. 404...

  20. 12 CFR 360.5 - Definition of qualified financial contracts.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 12 Banks and Banking 4 2011-01-01 2011-01-01 false Definition of qualified financial contracts... OF GENERAL POLICY RESOLUTION AND RECEIVERSHIP RULES § 360.5 Definition of qualified financial contracts. (a) Authority and purpose. Sections 11(e) (8) through (10) of the Federal Deposit Insurance Act...

  1. 42 CFR 417.418 - Qualifying condition: Quality assurance program.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 3 2010-10-01 2010-10-01 false Qualifying condition: Quality assurance program... Qualifying condition: Quality assurance program. (a) Condition. The HMO or CMP must make arrangements for a quality assurance program that meets the requirements of this section. (b) Standard. An HMO or CMP...

  2. 13 CFR 107.130 - Requirement for qualified management.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 13 Business Credit and Assistance 1 2011-01-01 2011-01-01 false Requirement for qualified management. 107.130 Section 107.130 Business Credit and Assistance SMALL BUSINESS ADMINISTRATION SMALL BUSINESS INVESTMENT COMPANIES Qualifying for an SBIC License Organizing An Sbic § 107.130 Requirement...

  3. 12 CFR 1806.201 - Measuring and reporting Qualified Activities.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 12 Banks and Banking 7 2010-01-01 2010-01-01 false Measuring and reporting Qualified Activities. 1806.201 Section 1806.201 Banks and Banking COMMUNITY DEVELOPMENT FINANCIAL INSTITUTIONS FUND, DEPARTMENT OF THE TREASURY BANK ENTERPRISE AWARD PROGRAM Awards § 1806.201 Measuring and reporting Qualified...

  4. What Is a Highly Qualified Adapted Physical Education Teacher?

    ERIC Educational Resources Information Center

    Lytle, Rebecca; Lavay, Barry; Rizzo, Terry

    2010-01-01

    This article presents information related to the new position statement on the definition of a "highly qualified adapted physical education teacher" published by the Adapted Physical Activity Council (a council of the American Alliance for Health, Physical Education, Recreation and Dance). It discusses the legal references for "highly qualified"…

  5. 36 CFR 908.13 - Rights of Qualified Persons.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 36 Parks, Forests, and Public Property 3 2010-07-01 2010-07-01 false Rights of Qualified Persons... POLICY AND PROCEDURES TO FACILITATE THE RETENTION OF DISPLACED BUSINESSES AND RESIDENTS IN THE PENNSYLVANIA AVENUE DEVELOPMENT AREA Preferential Right To Relocate § 908.13 Rights of Qualified Persons....

  6. 36 CFR 908.10 - Criteria of Qualified Person.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... POLICY AND PROCEDURES TO FACILITATE THE RETENTION OF DISPLACED BUSINESSES AND RESIDENTS IN THE PENNSYLVANIA AVENUE DEVELOPMENT AREA Preferential Right To Relocate § 908.10 Criteria of Qualified Person. Qualified Person is either (a) A Person whose place of business or residence was located in the...

  7. 19 CFR 102.17 - Non-qualifying operations.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 19 Customs Duties 1 2010-04-01 2010-04-01 false Non-qualifying operations. 102.17 Section 102.17... TREASURY RULES OF ORIGIN Rules of Origin § 102.17 Non-qualifying operations. A foreign material shall not be considered to have undergone an applicable change in tariff classification specified in §...

  8. 38 CFR 21.6509 - Notice to qualified veterans.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... reevaluation will be provided by a counseling psychologist in the Vocational Rehabilitation and Employment (VR... (CONTINUED) VOCATIONAL REHABILITATION AND EDUCATION Temporary Program of Vocational Training and Rehabilitation § 21.6509 Notice to qualified veterans. (a) At the time notice is provided to a qualified veteran...

  9. 38 CFR 21.6509 - Notice to qualified veterans.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... reevaluation will be provided by a counseling psychologist in the Vocational Rehabilitation and Employment (VR... (CONTINUED) VOCATIONAL REHABILITATION AND EDUCATION Temporary Program of Vocational Training and Rehabilitation § 21.6509 Notice to qualified veterans. (a) At the time notice is provided to a qualified veteran...

  10. 38 CFR 21.6509 - Notice to qualified veterans.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... reevaluation will be provided by a counseling psychologist in the Vocational Rehabilitation and Employment (VR... (CONTINUED) VOCATIONAL REHABILITATION AND EDUCATION Temporary Program of Vocational Training and Rehabilitation § 21.6509 Notice to qualified veterans. (a) At the time notice is provided to a qualified veteran...

  11. Hiring Highly Qualified Teachers Begins with Quality Interviews

    ERIC Educational Resources Information Center

    Clement, Mary C.

    2009-01-01

    School administrators have some tough hiring decisions to make, and an interview to select the most highly qualified applicants is critically important. Even before the mandates of No Child Left Behind, school administrators strove to hire the best new teachers. Competent, caring, qualified teachers are the keys to enhanced student achievement.…

  12. 7 CFR 1220.313 - Qualified State Soybean Boards.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 7 Agriculture 10 2011-01-01 2011-01-01 false Qualified State Soybean Boards. 1220.313 Section 1220... SERVICE (MARKETING AGREEMENTS AND ORDERS; MISCELLANEOUS COMMODITIES), DEPARTMENT OF AGRICULTURE SOYBEAN... Soybean Boards. The following State soybean promotion organizations shall be Qualified State...

  13. 7 CFR 1220.313 - Qualified State Soybean Boards.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 7 Agriculture 10 2012-01-01 2012-01-01 false Qualified State Soybean Boards. 1220.313 Section 1220... SERVICE (MARKETING AGREEMENTS AND ORDERS; MISCELLANEOUS COMMODITIES), DEPARTMENT OF AGRICULTURE SOYBEAN... Soybean Boards. The following State soybean promotion organizations shall be Qualified State...

  14. 7 CFR 1220.313 - Qualified State Soybean Boards.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 7 Agriculture 10 2010-01-01 2010-01-01 false Qualified State Soybean Boards. 1220.313 Section 1220... SERVICE (MARKETING AGREEMENTS AND ORDERS; MISCELLANEOUS COMMODITIES), DEPARTMENT OF AGRICULTURE SOYBEAN... Soybean Boards. The following State soybean promotion organizations shall be Qualified State...

  15. 7 CFR 1220.313 - Qualified State Soybean Boards.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 7 Agriculture 10 2013-01-01 2013-01-01 false Qualified State Soybean Boards. 1220.313 Section 1220... SERVICE (MARKETING AGREEMENTS AND ORDERS; MISCELLANEOUS COMMODITIES), DEPARTMENT OF AGRICULTURE SOYBEAN... Soybean Boards. The following State soybean promotion organizations shall be Qualified State...

  16. 7 CFR 1220.313 - Qualified State Soybean Boards.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 7 Agriculture 10 2014-01-01 2014-01-01 false Qualified State Soybean Boards. 1220.313 Section 1220... SERVICE (MARKETING AGREEMENTS AND ORDERS; MISCELLANEOUS COMMODITIES), DEPARTMENT OF AGRICULTURE SOYBEAN... Soybean Boards. The following State soybean promotion organizations shall be Qualified State...

  17. 7 CFR 701.10 - Qualifying minimum cost of restoration.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 7 Agriculture 7 2010-01-01 2010-01-01 false Qualifying minimum cost of restoration. 701.10 Section... RELATED PROGRAMS PREVIOUSLY ADMINISTERED UNDER THIS PART § 701.10 Qualifying minimum cost of restoration... assistance is or will be required to return the land to productive agricultural use or to provide emergency...

  18. 24 CFR 3286.303 - Responsibilities of qualified trainers.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ...-Administered States § 3286.303 Responsibilities of qualified trainers. (a) Curriculum and hours. In providing... program, qualified trainers must adequately address the curriculum and instruction-time requirements... compliance with the applicable curriculum and time requirements under subparts C and D of this part. (d...

  19. What Is a Highly Qualified Adapted Physical Education Teacher?

    ERIC Educational Resources Information Center

    Lytle, Rebecca; Lavay, Barry; Rizzo, Terry

    2010-01-01

    This article presents information related to the new position statement on the definition of a "highly qualified adapted physical education teacher" published by the Adapted Physical Activity Council (a council of the American Alliance for Health, Physical Education, Recreation and Dance). It discusses the legal references for "highly qualified"…

  20. What Constitutes a Highly Qualified Physical Education Teacher?

    ERIC Educational Resources Information Center

    American Alliance for Health, Physical Education, Recreation and Dance (NJ1), 2007

    2007-01-01

    It is the position of the National Association for Sport and Physical Education (NASPE) that is it critical to have highly qualified physical education teachers delivering a standards-based curriculum that will assist children in adopting and maintaining healthy lifestyles. NASPE acknowledges that highly qualified physical education teachers will…