Search

Objective To assess the extent to which user fees for antiretroviral therapy (ART) represent a financial barrier to access to ART among HIV-positive patients in Yaounde, Cameroon. Methods Sociodemographic, economic and clinical data were collected from a random sample of 707 HIV-positive patients followed up in six public hospitals of the capital city (Yaounde) and its surroundings through face-to-face interviews carried out by trained interviewers independently from medical staff and medical questionnaires filled out by prescribing physicians. Logistic regression models were used to identify factors associated with self-reported financial difficulties in purchasing ART during the previous 3 months. Findings Of the 532 patients treated with ART at the time of the survey, 20% reported financial difficulty in purchasing their antiretroviral drugs during the previous 3 months. After adjustment for socioeconomic and clinical factors, reports of financial difficulties were significantly associated with lower adherence to ART (odds ratio, OR: 0.24; 95% confidence interval, CI: 0.15-0.40; P< 0.0001) and with lower CD4+ lymphocyte (CD4) counts after 6 months of treatment (OR: 2.14; 95% CI: 1.15-3.96 for CD4 counts < 200 cells/[micro]l; P= 0.04). Conclusion Removing a financial barrier to treatment with ART by eliminating user fees at the point of care delivery, as recommended by WHO, could lead to increased adherence to ART and to improved clinical results. New health financing mechanisms based on the public resources of national governments and international donors are needed to attain universal access to drugs and treatment for HIV infection. Objectif Evaluer dans quelle mesure la participation financiere reglee par les usagers pour beneficier du traitement antiretroviral (ART) represente un obstacle financier a l&apos;acces a ce traitement pour les personnes positives pour le VIH a Yaounde, au Cameroun. Methodes Des donnees sociodemographiques, economiques et cliniques ont ete recueillies parmi un echantillon aleatoire de 707. individus seropositifs pour le VIH, suivis dans six hopitaux publics de la capitale du Cameroun (Yaounde) ou de ses environs, a travers des entretiens face-a-face menes par des enqueteurs formes et independants du personnel medical et a travers des questionnaires medicaux remplis par les medecins prescripteurs. Des modeles de regression logistique ont ete utilises pour identifier les facteurs associes au signalement spontane par les sujets de difficultes financieres pour se procurer les medicaments ART au cours des 3 derniers mois. Resultats Parmi les 532 patients prenant un traitement ART au moment de l&apos;enquete; 20 % ont signale" des difficultes financieres pour se procurer les medicaments antiretroviraux au cours des 3 derniers mois. Apres ajustement pour les facteurs socioeconomiques et cliniques, on a constate une association significative entre le signalement de difficultes financieres et une faible observance du traitement ART (odds ratio, OR: 0,24; intervalle de confiance a 95 %, IC: 0,15-0,40; p < 0,0001) et entre ce signalement et une numeration plus basse des lymphocytes CD4+ (CD4) apres 6 mois de traitement (OR: 2;14, IC a 95 %: 1,15-3,96 pour les numerations des CD4 < 200 cellules/[micro]l; p = 0,04). Conclusion L&apos;elimination de l&apos;obstacle financier au traitement antiretroval que constitue la participation financiere des usagers au point de delivrance des soins, comme le recommande l&apos;OMS, pourrait apporter une amelioration de l&apos;observance du traitement et des resultats cliniques. De nouveaux mecanismes financiers reposant sur les ressources publiques des gouvernements nationaux et sur les apports de donateurs internationaux sont necessaires pour obtenir un acces universel aux medicaments et au traitement contre l&apos;infection par le VIH. Objetivo Evaluar en que medida los honorarios cobrados a los usuarios por el tratamiento antirretroviral (TAR) representan una barrera financiera para acceder a dicha terapia entre los pacientes VIH-positivos en Yaunde, Camerun. Metodos Se reunieron datos sociodemograficos, economicos y clinicos a partir de una muestra aleatoria de 707 pacientes VIH-positivos sometidos a seguimiento en seis hospitales publicos de la capital (Yaunde) y sus alrededores mediante entrevistas personales llevadas a cabo por encuestadores debidamente preparados independientes del personal medico y cuestionarios medicos rellenados por los facultativos que recetaban los medicamentos. Se utilizaron modelos de regresion logistica para determinar los factores asociados a las dificultades financieras declaradas por los propios pacientes para adquirir TAR durante los 3 meses anteriores. Resultados De los 532 pacientes que recibian TAR en el momento de la encuesta, un 20% declararon haber tenido problemas economicos para adquirir la medicacion antirretroviral en los 3 meses anteriores. Tras los ajustes pertinentes en funcion de factores socioeconomicos y clinicos, las referencias a problemas economicos se asociaron de forma significativa a un menor seguimiento dei TAR (razon de posibilidades, OR: 0,24; intervalo de confianza [IC] del 95%: 0,15-0,40; p < 0,0001) y a recuentos mas bajos de los linfocitos CD4+ (CD4) a los 6 meses de tratamiento (OR: 2,14; IC95%: 1,15-3,96 para los recuentos de CD4 < 200 celulas/[micron]l; p = 0,04). Conclusion La supresion de las trabas financieras ai tratamiento con antirretrovirales mediante la eliminacion de los honorarios cobrados a los usuarios en los puntos de atencion sanitaria, de acuerdo con las recomendaciones de la OMS, podria traducirse en un mayor cumplimiento del TAR y unos resultados clinicos mejores. Se necesitan nuevos mecanismos de financiacion sanitaria basados en los recursos publicos de los gobiernos nacionales y los donantes internacionales para garantizar el acceso universal a los medicamentos y el tratamiento que requiere la infeccion por VIH., Introduction After the Bamako Initiative, which was launched at a meeting of African ministers of health in Mali in 1987, many developing countries introduced or expanded cost recovery policies by [...]

Objectives. We monitored changes in self-reported knowledge, attitudes, and behaviors regarding fruit and vegetable consumption in Western Australia prior to and after a healthful-eating campaign. Methods. We obtained telephone survey data from 2854 adults in Perth from Nutrition Monitoring Surveys conducted in 1995, 1998, 2001, and 2004. The 'Go for 2&5' fruit and vegetable campaign was implemented from 2002 to 2005. Results. We observed changes in knowledge, attitudes, and behaviors regarding fruit and vegetable intake. In 2004, respondents were more likely than in 1995 to report 2 servings of fruit (odds ratio [OR] = 3.66; 95% confidence interval [Cl] = 2.85, 4.70) and 5 servings of vegetables (OR = 4.50; 95% Cl = 3.49, 5.80) per day as optimal. Despite this, vegetable consumption in 2004 was less than in 1995 (rate ratio=0.88; 95% Cl = 0.82, 0.96; P=.003). Perceived adequacy of vegetable (59.3%) or fruit (34.5%) intake and insufficient time for vegetable preparation (14.3%) were the main barriers. Conclusions. Knowledge of the recommended fruit and vegetable intake increased following the Go for 2&5 campaign. Perceptions of the adequacy of current intake and time scarcity should be considered when designing nutrition interventions. (Am J Public Health. 2009;99:355-361. doi:10.2105/AJPH.2007. 131367)

The analysis of the data from the 2003 National Survey of Children's Health reveal that there is a significant racial/ethnic disparity that exist in parental reports of their children's oral health and that the most disadvantaged group is the Hispanics. The gaps appear to be independent of socioeconomic status and preventive-care attitudes.

Objective This study describes the prevalence, adequacy and correlates of 12-month mental health service use among participants in the Mexican Adolescent Mental Health Survey. Methods The authors conducted face-to-face household surveys of a probability sample of 3005 adolescents aged 12-17 years residing in the Mexico City metropolitan area during 2005. The prevalence of mental health disorders and the use of services were assessed with the computer-assisted adolescent version of the World Mental Health Composite International Diagnostic Interview. Correlates of service use and adequate treatment were identified in logistic regression analyses that took into account the complex sample design and weighting process. Findings Less than one in seven respondents with psychiatric disorders used any mental health services during the previous year. Respondents with substance-use disorders reported the highest prevalence of service use and those with anxiety disorders the lowest. Approximately one in every two respondents receiving any services obtained treatment that could be considered minimally adequate. Conclusion We found large unmet needs for mental health services among adolescents with psychiatric disorders in Mexico City. Improvements in the mental health care of Mexican youth are urgently needed. Bulletin of the World Health Organization 2008;86:757-764. Une traductlon en francais de ce resume figure a la fin de l&apos;article. Al final de articulo se facilita una traduccion al espanol Objectif La presente etude decrit la prevalence, l&apos;adequation aux besoins et les correlats du recours aux services de sante mentale sur 12 mois chez les sujets de l&apos;Enquete sur la sante mentale des adolescents de Mexico. Methodes Les auteurs ont mene une enquete en face-a-face darts les menages sur un echantillon probabiliste de 3005 adolescents de 12 a 17 ans, residant dans la zone metropolitaine de Mexico en 2005. Ils ont evalue la prevalence des troubles mentaux et le recours aux services de sante mentale a l&apos;aide de la version Adolescents et assistee par ordinateur du World Mental Health Composite International Diagnostic Interview. Des correlations entre le recours aux services de sante mentale et l&apos;adequation du traitement ont ete identifiees a l&apos;aide d&apos;analyses par regression logistique prenant en compte le mode de constitution de l&apos;echantillon complexe et les processus de ponderation. Resultats Parmi les adolescents interroges souffrant de troubles psychiatriques, moins d&apos;un sur sept avaient fait appel aux services de sante mentale au cours de l&apos;annee precedente. Ce sont les adolescents interroges presentant des troubles toxicomaniaques qui ont mentionne la plus forte prevalence du recours a ces services et dont les troubles anxieux etalent les plus faibles. Parmi les adolescents interroges ayant beneficie de services de sante mentale, environ un sur deux avait recu un traitement pouvant etre considere comme tres peu adapte. Conclusion Nous avons releve d&apos;importants besoins non satisfaits en matiere de sante rnentale chez les adolescents de Mexico souffrant de troubles psychiatriques. Il est urgent d&apos;ameliorer les soins de sante mentale dispenses aux jeunes de cette ville. Objetivo Se describen aqui la prevalencia, la idoneidad y los factores correlacionados del uso de servicios de salud mental a Io largo de 12 meses entre los participantes en la Encuesta de Salud Mental de Adolescentes de Mexico. Metodos Los autores llevaron a cabo encuestas de hogares personales con una muestra probabilistica de 3005 adolescentes de 12 a 17 anos residentes en el Area metropolitana de Mexico D.F. durante 2005. La prevalencia de trastornos de salud mental y el uso de los servicios correspondientes se evaluaron con la versien computadorizada para adolescentes de la Entrevista CIDI (Composite International Diagnostic Interview) sobre Salud Mental Mundial. Los factores correlacionados con la utilizacien de los servicios y el tratamiento adecuado se determinaron mediante analisis de regresien logistica adaptados al complejo proceso de diseno y ponderacien de muestras. Resultados Menos de uno de cada siete encuestados con trastornos psiquiatricos habian usado algun tipo de servicio de salud mental durante el ano precedente. Los encuestados con trastornos de consumo de sustancias son los que declararon la maxima prevalencia de uso de servicios, y la prevalencia mas baja correspondio a los afectados por trastornos de ansiedad. Entre quienes usaron algun tipo de servicio, alrededor de uno de cada dos encuestados recibieron un tratamiento minimamente adecuado. Conclusion Se han detectado importantes necesidades no atendidas de servicios de salud mental entre los adolescentes con trastornos psiquiatricos de Mexico D.E Es preciso mejorar urgentemente la atencien de salud mental de los jovenes mexicanos., Introduction In Mexico, (1) as elsewhere, only a minority of adults with psychiatric disorders receive some form of treatment. (2-5) However, it is unclear to what extent this situation is [...]