Determinants of help seeking and treatment seeking behavior of Tuberculosis patients ‐ Gender perspective: A systematic review Gender differences in first-episode psychosis at 5-year follow-up--two different courses of disease? Results from the OPUS study at 5-year follow-up.
Background Help and treatment seeking behavior of men and women suffering from tuberculosis is largely determined by how he/she and those around them perceive the causes , regard the diagnosis , accept the treatment , and adhere to the treatment . Objectives To critically appraise and synthesize the best available evidence on gender‐based determinants of help and treatment seeking behavior of tuberculosis patients . Inclusion criteria Male and female tuberculosis patients ( > = 15 years ) living in developed and developing countries were included . Quantitative studies examining gender differences in help and treatment seeking among tuberculosis patients with cross‐sectional , retrospective and prospect i ve cohort were included . Types of primary outcomes Outcomes related to determinants of help seeking : pattern of distress , perceived cause of tuberculosis and stigma related to tuberculosis patients and determinants of treatment seeking : delay in diagnosis , health service utilization , and consequence of treatment seeking ; treatment outcomes . Search strategy The review considered both published and unpublished studies in the English language published between January 1990 and December 2010 . Data bases of the Joanna Briggs Institute , PubMed , Popline , Cochrane Library , CINAHL and MedNar were search ed . The search focused on key elements of objectives ( participants , comparator , and outcome ) and a thorough search was undertaken utilizing a st and ardized three step approach . Method ological quality Considered papers were critically appraised by two independent review ers using st and ardized Joanna Briggs Institute tools . Data was extracted using the Joanna Briggs Institute Meta Analysis of Statistical Assessment and Review Instrument data extraction tool . Data was analyzed using Revman 5.1 software from the Cochrane collaboration . Results Nine cross‐sectional , two retrospective and one prospect i ve cohort studies were included in the review . Males were 49 % less likely to have psychological distress than females ( OR=0.51 , 95 % CI=0.32‐0.83 ) . Males were 46 % less likely to perceive health , illness and injuries as a cause of tuberculosis infection than females ( OR=0.54 , 95 % CI=0.31‐0.96 ) . Males were 78 % less likely to use a traditional healer as health service utilization than females ( OR=0.22 , 95 % CI=0.07‐0.66 ) . Males were almost twice more likely to be diagnosed within 30 days in a health institution than females ( OR=1.76 , 95 % CI=1.09‐2.84 ) however , they were 23 % less likely to successfully complete tuberculosis treatment ( OR=0.77 , 95 % CI=0.68‐0.87 ) . Conclusions Gender differences were observed on determinants of help seeking such as distress , perceived causes of tuberculosis infection and stigma components . Determinants of treatment seeking that showed significant gender differences were utilization of health services for diagnosis and treatment , patient delay in seeking health service and treatment outcome of tuberculosis . Implication s for Practice Gender specific strategies for behavioral change should be implemented by health professionals on causes of tuberculosis , early treatment seeking , signs/symptoms , related stigma and adherence of treatment to raise awareness in the community . Practitioners should suspect tuberculosis among women at early stages of their visits to health facilities and screen for tuberculosis . Special efforts should be made by practitioners for male tuberculosis patients to complete the treatment . Implication s for Research Further research with gender perspective should be conducted using behavioral change models on screening of patients and sensitizing communities to uptake of tuberculosis facilities for tuberculosis control OBJECTIVE Gender differences in psychosis have been investigated , and the results have contributed to a better underst and ing of the disease , but many questions are unanswered . In clinical terms , women and men with psychosis differ in terms of access to social support , tendency of substance abuse , level of functioning and symptom patterns . We aim ed to investigate how gender differences at onset of psychosis develop during the first 5years of treatment . METHOD A total of 578 patients with a first-episode psychosis in the schizophrenia spectrum were included in the Danish OPUS trial -- a r and omized clinical trial comparing 2 years of intensive early-intervention programme with st and ard treatment . All patients were assessed with vali date d instruments at inclusion , and after 2 and 5 years . Data were analysed for significant gender differences . RESULTS Males have significantly higher levels of negative symptoms at all times , and are more likely to live alone and suffer from substance abuse . Females reach higher levels of social functioning at follow-up , and show a greater tendency to be employed or in education than males . Markedly more women than men live with children . More women than men reach a state of recovery and are more compliant with medication . CONCLUSION There are significant gender differences at 2- and 5-year follow-up in this large cohort of first-episode psychotic patients . Males and females show different symptomatology and different levels of social functioning
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