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PATIENT COMPLIANCE

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Most women who undergo a vaginal birth will suffer from some degree of perineal tear, especially women who give birth for the first time. Perineal tears can cause major problems in both the short and long term for example pain, psychological distress, dyspareunia, prolapse, and incontinence.

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PATIENT EDUCATION

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Late management in dengue can result to poor health outcome. Factors that can affect early treatment such as the lime of admission needs to be determined. This can improve promptness of care and early disease notification. The factors investigated in this study were: a) age and sex, b) clinical type, c) case classification, d) health care facility sector, e) hospital level, and f) period of admission. The period of admission refers to post-typhoon Haiyan, Region VIII epidemic in 2010 and period with no high impact disaster. The time of admission is the interval from the onset of illness to the time of hospitalization. An exhaustive retrospective sampling and analysis was conducted on a secondary data from the Dengue surveillance of Region VIII, Philippines for the period of 2008-2014. Two analyses were used to determine association, a chi-square test at a p-value <0.01 and ordinal logistic regression at a 95% confidence interval (Cl).The factors associated with a higher likelihood of a late hospitalization included a) age of 15-64 years old (OR 1.39; 95% Cl 1.29-1.49) as opposed to the children; b) having the severe types of the disease, Dengue Hemorrhagic Fever (OR 1.17; 95% Cl 1.08-1.26) and Dengue Shock Syndrome (OR 1.34; 95% Cl 1.01-1.78) in comparison to Dengue Fever; c) being in a tertiary level hospital (OR 1.32; 95% Cl 1.23-1.42) in comparison to a non-tertiary hospital. The inverse of these factors are associated to a lower likelihood of a late hospitalization. ln addition, the other factors associated with a lower likelihood of a late admission are: a) being in a private sector or privately owned health care facility (OR 0.73; 95% Cl 0.68-0.79) in comparison to a publicly owned health care facility; b) and of being admitted during periods of disaster such as the post-typhoon Haiyan (Cl 0.90; 95% Cl 0.72-0.90) and Region VIII - 2010 epidemic (OR 0.82; 95% Cl 0.76-0.89) as opposed to years with no high impact disasters. The patient's sex (OR 1.02, 95% Cl 0.96-1.08) and of being an elderly (OR 1.54; 95% Cl 0.90-2.64) are not associated to the time of admission. Confirming the diagnosis with laboratory tests is not associated to an early admission. The suspected case’s (OR 0.93; 95% Cl 0.72-1.22) and the probable cases (OR 1.10; 95% Cl 0.83-1.44) which are often diagnosed clinically and epidemiologically, are admitted on an equal lime to those confirmed with laboratory tests. Only 1.44% of the admitted cases in this study were confirmed with laboratory tests. Cast-effective laboratory test still needs to be developed to facilitate early admission particularly for the severe cases. The case fatality rate of severe cases is 26 times higher than Dengue Fever when admitted late. Late admission should alert health care workers that the case is likely severe and fatal. The earlier hospitalization during periods of disaster seems contrary to the strained health system. However, evidence indicated adaptive changes in the age and disease type distribution during the post­ typhoon Haiyan. There was higher private to public ratio of patients. The number of reported dengue cases increased by 10% in non-tertiary hospitals. During the 2010 epidemic, the hospitals increased in capacity by 10limes their regular yearly capacity. The late hospitalization among adults support the evidences painting less severe cases in this age group, consequently suggesting a different health seeking behavior. The private and non-tertiary hospitals are valuable health care facilities which can be developed for early case admission and notification, likewise, they are beneficial in coping during disasters. Inclusion and consistent recording of the identified factors in this study can facilitate in evaluating the population health status and accession medical care. The influence of external aid during disasters and using a surveillance data with widely confirmed cases necessitates investigation.

Patient Admission