BackgroundChagas disease (CD) affects over 300,000 people in the United States, but fewer than 1% have been diagnosed and less than 0.3% have received etiological treatment. This is a significant public health concern because untreated CD can produce fatal complications. What factors prevent people with CD from accessing diagnosis and treatment in a nation with one of the world’s most advanced healthcare systems?Methodology/Principal findingsThis analysis of barriers to diagnosis and treatment of CD in the US reflects the opinions of the authors more than a comprehensive discussion of all the available evidence. To enrich our description of barriers, we have conducted an exploratory literature review and cited the experience of the main US clinic providing treatment for CD. We list 34 barriers, which we group into four overlapping dimensions: systemic, comprising gaps in the public health system; structural, originating from political and economic inequalities; clinical, including toxicity of medications and diagnostic challenges; and psychosocial, encompassing fears and stigma.ConclusionsWe propose this multidimensional framework both to explain the persistently low numbers of people with CD who are tested and treated and as a potential basis for organizing a public health response, but we encourage others to improve on our approach or develop alternative frameworks. We further argue that expanding access to diagnosis and treatment of CD in the US means asserting the rights of vulnerable populations to obtain timely, quality healthcare.

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This study was designed to investigate the effect of short-term cognitive-behavioral group therapy on fourteen adolescents with attachment difficulties. All of the participants in this study had a history of child abuse/neglect and have been in foster or adoptive care. participants were divided into two male adolescent groups and two female adolescent groups. each participant completed the Reynolds Adolescent Adjustment Screening Inventory (RAASI; Reynolds, 2001) pre -and post group intervention. A six-week group intervention resulted in a significant change in self-ratings on measures of both externalizing and internalizing adjustment problems. results of the study are encouraging given that there is a stigma among adolescents, especially males, related to disclosing in groups with peers (Black & Rosenthal, 2005).

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