Research and applications: A question of trust: user-centered design requirements for an informatics intervention to promote the sexual health of African-American youth

Objective

We investigated the user requirements of African-American youth (aged 14–24 years) to inform the design of a culturally appropriate, network-based informatics intervention for the prevention of HIV and other sexually transmitted infections (STI).

Materials and Methods

We conducted 10 focus groups with 75 African-American youth from a city with high HIV/STI prevalence. Data analyses involved coding using qualitative content analysis procedures and memo writing.

Results

Unexpectedly, the majority of participants’ design recommendations concerned trust. Youth expressed distrust towards people and groups, which was amplified within the context of information technology-mediated interactions about HIV/STI. Participants expressed distrust in the reliability of condoms and the accuracy of HIV tests. They questioned the benevolence of many institutions, and some rejected authoritative HIV/STI information. Therefore, reputational information, including rumor, influenced HIV/STI-related decision making. Participants’ design requirements also focused on trust-related concerns. Accordingly, we developed a novel trust-centered design framework to guide intervention design.

Discussion

Current approaches to online trust for health informatics do not consider group-level trusting patterns. Yet, trust was the central intervention-relevant issue among African-American youth, suggesting an important focus for culturally informed design. Our design framework incorporates: intervention objectives (eg, network embeddedness, participation); functional specifications (eg, decision support, collective action, credible question and answer services); and interaction design (eg, member control, offline network linkages, optional anonymity).

Conclusions

Trust is a critical focus for HIV/STI informatics interventions for young African Americans. Our design framework offers practical, culturally relevant, and systematic guidance to designers to reach this underserved group better.     

Self-reported sexually transmitted infections among female university students

Aim

To investigate the occurrence of self-reported sexually transmitted infections (STIs) and associated factors among female university students requesting contraceptive counselling.

Material and methods

Cross-sectional study. Female university students (n = 353) completed a waiting-room questionnaire in connection with contraceptive counselling at a Student Health Centre in Uppsala, Sweden.

Results

Ninety-three (26.3%) female students had experienced an STI. The three most frequently reported STIs were chlamydia trachomatis, condyloma, and genital herpes. The experience of an STI was significantly associated with the total number of sexual partners (OR 1.060, 95% CI 1.030–1.091, P < 0.001), being heterosexual (OR 4.640, 95% CI 1.321–16.290, P = 0.017), having experienced an abortion (OR 2.744, 95% CI 1.112–6.771, P = 0.028), not being HPV-vaccinated (OR 2.696, 95% CI 1.473–4.935, P = 0.001), and having had intercourse on first night without using a condom (OR 2.375, 95% CI 1.182–4.771, P = 0.015).

Conclusions

Contraceptive counselling should also include information about primary and secondary prevention of STI, such as the importance of correct use of a condom and STI testing, to prevent a further spread of STIs.     

What do Malawi Polytechnic first year students know and do about HIV and AIDS?

Background

The Polytechnic introduced a “WHY WAIT?” course to equip first year students with skills to help reduce transmission of Human Immune-deficiency Virus (HIV). Training is conducted during the first week of arrival at college. The study aimed to explore existing knowledge, beliefs and attitudes in order to tailor the training programme to students'' needs.

Methods

This was a cross sectional study. During first day of arrival, first year students available on campus were given a structured self-administered questionnaire which was filled and submitted before the course. Out of 320 questionnaires distributed, 295 were returned representing 92% response rate.

Results

Ten percent (30) had more than one girlfriend or boyfriend. Ninety-seven percent (286) indicated that condoms are not 100% effective towards prevention of HIV while 72% (169) reported that they had never had sexual intercourse before. Of 66 students who had had sexual intercourse before, 30% indicated that they used condoms always during sexual intercourse, 40% used it occasionally while 30% never used condoms. Thirty-two percent (94) reported having an HIV test before and 19% (56) would feel uncomfortable to share a room with an HIV infected person.

Conclusion

The Polytechnic first year students have varying knowledge and practices about HIV and AIDS. There is need to intensify “WHY WAIT?” course to first years during first week at College to help equip them with necessary knowledge and skills to protect themselves against HIV and AIDS.     

Study of blood pressure profile of school children 6–15 years in a rural setting of Maharashtra

Background

High blood pressure in childhood is a major risk factor for heart disease and stroke in adulthood. There is enough evidence to suggest that the roots of essential hypertension in adults extend into childhood. There is a paucity of literature on the blood pressure measurements amongst children. This study was done to study blood pressure profile of school children in rural area of Maharashtra.

Aim & objectives

This cross sectional study was carried out to determine the prevalence of hypertension in children 6–15 years and to study the association between selected variables and blood pressure.

Material & methods

This study was done using a predesigned questionnaire and making measurements of height, BMI and Blood pressure using standardized physical instruments following standard guidelines. The data was collected and analyzed using appropriate statistical tests.

Results

The prevalence of hypertension in the study was found to be 4.4% with 3.5% in females and 5.1% in males.

Conclusion

In the study, hypertension in students was found to be significantly associated with higher BMI and with family history of hypertension. Age, height and BMI were found to correlate positively with Blood pressure levels in this study.     

Trends of Sexually Transmitted Infections : A 33 Year Experience

Background

Sexually Transmitted Infections (STIs) are a major public health problem the world over. This study was aimed at analyzing the trends of STIs in a 33 year period at a tertiary care service hospital.

Methods

A retrospective data analysis was done of all the cases diagnosed as STIs during a 33 year period from 1974 to 2006.

Result

A total of 4532 STIs were seen in 4215 males. The commonest STI was chancroid (37.2%), followed by syphilis (16.2%). The commonest age group involved was the 21-30 year group (57.6 %). STIs declined from a total of 311 cases in 1974 to seven cases in 2006. This trend was mirrored in all major STIs. Multiple STIs were seen in 317 (07.5%) cases.

Conclusion

The frequency of STIs has shown a distinctly decreasing trend from over the last 33 years.Key Words: Sexually transmitted infections, Trends     

Factors motivating and affecting health information exchange usage

Objective

Health information exchange (HIE) is the process of electronically sharing patient-level information between providers. However, where implemented, reports indicate HIE system usage is low. The aim of this study was to determine the factors associated with different types of HIE usage.

Design

Cross-sectional analysis of clinical data from emergency room encounters included in an operational HIE effort linked to system user logs using crossed random-intercept logistic regression.

Measurements

Independent variables included factors indicative of information needs. System usage was measured as none, basic usage, or a novel pattern of usage.

Results

The system was accessed for 2.3% of all encounters (6142 out of 271 305). Novel usage patterns were more likely for more complex patients. The odds of HIE usage were lower in the face of time constraints. In contrast to expectations, system usage was lower when the patient was unfamiliar to the facility.

Limitations

Because of differences between HIE efforts and the fact that not all types of HIE usage (ie, public health) could be included in the analysis, results are limited in terms of generalizablity.

Conclusions

This study of actual HIE system usage identifies patients and circumstances in which HIE is more likely to be used and factors that are likely to discourage usage. The paper explores the implications of the findings for system redesign, information integration across exchange partners, and for meaningful usage criteria emerging from provisions of the Health Information Technology for Economic & Clinical Health Act.     

Antimicrobial resistance of abnormal vaginal discharges microorganisms in Ouagadougou,Burkina Faso

Objective

To assess the prevalence of bacterial strains and fungal strains infecting the vaginal tract and test their sensitivity to antibiotics in women attending Saint Camille Medical Centre in Ouagadougou.

Methods

From January 2008 to December 2009, a total of 2 000 vaginal swabs were cultivated for bacterial and fungal identification and isolation. Furthermore, bacterial strains were tested for their susceptibility to several antibiotics used in routine in the centre.

Results

The results revealed that microbial isolation and identification was attempted for 1 536/2 000 sample, a positivity rate of 76.80%. Candida albicans (48.76%), followed by Escherichia coli (16.67%), Streptococcus agalactiae (8.14%) and Staphylococcus aureus (7.55%) were the major agents of genital tract infections in patients. Mycoplasma hominis and Ureaplasma urealyticum combined accounted for less than 7%. Trichomonas vaginalis was identified in 1.04% cases. The antimicrobial tests revealed that the microorganisms developed resistance to several antibiotics including beta lactams. However, antibiotics such as cefamenzol, ciprofloxacin and norfloxacin were still active on these bacteria.

Conclusions

The results reveal that many sexually active women are infected by one or more microbial pathogens, probably because of the lack of hygiene or the adoption of some risky behaviors, such as not using condoms or having multiple sexual partners. Efforts should be made to address these points in the country.     

Stress fractures—a prospective study amongst recruits

Background

Stress fracture (SF) is the single most common cause for the lost number of manpower days during training of recruits in the Armed Forces. This prospective study was undertaken with a view to develop baseline data on incidence of SF and to identify related variables.

Methods

A prospective study over a period of five years during 2004–2009 in which a total of 8,570 recruits were enrolled at the start of their training to find out the incidence and pattern of SFs.

Results

A total of 604 (7.04%, 95% CI 6.40–7.40%) out of a total of 8,570 recruits sustained SF during the study period. The majority of fractures occurred during basic training. The factors like urban residence, vegetarianism and those without prior history of physical activity were found to be associated with SF. Tibia was the commonest bone involved.

Conclusion

Prevention is undoubtedly the best approach in SF and other sports injuries. Priority should be given to individuals with good sports and physical activity background during recruitment. Intensity of training should be gradually increased during first three months (12 weeks) of training.Key Words: recruits, stress fracture     

Barriers to maternal health service use in Chikhwawa,Southern Malawi

Introduction

Research was conducted to get a community''s perspective on the factors contributing to continued maternal and neonatal deaths. The aim of the study was to identify and understand experiences, perceptions and needs of the community on maternal health service utilization.

Methods

Qualitative data was obtained through focus group discussions with community leaders, women, men and youth in the catchment areas of three remote health centres. A total of fourteen focus groups were held: three each with community leaders, men, women, boys and two with girls.Data was transcribed and analyzed manually through the use of thematic analysis.

Results

The discussions revealed the following as barriers to maternal health service utilization: walking long distances to access health facilities, lack of midwives, lack of or insufficient items to be used during delivery, long stay and rude health personnel. Seeking help from Traditional Birth Attendants (TBAs) during delivery was a common option because TBAs are within reach, do not demand many items for delivery, and treat the women with respect.

Conclusion

This study suggests some factors that are contributing to the high burden of maternal deaths in Malawi. Interventions should be developed and implemented to improve the barriers reported.     

Neurocognitive sequelae of cerebral malaria in adults: A pilot study in Benguela Central Hospital,Angola

Objective

To characterize the neurocognitive sequelae of cerebral malaria (CM) in an adult sample of the city of Benguela, Angola.

Methods

A neuropsychological assessment was carried out in 22 subjects with prior history of CM ranging from 6 to 12 months after the infection. The obtained results were compared to a control group with no previous history of cerebral malaria. The study was conducted in Benguela Central Hospital, Angola in 2011.

Results

CM group obtained lower results on the two last trials of a verbal learning task and on an abstract reasoning test.

Conclusions

CM is associated to a slower verbal learning rate and to difficulties in the ability to discriminate and perceive relations between new elements.     

Socio Behavioural Profile of HIV Positive DSC Personnel

Background

Few human immunodeficiency virus (HIV) positive Defence Security Corps (DSC) personnel reported for surveillance at one of the Air Force (AF) stations in 1992 and it was appropriate to study socio-behavioural profile of HIV positive DSC personnel to determine the reason for their vulnerability.

Method

The study was conducted among 46 HIV positive DSC personnel during 1992-2004 at various AF stations. Pretested questionnaires were introduced to the subjects to ascertain their demographic, social, educational and behavioural profile vis-à-vis their HIV-AIDS awareness.

Results

Majority of the subjects detected during pre-donation screening were middle aged, rural, semiliterate, (56.5%) and acquired the disease through heterosexual (95.66%) mode, mostly from commercial sex workers (CSWs). All were aware of HIV-AIDS prevention and most of them (77.2%) stated that condoms were easily available but 70.7% did not use the same for the fear of failure to perform under the influence of liquor. 74% subjects were found complying with medical instructions.

Conclusion

The study brings out a discernable gap between the knowledge and practice of safe sex. Adequate preventive knowledge did not always result in practice of safe sex.Key Words: Socio behavioural profile, HIV, Condom gap     

Modeling nurses' acceptance of bar coded medication administration technology at a pediatric hospital

Objective

To identify predictors of nurses'' acceptance of bar coded medication administration (BCMA).

Design

Cross-sectional survey of registered nurses (N=83) at an academic pediatric hospital that recently implemented BCMA.

Methods

Surveys assessed seven BCMA-related perceptions: ease of use; usefulness for the job; social influence from non-specific others to use BCMA; training; technical support; usefulness for patient care; and social influence from patients/families. An all possible subset regression procedure with five goodness-of-fit indicators was used to identify which set of perceptions best predicted BCMA acceptance (intention to use, satisfaction).

Results

Nurses reported a moderate perceived ease of use and low perceived usefulness of BCMA. Nurses perceived moderate-or-higher social influence to use BCMA and had moderately positive perceptions of BCMA-related training and technical support. Behavioral intention to use BCMA was high, but satisfaction was low. Behavioral intention to use was best predicted by perceived ease of use, perceived social influence from non-specific others, and perceived usefulness for patient care (56% of variance explained). Satisfaction was best predicted by perceived ease of use, perceived usefulness for patient care, and perceived social influence from patients/families (76% of variance explained).

Discussion

Variation in and low scores on ease of use and usefulness are concerning, especially as these variables often correlate with acceptance, as found in this study. Predicting acceptance benefited from using a broad set of perceptions and adapting variables to the healthcare context.

Conclusion

Success with BCMA and other technologies can benefit from assessing end-user acceptance and elucidating the factors promoting acceptance and use.     

Electronic health records in small physician practices: availability,use, and perceived benefits

Objective

To examine variation in the adoption of electronic health record (EHR) functionalities and their use patterns, barriers to adoption, and perceived benefits by physician practice size.

Design

Mailed survey of a nationally representative random sample of practicing physicians identified from the Physician Masterfile of the American Medical Association.

Measurements

We measured, stratified by practice size: (1) availability of EHR functionalities, (2) functionality use, (3) barriers to the adoption and use of EHR, and (4) impact of the EHR on the practice and quality of patient care.

Results

With a response rate of 62%, we found that <2% of physicians in solo or two-physician (small) practices reported a fully functional EHR and 5% reported a basic EHR compared with 13% of physicians from 11+ group (largest group) practices with a fully functional system and 26% with a basic system. Between groups, a 21–46% difference in specific functionalities available was reported. Among adopters there were moderate to large differences in the use of the EHR systems. Financial barriers were more likely to be reported by smaller practices, along with concerns about future obsolescence. These differences were sizable (13–16%) and statistically significant (p<0.001). All adopters reported similar benefits.

Limitations

Although we have adjusted for response bias, influences may still exist.

Conclusion

Our study found that physicians in small practices have lower levels of EHR adoption and that these providers were less likely to use these systems. Ensuring that unique barriers are addressed will be critical to the widespread meaningful use of EHR systems among small practices.     

Adoption of Order Entry with Decision Support for Chronic Care by Physician Organizations

Objective

This study sought to explore physician organizations’ adoption of chronic care guidelines in order entry systems and to investigate the organizational and market-related factors associated with this adoption.

Design

A quantitative nationwide survey of all primary care medical groups in the United States with 20 or more physicians; data were collected on 1,104 physician organizations, representing a 70% response rate.

Measurements

Measurements were the presence of an asthma, diabetes, or congestive heart failure guideline in a physician organization’s order entry system; size; age of the organization; number of clinic locations; type of ownership; health maintenance organization market penetration; urban/rural location; and presence of external incentives to improve quality of care.

Results

Only 27% of organizations reported access to order entry with decision support for chronic disease care. External incentives for quality is the only factor significantly associated with adoption of these tools. Organizations experiencing greater external incentives for quality are more likely to adopt order entry with decision support.

Conclusion

Because external incentives are strong drivers of adoption, policies requiring reporting of chronic care measurements and rewarding improvement as well as financial incentives for use of specific information technology tools are likely to accelerate adoption of order entry with decision support.     

Characteristics associated with Regional Health Information Organization viability

Objective

Regional Health Information Organizations (RHIOs) will likely play a key role in our nation''s effort to catalyze health information exchange. Yet we know little about why some efforts succeed while others fail. We sought to identify factors associated with RHIO viability.

Design

Using data from a national survey of RHIOs that we conducted in mid-2008, we examined factors associated with becoming operational and factors associated with financial viability. We used multivariate logistic regression models to identify unique predictors.

Measurements

We classified RHIOs actively facilitating data exchange as operational and measured financial viability as the percent of operating costs covered by revenue from participants in data exchange (0–24%, 25–74%, 75–100%). Predictors included breadth of participants, breadth of data exchanged, whether the RHIO focused on a specific population, whether RHIO participants had a history of collaborating, and sources of revenue during the planning phase.

Results

Exchanging a narrow set of data and involving a broad group of stakeholders were independently associated with a higher likelihood of being operational. Involving hospitals and ambulatory physicians, and securing early funding from participants were associated with a higher likelihood of financial viability, while early grant funding seemed to diminish the likelihood.

Conclusion

Finding ways to help RHIOs become operational and self-sustaining will bolster the current approach to nationwide health information exchange. Our work suggests that convening a broad coalition of stakeholders to focus on a narrow set of data is an important step in helping RHIOs become operational. Convincing stakeholders to financially commit early in the process may help RHIOs become self-sustaining.     

Making electronic prescribing alerts more effective: scenario-based experimental study in junior doctors

Objective

Expert authorities recommend clinical decision support systems to reduce prescribing error rates, yet large numbers of insignificant on-screen alerts presented in modal dialog boxes persistently interrupt clinicians, limiting the effectiveness of these systems. This study compared the impact of modal and non-modal electronic (e-) prescribing alerts on prescribing error rates, to help inform the design of clinical decision support systems.

Design

A randomized study of 24 junior doctors each performing 30 simulated prescribing tasks in random order with a prototype e-prescribing system. Using a within-participant design, doctors were randomized to be shown one of three types of e-prescribing alert (modal, non-modal, no alert) during each prescribing task.

Measurements

The main outcome measure was prescribing error rate. Structured interviews were performed to elicit participants'' preferences for the prescribing alerts and their views on clinical decision support systems.

Results

Participants exposed to modal alerts were 11.6 times less likely to make a prescribing error than those not shown an alert (OR 11.56, 95% CI 6.00 to 22.26). Those shown a non-modal alert were 3.2 times less likely to make a prescribing error (OR 3.18, 95% CI 1.91 to 5.30) than those not shown an alert. The error rate with non-modal alerts was 3.6 times higher than with modal alerts (95% CI 1.88 to 7.04).

Conclusions

Both kinds of e-prescribing alerts significantly reduced prescribing error rates, but modal alerts were over three times more effective than non-modal alerts. This study provides new evidence about the relative effects of modal and non-modal alerts on prescribing outcomes.     

Mass scale screening of common arboviral infections by an affordable,cost effective RT-PCR method

Objective

To develop a rapid, cost effective RT-PCR method for the mass scale diagnosis of such diseases at the viremia stage to find out the actual disease burden in that area.

Methods

For this purpose, cases with the history of only short febrile illness were considered. Thus 157 samples with the history of dengue/chikungunya like illness and only 58 samples with a history of acute encephalitis syndrome (AES) were selected.

Results

Out of 157 samples, 42 and 74 were detected as dengue and chikungunya, respectively and out of 58 AES cases only 23 could be detected as Japanese encephalitis by this RT-PCR method.

Conclusions

This cost effective RT-PCR method can detect the total positive cases that remain undetected by ELISA method. Moreover, this method is capable to detect the viral RNA from patients'' sera even after the appearance of IgM antibody at one fifth costs as compared with the other commercially available kits.     

Low copulatory activity in selectively bred Sardinian alcohol-nonpreferring (sNP) relative to alcohol-preferring (sP) rats

Background

There is a growing consensus that similar neural mechanisms are involved in the reinforcing properties of natural rewards, like food and sex, and drugs of abuse. Rat lines selectively bred for high and low oral alcohol intake and preference have been useful for understanding factors contributing to excessive alcohol intake and may constitute proper animal models for investigating the neurobiological basis of natural rewarding stimuli.

Methods

The present study evaluated copulatory behavior in alcohol and sexually naïve Sardinian alcohol-preferring (sP) and -nonpreferring (sNP) male rats in three consecutive copulatory behavior tests.

Results

The main finding was that, under the conditions used in this study, sNP rats were sexually inactive relative to sP rats. To gain more information about the sexual behavior in sP rats, Wistar rats were included as an external reference strain. Only minor differences between sP and Wistar rats were revealed.

Conclusions

The reason behind the low copulatory activity of sNP rats remains to be elucidated, but may in part be mediated by innate differences in brain transmitter systems. The comparison between sP and Wistar rats may also suggest that the inherent proclivity to excessive alcohol drinking in sP rats may mainly be dependent on its anxiolytic properties, as previously proposed, and not changes in the reward system.     

Presentation of child sexual abuse cases to Queen Elizabeth Central Hospital following the establishment of an HIV post-exposure prophylaxis programme

Aims

To review child sexual abuse cases and their management presenting to Queen Elizabeth Central Hospital (QECH), Blantyre, since the introduction of an HIV post-exposure prophylaxis (PEP) programme.

Methods

Demographic and medical data was collected from all children presenting to Queen Elizabeth Central Hospital, Blantyre, Malawi between January 2005 and February 2007 with alleged child sexual abuse (CSA).

Results

Between January 2005 and February 2007, 217 children presented with alleged CSA. This is an average of 3 more per month since the previous year. The results of the physical examination in 60% (130/217) of the cases showed signs of trauma. 63% (137/217) of the cases presented within 72 hours of defilement. Overall in 42% (92/217) of children a one month course of HIV PEP was indicated and given. In 58% (125/217) HIV PEP was not indicated in view of normal examination, presentation too late (>72 hrs after abuse), multiple abuse episodes in the last 6 months, HIV test positive or HIV test refused. In 66% (144/217) of assessed children antibiotic treatment was given for the prevention and/ or treatment of sexually transmitted infections (STIs).

Conclusions

The introduction of an HIV PEP programme for victims of CSA has lead to increased numbers presenting and being treated. In conclusion it is likely that a significant number of children have been prevented from acquiring HIV and other STIs following CSA. The key area where our service needs to be improved is in establishing documented follow up of all cases to monitor medication compliance, side effects and rates of HIV seroconversion following CSA.