Suchergebnisse

OBJECTIVES: To examine patients' accounts of their use of the internet before seeing a general practitioner (GP) using thematic analysis of semistructured interviews. DESIGN: Qualitative semistructured interview study with transcripts analysed thematically. SETTING: Primary care patients consulting with 10 GPs working at 7 GP practices of varying sizes and at a range of locations around London and the Southeast of England. PARTICIPANTS: 28 adult patients: 16 women and 12 men ranging in age from 18 to 75 from a range of self-defined ethnic backgrounds. Participants were selected based on instances when the patients reported having used the internet before the consultation, when patients referred to the internet in the consultation or when the physician used the internet or made reference to it during the consultation. RESULTS: Patients report that they can find health information online that they believe is reliable and helpful for both themselves and their GP. However, they report uncertainty about how to share internet-based findings and reluctance to disclose their efforts at researching health issues online for fear of appearing disrespectful or interfering with the flow of the consultation. CONCLUSIONS: Despite the democratisation of access to information about health due via the internet, patients continue to experience their use of the internet for health information as a sensitive and potentially problematic topic. The onus may well be on GPs to raise the likelihood (without judgement) that patients will have looked things up before consulting and invite them to talk about what they found.

Objectives: to examine patients' accounts of their use of the internet before seeing a general practitioner (GP) using thematic analysis of semistructured interviews. Design: qualitative semistructured interview study with transcripts analysed thematically. Setting: primary care patients consulting with 10 GPs working at 7 GP practices of varying sizes and at a range of locations around London and the Southeast of England. Participants: 28 adult patients: 16 women and 12 men ranging in age from 18 to 75 from a range of self-defined ethnic backgrounds. Participants were selected based on instances when the patients reported having used the internet before the consultation, when patients referred to the internet in the consultation or when the physician used the internet or made reference to it during the consultation. Results: patients report that they can find health information online that they believe is reliable and helpful for both themselves and their GP. However, they report uncertainty about how to share internet-based findings and reluctance to disclose their efforts at researching health issues online for fear of appearing disrespectful or interfering with the flow of the consultation. Conclusions: despite the democratisation of access to information about health due via the internet, patients continue to experience their use of the internet for health information as a sensitive and potentially problematic topic. The onus may well be on GPs to raise the likelihood (without judgement) that patients will have looked things up before consulting and invite them to talk about what they found.

Background: The use of mobile phone technologies for health promotion and disease prevention has advanced rapidly in recent years. Text4baby is a theory-based mobile health (mHealth) program in which text messages are delivered to pregnant women and new mothers to improve their health care beliefs and behaviors and improve health status and clinical outcomes. Recent evaluations of Text4baby have found that it improves targeted health attitudes and beliefs, but effects on behavior have not yet been determined. Objective: In this study, investigators aimed to evaluate Text4baby in the military women's population. Methods: Investigators conducted a randomized controlled trial at Madigan Army Medical Center in Tacoma, Washington, from December 2011 through September 2013. All participants were pregnant women first presenting for care at Madigan. Investigators conducted a baseline assessment using a 24-item, self-administered online survey of attitudes and behaviors related to Text4baby message content. Participants were randomized to Text4baby plus usual care (intervention) or usual care alone (control). Investigators analyzed treatment effects of Text4baby on short-term targeted outcomes 4 weeks post enrollment. Results: For this study, 943 patients were randomized and completed a baseline assessment. The average patient age was 28 years and nearly 70% self-identified as Caucasian. 48.7% of enrollees (459/943) completed the first follow-up assessment. Higher rates of single and working/in-school patients dropped out of the intervention arm of the study, and we adjusted for this finding in subsequent models. However, while investigators were unable to re-survey these participants, only 1.9% of Text4baby enrollees (18/943) dropped the service during the study period. Adjusted and unadjusted logistic generalized estimating equation models were developed to assess intervention effects on measured outcomes. In the model adjusting for age, marital status, having had a previous baby, and race/ethnicity, there was a ...

AbstractWould-be adopters of ecosystem service analysis frameworks might ask, 'Do such frameworks improve ecosystem service provision or social benefits sufficiently to compensate for any extra effort?' Here we explore that question by retrospectively applying an ecosystem goods and services (EGS) analysis framework to a large river restoration case study conducted by the US Army Corps of Engineers (USACE) and comparing potential time costs and outcomes of traditional versus EGS-informed planning. USACE analytic methods can have a large influence on which river and wetland restoration projects are implemented in the United States because they affect which projects or project elements are eligible for federal cost-share funding. A new framework is designed for the USACE and is primarily distinguished from current procedures by adding explicit steps to document and compare tradeoffs and complementarity among all affected EGS, rather than the subset that falls within project purposes. Further, it applies economic concepts to transform ecological performance indicators into social benefit indicators, even if changes cannot be valued. We conclude that, for large multi-partner restoration projects like our case study, using the framework provides novel information on social outcomes that could be used to enhance project design, without substantially increasing scoping costs. The primary benefits of using the framework in the case study appeared to stem from early comprehensive identification of stakeholder interests that might have prevented project delays late in the process, and improving the communication of social benefits and how tradeoffs among EGS benefits were weighed during planning.

BACKGROUND: Mobile health (mHealth) is growing rapidly, but more studies are needed on how to optimize programs, including optimal timing of messaging, dose of exposure, and value of interactive features. This study evaluates final outcomes of text4baby (a text message service for pregnant and postpartum women) from a randomized trial performed in a population of pregnant female soldiers and family members. OBJECTIVE: The study aims were to evaluate (1) treatment effects and (2) dose-response effects of text4baby on behavioral outcomes compared to control (no text4baby) condition. METHODS: The study was a randomized trial of text4baby at Madigan Army Medical Center. Female military health beneficiaries who met inclusion criteria were eligible for the study. Participants provided consent, completed a baseline questionnaire, and then were randomized to enroll in text4baby or not. They were followed up at 3 time points thereafter through delivery of their baby. Generalized estimating equation models were used to evaluate outcomes. We examined treatment effects and the effects of higher doses of text4baby messages on outcomes. RESULTS: We report descriptive statistics including dosage of text messages delivered. The main finding was a significant effect of high exposure to text4baby on self-reported alcohol consumption postpartum (OR 0.212, 95% CI 0.046-0.973, P=.046), as measured by the question "Since you found out about your pregnancy, have you consumed alcoholic beverages?" The text4baby participants also reported lower quantities of alcohol consumed postpartum. CONCLUSIONS: Studies of text4baby have helped to build the mHealth evidence base. The effects of text4baby offer lessons for future scalable mHealth programs and suggest the need to study dose-response effects of these interventions.

"Over the past two decades, Africa has seen dozens of conflicts over a variety of issues. Responding to these conflicts requires concerted action to manage the crises--the violence, the political discord, and the humanitarian consequences of prolonged fighting. But it is also necessary to rebuild communities, societies and states torn apart by the conflict, addressing the long-term social and economic impact of the conflict. To do so, it is necessary to look at institutions and groups rarely considered in formal official conflict management activities of African and partner governments--schools, universities, religious institutions, media, commercial enterprises, legal institutions, civil society groups, youth, women and migrants. These entities can potentially play an important role in building a sense of identity, fairness, shared norms, and a cohesion between state and society--all critical components of the fabric of peace and security in Africa. This book brings together leading experts from Africa, Europe and North America to examine these critical social institutions and groups and identify how they can either build or impede peaceful resolution of conflicts and commitment to common purpose. This book will open new doors of understanding for students, scholars and practitioners focused on bringing strengthening peace in Africa."--