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  • ISSN: 2379-0547
    Volume 1, Issue 2
    Research Article
    Rohan D Jeremiah*
    Abstract: The purpose of this study was to explore the socio-cultural factors that influence vulnerabilities associated to HIV infection for men who have sex with men (MSM) in the small Caribbean nation, Grenada. Forty-seven Grenadian MSM ages 16 to 42 provided data regarding homophobia, stigma and discrimination, sexual behaviors, HIV/AIDS, and Sexually Transmitted Infections (STIs). Results indicated that MSM who participated in a formal educational program were significantly more likely than non-participants to get tested for HIV every 10 – 12 months. Since stigma and discrimination were found to affect both groups, successful HIV interventions within communitiesthat seek to engage MSM need to focus on ensuring confidentiality, creating safe spaces, and enhancing cultural competence.
    Kamilah B Thomas-Purcell1*, Will L Tarver2, Martha Coulter3, Julie Baldwin3 and Clement K Gwede4
    Abstract: The incidence and mortality rates of Colorectal Cancer (CRC) are highest among African American men and women in the United States. For those with an increased risk of the disease, compliance with screening recommendations requires one to know if a First- Degree Relative (FDR) has been diagnosed with CRC. When patients do not share information about their CRC diagnosis with FDRs who are potentially at risk, those relatives are denied the opportunity to take appropriate preventive measures. The purpose of this manuscript was to explore the decision to disclose a CRC diagnosis to family members among a sample of African American CRC patients, using Petronio's Communication Privacy Management Theory as a guide. A cross sectional sample of patients completed in-depth interviews related to the disclosure of a CRC diagnosis to FDRs. Using a grounded theory approach, emergent themes included: 1) the diagnosis experience, 2) barriers to disclosure, 3) style of disclosure, 4) enabling factors and 5) benefits of disclosure. Results revealed that patients were willing to disclose their diagnosis, however they experienced distress when contemplating disclosure to family and were unable to explain the meaning of their diagnosis. Patients emphasized spirituality, social support and a close relationship with family as important factors related to disclosure. Data from this research may facilitate the design of interventions that assist patients in the diagnosis disclosure process.
    Lila C McCormick and Paula C Barata*
    Abstract: Research has shown that most people are inaccurate in estimating their susceptibility to many health concerns, including Human Papillomavirus (HPV); this is problematic because perceived susceptibility has an influence on preventative health behaviours such as obtaining HPV vaccines. Thus, the goal of the current study was to enhance the accuracy of young women's perceived susceptibility to HPV through the provision of tailored prevalence information. The young women who participated in this study were provided with general HPV prevalence information (i.e., rate for all women), tailored HPV prevalence information based on age and number of sexual partners (e.g., rate for women ages 18-24 who have had three or more sexual partners), or no prevalence information. Accuracy of perceived susceptibility to HPV was then measured, as was fear and perceived stigma regarding HPV. The results revealed that participants who were provided with tailored information provided more accurate assessments of cancer-causing HPV susceptibility than those provided with general prevalence information. Furthermore, type of prevalence information did not affect participants' fear or perceived stigma regarding HPV. Thus, the current study suggests that the provision of tailored prevalence information can be beneficial in increasing awareness and acceptance of one's susceptibility to HPV, enabling individuals to make informed decisions regarding HPV and related risk-reduction behaviours.
    Kennedy KM1*, Jennings P1, O'Brien N2 and Glynn LG2
    Abstract:
    Background: The 80-20 rule states that for many events 80% of the effects result from 20% of the causes.
    Aims: We present a novel application of the 80-20 rule to Irish healthcare utilisation across primary and secondary care in patients aged 50 years and over.
    Methods: All patients in three General Practices, who were aged 50 years and over, were included in the study. Utilisation was measured in terms of primary care consultations, hospital out-patient visits and hospital admissions.
    Results: Each study participant (average age 65.3 years) had an average of 9.9 health service contacts per year. Application of the 80-20 rule revealed that 80% of all primary care consultations, hospital out-patient visits and hospital admissions were accounted for by 49%, 39% and 12% of patients respectively.
    Conclusion: Whilst healthcare use if more evenly distributed amongst the population at primary care level, it is suggested that a relatively small number of patients are responsible for the majority of admissions to hospital. Targeted interventions, focused at carefully identified population subgroups, could reduce healthcare utilisation.
    Abhi Sanka1, R. Ryanne Wu2,3,4*, Chris Beadles2,3,4, Tiffany Himmel2, Adam H Buchanan5, Karen P Powell6, Elizabeth R Hauser7,8, Geoffrey S Ginsburg3 and Lori A Orlando2,3
    Abstract:
    Introduction: There are several barriers to the appropriate use of Family Health History (FHH) for risk management within primary care. Among these is a lack of physician confidence in their ability to identify high risk individuals and determine guideline concordant care. In this study, we compared Primary Care Providers' (PCP) clinical assessment of appropriate risk-management for patients to guideline based recommendations generated by an IT platform, MeTree. In addition, we compared MeTree with clinical assessments of Genetic Counselors (GC).
    Methods: Pedigrees from 100 consecutive patients who entered their FHH into MeTree were evaluated by a PCP and a GC. Recommendations from MeTree were compared to those selected by the PCP and GC.
    Results: PCPs and GCs were discordant with MeTree 13.7% (N=49/356) and 13.5% (N=48/356) of the time respectively. In instances of discordance, PCPs were more likely to underestimate risk (77.5%, N=38/49) while GCs underestimated (45.8%, N=22/48) and overestimated (54.2%, N=26/48) risk almost equally in instances of discordance. PCPs most commonly underestimated risk regarding need for genetic counseling and early colonoscopy. PCPs overestimated the need for breast MRI, chemoprophylaxis, and ovarian cancer screening.
    Conclusion: In this study we have demonstrated that provider knowledge of risk stratification and identification of appropriate risk-management strategies is in fact a significant barrier to guideline concordant care for patients. Our findings support the need to embed a clinical tool such as MeTree, into primary care to act as an intermediary between the PCP and GC.
    Sheila Gopal-Krishnan1*, Sondi Sararaks2, Amar-Singh HSS3, Lidwina Edwin Amir4, Mohd Yusof Ibrahim5, Ranjit Kaur Praim Singh6, Maimunah A Hamid7, Faridah Abu Bakar8, Kok Juan Loong9, Noorizah Mokhtar10 and Wong Swee Lan11
    Abstract:
    Aim: Vaccine storage practice in private practitioner clinics is poor, and concerted effort to improve practice at national level is lacking. This study sought to identify practices in private practitioner clinics and assess the effectiveness of an intervention.
    Methods: A non-controlled community trial was conducted in four administrative regions. The intervention was implemented concurrent with the first baseline audit and reinforced in the subsequent 3 audits. We designed a comprehensive, multipronged intervention package to effect behavioral change. It consisted of training, enabling resources, educational materials and non-monetary incentives. Outcomes were assessed based on six essential criteria: temperature between 2-8°C, refrigerator type and placement, dedicated vaccine refrigerator, vaccine placement and temperature monitoring. Analysis was done at private practitioner clinics level and estimates pooled by meta-analysis.
    Results: Of 467 clinics invited, 442 participated. One year later, 430 remained. At baseline, no clinic complied with the combined six criteria. Significant improvement was seen for the combined four criteria with drugs, 1.2% (0.0-2.3%) at baseline to 50.9% (37-64.7%) at 1 year. Improvement in five criteria were all statistically significant, most notably in the correct placement of vaccine [31.7% (27.3-36.0%) to 75.0% (62.9-87.0%)], maintenance of temperature between 2-8°C [56.9% (45.2-68.7%) to 88.2% (84.1-92.4%)] and daily monitoring of temperature [2.3% (0.9-3.7%) to 84.1% (74.1-94.2%)].
    Conclusions: The intervention was able to improve practice, and this change was sustained at one year. This intervention package had been adopted for all private practitioner clinics in Malaysia, and could be implemented in other countries to improve practice.
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