Sarah Miner

Mano a Mano-Mujer: An Effective HIV Prevention Intervention for Chilean Women

The impact of a professionally facilitated peer group intervention for HIV prevention among 400 low-income Chilean women was examined using a quasiexperimental design. At 3 months postintervention, the intervention group had higher HIV-related knowledge, more positive attitudes toward people living with HIV, fewer perceived condom use barriers, greater self- efficacy, higher HIV reduction behavioral intentions, more communication with partners about safer sex, and decreased depression symptoms. They did not, however, have increased condom use or self-esteem. More attention to gender barriers is needed. This intervention offers a model for reducing HIV for women in Chile and other Latin American countries.

The Development of an Automated Device for Asthma Monitoring for Adolescents: Methodologic Approach and User Acceptability

Background Many adolescents suffer serious asthma related morbidity that can be prevented by adequate self-management of the disease. The accurate symptom monitoring by patients is the most fundamental antecedent to effective asthma management. Nonetheless, the adequacy and effectiveness of current methods of symptom self-monitoring have been challenged due to the individuals’ fallible symptom perception, poor adherence, and inadequate technique. Recognition of these limitations led to the development of an innovative device that can facilitate continuous and accurate monitoring of asthma symptoms with minimal disruption of daily routines, thus increasing acceptability to adolescents. Objective The objectives of this study were to: (1) describe the development of a novel symptom monitoring device for teenagers (teens), and (2) assess their perspectives on the usability and acceptability of the device. Methods Adolescents (13-17 years old) with and without asthma participated in the evolution of an automated device for asthma monitoring (ADAM), which comprised three phases, including development (Phase 1, n=37), validation/user acceptability (Phase 2, n=84), and post hoc validation (Phase 3, n=10). In Phase 1, symptom algorithms were identified based on the acoustic analysis of raw symptom sounds and programmed into a popular mobile system, the iPod. Phase 2 involved a 7 day trial of ADAM in vivo, and the evaluation of user acceptance using an acceptance survey and individual interviews. ADAM was further modified and enhanced in Phase 3. Results Through ADAM, incoming audio data were digitized and processed in two steps involving the extraction of a sequence of descriptive feature vectors, and the processing of these sequences by a hidden Markov model-based Viterbi decoder to differentiate symptom sounds from background noise. The number and times of detected symptoms were stored and displayed in the device. The sensitivity (true positive) of the updated cough algorithm was 70% (21/30), and, on average, 2 coughs per hour were identified as false positive. ADAM also kept track of the their activity level throughout the day using the mobile system’s built in accelerometer function. Overall, the device was well received by participants who perceived it as attractive, convenient, and helpful. The participants recognized the potential benefits of the device in asthma care, and were eager to use it for their asthma management. Conclusions ADAM can potentially automate daily symptom monitoring with minimal intrusiveness and maximal objectivity. The users’ acceptance of the device based on its recognized convenience, user-friendliness, and usefulness in increasing symptom awareness underscores ADAM’s potential to overcome the issues of symptom monitoring including poor adherence, inadequate technique, and poor symptom perception in adolescents. Further refinement of the algorithm is warranted to improve the accuracy of the device. Future study is also needed to assess the efficacy of the device in promoting self-management and asthma outcomes.

Intimate Partner Violence and HIV Risk Behaviors Among Socially Disadvantaged Chilean Women

The objective of this study was to determine if a relationship exists between intimate partner v iolence (IPV) and HIV risk among socioeconomically disadvantaged Chilean women. A correlational analysis with data from the NIH-funded project, “Testing an HIV/AIDS Prevention Intervention for Chilean Women,” was conducted. Two hundred and sixty-one women were included in this analysis (n = 261). Those women who had experienced any type of IPV in the past 3 months had significantly higher risk for HIV than those who had not (t = -2.016, p < .05). Also a linear trend was found among those women who had experienced more than one type of IPV in the past 3 months and HIV risk.

HIV Issues and Mapuches in Chile

Chile is a country with an incipient HIV epidemic. Just as in other countries, disadvantaged groups in Chile are contributing to the increased incidence of the disease. The Mapuche indigenous population is one such group that has been affected by the spread of HIV. However, no prevention programs are tailored to the culturally specific needs of this community. In recognition of this discrepancy, an academic‐community partnership was formed to develop an HIV educational module for a Mapuche community. The module was developed for use as part of an already established health‐related program. The aims of the module were to identify perceptions about HIV among Mapuches and present information specific to HIV and its prevention. Focus was placed on cultural sensitivity. A total of 16 Mapuches participated voluntarily and showed some knowledge regarding HIV, but they lacked an overall understanding as to how it is transmitted and why prevention strategies are effective. Continued collaboration between academia and affected communities as well as incorporating HIV information into established programs are effective strategies for delivering prevention information to disadvantaged populations and for further understanding their perceptions and health care needs.

Meeting the Needs of Older Adult Refugee Populations With Home Health Services

The United States resettles close to 70,000 refugees each year more than any other country in the world. Adult refugees are at risk for negative health outcomes and inefficient health resource use, and meeting the multiple health needs of this vulnerable population is a challenge. The purpose of this study was to assess the impact of a home health care (HHC) pilot project on meeting the needs of older adult refugee patients. A retrospective chart review of 40 refugee adult patients who participated in an HHC pilot was done to analyze their health outcomes using OASIS-C data. Participants’ pain level, anxiety level, medication management, and activities of daily living management all significantly improved over the course of their HHC episode. Results of this study indicate that HHC has great potential to improve the health of vulnerable refugee populations and assist the families involved in their care.

Análisis reflexivo del cuidado en reflexología y masoterapia centrado en la persona, por parte del profesional de enfermería

Las terapias alternativas y complementarias (TAC) constituyen parte importante de las intervenciones desarrolladas en salud y solicitadas por quienes buscan resolver algun problema, mantener o mejorar su situacion de salud y bienestar. El presente estado del arte tiene como proposito dar a conocer el analisis reflexivo del cuidado centrado en la persona e integral que surge de la realizacion de reflexologia y masoterapia por parte del profesional de Enfermeria. Primero, se desarrolla una descripcion de diversas definiciones existentes en torno a TAC, luego se describe la conexion existente entre el cuidado alternativo y complementario y la ciencia de Enfermeria, a continuacion se desarrolla el proceso de cuidado en masoterapia y reflexologia, posteriormente se exponen a traves de una discusion los elementos centrales del cuidado centrado en la persona, pilar esencial de las TAC, y finalmente se establecen las conclusiones e implicancias para la practica de Enfermeria de estas terapias.

Using a Clinical Outreach Project to Foster a Community-Engaged Research Partnership With Somali Families

Background: Community-engaged research partnerships build the capacity of community and educational organizations to work together toward addressing important health issues and disparities for vulnerable populations, such as refugees or immigrants. A critical step for building a community-engaged research partnership is the Thrst contact or entrée into the community.Purpose: The purpose of this paper is to describe how a successful home health community-engaged partnership became the entrée and foundation for a community-engaged research partnership to explore the home health needs of Somali older adults and their families.Methods: A number of strategies were used to engage the Somali community, initially in a clinical home health project and subsequently in an academic research study.Lessons Learned: Valuable lessons were learned on delivering home health care (HHC) services to Somali older adults and their families as well as conducting research with this population. The most important lesson was that none of the work could be done without the involvement of the Somali community. The partnership described is one of the Thrst to address the home health needs and experiences of Somali older adults and their families. The project illustrates a mutually beneThcial relationship that can occur when a community-engaged clinical project expanded to address an issue of importance to the community through research.Conclusions: This foundation served to create an opportunity for more comprehensive community–academic partnerships with the potential to improve the delivery of HHC to Somali older adults, as well as open avenues for research in other areas that are relevant to the Somali, medical, and academic communities.

Development of a Web-Based Self-management Intervention for Intermittent Urinary Catheter Users With Spinal Cord Injury.

While Web-based interventions have proliferated recently, information in the literature is often lacking about how the intervention was developed. In response to that gap, this is a report of the development of a Web-based self-management intervention for intermittent urinary catheter users and pretesting with four adults with spinal cord injury living in the community. Two Web sites were created, one for recruitment and the other for the intervention itself. The intervention involved developing new Web-based technology, including an interactive urinary diary (with fluid intake/urine output and a journal), extensive catheter products information, three intervention nurse phone call consultations, and user-community discussion forums. Study participants completed an online survey and were interviewed twice about the enrollment process and their perceptions of their involvement in the intervention. Suggestions from the pretesting participants were used to revise the Web site applications prior to the next stage of research (a feasibility study). Numerous recommendations and comments were received related to content, interactivity of components, and usability. This article provides a description of how the Web sites were developed (including the technologyand software programs used), issues encountered and what was done to address them, and how the Web-based intervention was modified for improvements.

Effectiveness of an educational program about the Chilean AIDS law in primary care health workers

BACKGROUND In Chile, members of the civil society and government achieved the passing of the HIV/AIDS Law (19.779). The level of knowledge of the law held by healthcare workers in Chile is not well known. AIM To analyze the effect of an intervention on knowledge of the existence of the law and its application in clinical practice among primary healthcare workers in southeastern Santiago. MATERIAL AND METHODS Healthcare workers of primary care centers were invited to participate in the study. One group received an educational intervention lasting a total of 16 hours, about AIDS physiopathology, sexually transmitted diseases, communication with patients and current legislation. A control group did not receive the educational intervention. Both groups answered a self-administered questionnaire about the HIV/AIDS law at baseline and three months after the intervention. RESULTS The intervention was carried out in 262 workers and 293 participated as controls. The initial evaluation revealed that only 16.3% (n = 89) had heard of the law, without any significant difference between intervention and control groups. The knowledge about the law improved by 65% in the intervention group and did not change in controls. At the end of the education period, the intervention and control groups improved their global knowledge by 29 and 3%, respectively (p < 0.05). CONCLUSIONS The educational intervention was effective in improving knowledge of the HIV/AIDS Law among Chilean healthcare workers.

The Prevalence, Reasons, and Risk Factors for Hospital Readmissions Among Home Health Care Patients: A Systematic Review

Preventing hospital readmissions is one of the top priorities of the U.S. health care system. This systematic review examined the current evidence about hospital readmissions from home health care (HHC). Literature was searched in PubMed, CINAHL, PsycINFO, Scopus, and Web of Science. Eligible studies were reviewed and evaluated using a validated tool. Eighteen articles were reviewed. Reported readmission rates and risk factors varied dramatically between studies. Reasons for readmissions were understudied. Findings of reviewed studies were limited by small sample sizes, single data source, and methodological flaws. Future studies should use multiple national data sources across patients’ care spectrum and advanced statistical models to identify who among HHC patients are most likely to be readmitted to hospital and for what reason.