The Comal County Needs Assessment Youth Survey

A crucial link in preserving and protecting the future of our communities resides in maintaining the health and well being of our youth. While every member of the community owns an opinion regarding where to best utilize monies for prevention and intervention, the data to support such opinion is often scarce. In an effort to generate data-driven indices for community planning and action, the United Way of Comal County, Texas partnered with the University Of Texas - Houston Health Science Center, School Of Public Health to accomplish a county-specific needs assessment. A community-based participatory research emphasis utilizing the Mobilization for Action through Planning and Partnership (MAPP) format developed by the National Association of City and County Health Officials (NACCHO) was implemented to engage community members in identifying and addressing community priorities. The single greatest area of consensus and concern identified by community members was the health and well being of the youth population. Thus, a youth survey, targeting these specific areas of community concern, was designed, coordinated and administered to all 9-11th grade students in the county. 20% of the 3,698 completed surveys (72% response rate) were randomly selected for analysis. These 740 surveys were coded and scanned into an electronic survey database. Statistical analysis provided youth-reported data on the status of the multiple issues affecting the health and well being of the community's youth. These data will be reported back to the community stakeholders, as part of the larger Comal County Needs Assessment, for the purposes of community planning and action. Survey data will provide community planners with an awareness of the high risk behaviors and habit patterns amongst their youth. This knowledge will permit more effective targeting of the means for encouraging healthy behaviors and preventing the spread of disease. Further, the community-oriented, population-based nature of this effort will provide answers to questions raised by the community and will provide an effective launching pad for the development and implementation of targeted, preventive health strategies. ^

Physician knowledge and beliefs toward hospice and the effect on hospice referral in El Paso, Texas

Hospice care has existed in the United States for over 20 years yet referral rates to hospice services are still well under the 180 days allowed by the Medicare Hospice Benefit. The average length of stay in El Paso is 56.8. ^ The aim of this study was to ascertain physician’s knowledge and attitudes towards hospice referral in the El Paso County. Particular issues to be addressed were: Physician’s knowledge of patient’s eligibility criteria and perception of the type of services provided by hospice. Other issues included, physician’s comfort level and willingness to determine terminal diagnosis and to discuss hospice services. Furthermore, physician’s perceptions of barriers to hospice referrals and how those perceptions differ between physicians who refer as compared to those who do not refer. ^ There were seven hypothesis tested to determine physicians knowledge and perceptions of hospice services. Using a mail-survey developed by Ogle, Mavis and Wang, this study surveyed 165 cardiologists, pediatric cardiologists, gastroenterologists, pulmonologists, neurologists, nephrologists, family practice, internists, oncologists, and pediatric oncologists. A t-test was used to test a comparison of means of categorical associations for all hypotheses. The data in the current study however, did not support the hypotheses tested. ^ Results indicated that physicians (52%) are knowledgeable with the eligibility criteria for hospice and that 95% are knowledgeable of the services hospice offers. Research findings appear to indicate physicians are not the hindering factor when making referrals to hospice. Physicians (46%) felt that one of the strongest barriers to hospice referrals is the patient/family unwillingness to accept hospice services. This offers an opportunity for future research in patients/families behavioral attitudes and beliefs toward death and dying issues and their perception of hospice services. ^

US medical students' knowledge of obstetric fistula in developing countries

Obstetric fistula is a devastating child birth injury affecting millions of women worldwide. This paper explores the knowledge and understanding of medical students at the University of Texas Health Science Center at San Antonio regarding this global public health issue. Obstetric fistula has been eradicated in most industrialized nations, and has therefore faded from view of many modern medical organizations. The United Nations Population Fund has launched a “Campaign to End Fistula” in an attempt to bring global awareness to this preventable and treatable condition. Based on a survey administered to medical students at UTHSCSA, a baseline understanding of this disorder based on current curriculum is reviewed, with the objective of improving future physicians’ awareness of obstetric fistula. Despite a low survey response rate, there was a significant association between greater knowledge about causes, treatment, and complications of obstetric fistula and advanced years in medical school. However, the fourth year medical students averaged only a 70.5 percent of correct responses on the survey, indicating room for improvement in addressing this topic during medical school. ^

Knowledge and Attitudes of Young People in Nigeria about HIV/AIDS---A systematic review

Background: HIV/AIDS has remained one of Nigeria's biggest health and social issues for decades. People aged between 10 and 24 are the most affected. Research into why this population subset is affected is very pertinent. We therefore conducted a systematic review of the Knowledge and Attitudes of young people in Nigeria about HIV/AIDS to understand where the gaps between knowledge and attitudes can be bridged. ^ Methods: We conducted searches in Medline, PubMed, African Index Medicus, Cumulative Index of Nursing and Allied Health. WHO and UNAIDS documents were also searched. Other journals were hand searched. Searches were for studies between 1986 (when HIV/AIDS was first reported in Nigeria) till date. In addition, data abstraction and quality assessment were done. ^ Results: 279 titles and abstracts were found and 33 articles in full text were appraised critically and 17 articles were selected based on our criteria. This revealed a dearth of well conducted studies in the literature despite the enormity of the HIV/AIDS epidemic. Constructs for Knowledge and attitudes were itemized on two tables for each article based on the Health Belief Model. Even though many of the studies showed high level of knowledge about HIV/AIDS, it did not impact attitudes about the disease. Also fear and anxiety prevented participants from acquiring knowledge. These recurring themes arguably were not limited to any region or area, background or group. ^ Conclusion: There is a need for future research to be culturally sensitive with a focus on attitudes and correction of misconceptions about HIV/AIDS among our youth.^

Formalizing a Conceptual Framework of Work Domain Knowledge

Background: The failure rate of health information systems is high, partially due to fragmented, incomplete, or incorrect identification and description of specific and critical domain requirements. In order to systematically transform the requirements of work into real information system, an explicit conceptual framework is essential to summarize the work requirements and guide system design. Recently, Butler, Zhang, and colleagues proposed a conceptual framework called Work Domain Ontology (WDO) to formally represent users’ work. This WDO approach has been successfully demonstrated in a real world design project on aircraft scheduling. However, as a top level conceptual framework, this WDO has not defined an explicit and well specified schema (WDOS) , and it does not have a generalizable and operationalized procedure that can be easily applied to develop WDO. Moreover, WDO has not been developed for any concrete healthcare domain. These limitations hinder the utility of WDO in real world information system in general and in health information system in particular. Objective: The objective of this research is to formalize the WDOS, operationalize a procedure to develop WDO, and evaluate WDO approach using Self-Nutrition Management (SNM) work domain. Method: Concept analysis was implemented to formalize WDOS. Focus group interview was conducted to capture concepts in SNM work domain. Ontology engineering methods were adopted to model SNM WDO. Part of the concepts under the primary goal “staying healthy” for SNM were selected and transformed into a semi-structured survey to evaluate the acceptance, explicitness, completeness, consistency, experience dependency of SNM WDO. Result: Four concepts, “goal, operation, object and constraint”, were identified and formally modeled in WDOS with definitions and attributes. 72 SNM WDO concepts under primary goal were selected and transformed into semi-structured survey questions. The evaluation indicated that the major concepts of SNM WDO were accepted by 41 overweight subjects. SNM WDO is generally independent of user domain experience but partially dependent on SNM application experience. 23 of 41 paired concepts had significant correlations. Two concepts were identified as ambiguous concepts. 8 extra concepts were recommended towards the completeness of SNM WDO. Conclusion: The preliminary WDOS is ready with an operationalized procedure. SNM WDO has been developed to guide future SNM application design. This research is an essential step towards Work-Centered Design (WCD).