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Aims: This study sought to assess factors associated with the justification of Intimate Partner Violence (IPV) among men in sub-Saharan Africa using data from 27 countries. Methods: The study used data from the male file of the most current Demographic and Health Surveys (DHSs) conducted in 27 countries in sub-Saharan Africa. Men aged 15–64 years were included (N = 170,361). Binary logistic regression models were used to examine the relationship between the independent variables and justifying at least one form of physical IPV. Results: Overall, 33% of men in this sample reported that at least one form of physical IPV was justified, ranging from a high of 67% in Guinea to a low of 12% in Malawi. Results showed that justification of physical violence varied by country. The odds of justifying IPV for at least one of the five situations ranged from 0.42 (OR = 0.42, CI = 0.36–0.51) in Malawi to 4.86 (OR = 4.86, CI = 4.45–5.32) in Guinea compared with men in Burkina Faso. Education (no education [OR = 2.80, CI = 2.53–3.10]), wealth status (poorest [OR = 1.58, CI = 1.46–1.72]), place of residence (rural residence [OR = 1.13, CI = 1.06–1.21]), marital status (married men [OR = 0.88, CI = 0.83–0.92], separated men [(OR = 1.16, CI = 1.04–1.30]), occupation (employed men [OR = 1.23, (CI = 1.17–1.30]) and age (men aged 55–64 [OR = 0.78, CI = 0.74–0.82]) predicted justification of physical IPV among men in sub-Saharan Africa. Conclusion: This study finds that men's justification of IPV against women in sub-Saharan Africa is substantial, although not universal across countries in the sub-region. Policies and interventions should be geared toward breaking the societal norms that affirm women's vulnerability in the society. Advocacy to stop physical intimate violence against women should be strengthened by NGOs, civil groups and government agencies. [ABSTRACT FROM AUTHOR]

Objectives: Low birthweight (LBW) is a significant public health problem in sub-Saharan Africa and LBW in rural Zambia is high. Our study explored the prevalence of LBW for newborns whose mothers were referred from a rural health center to a district referral hospital in Lundazi, Zambia. Methods: A five-month retrospective record review of Ministry of Health data was performed to examine birthweight characteristics of a convenience sample of newborns from ten facilities referring to one district hospital (n = 234). Results: Among all cases, 21% (n = 49) of newborns were LBW. For LBW newborns, 73% (n = 36) were preterm with mothers having a pregnancy duration of less than 37 weeks. Newborns whose mothers experienced twin pregnancies (p =.021) and prolonged labor (p =.033) were more often LBW. However, regression models demonstrated no difference among newborns with and without LBW for prolonged labor (p =.344) and twin pregnancies (p =.324) when controlling for variables that could interact with the maternal-newborn delivery outcomes. Conclusions: for Practice Healthcare providers and policy makers need to address the short and long-term effects of LBW throughout the lifecycle in rural Zambia. More maternal-newborn health research is needed to understand the underlying socioeconomic, social, and cultural determinants influencing LBW in rural Zambia. [ABSTRACT FROM AUTHOR]

Globally, sickle cell disease (SCD) is a common, yet often neglected, non-communicable disease. Community health worker (CHW) interventions have been shown to improve outcomes for chronic diseases but have not been evaluated with SCD. This study assessed the interest in and feasibility of establishing a network of CHWs to support care of people with SCD in Kumasi, Ghana. Using in-depth interviews with key stakeholders (N = 15) identified through purposive and snowball sampling from January to March 2020, we gathered focused information about interest in and feasibility of establishing a network of CHWs. Respondents were chosen for their knowledge and oversight of health services for people with SCD. Latent content analysis was used to examine the data. Participants expressed interest in establishing a network of CHWs to better support care for people with SCD. Three primary themes emerged from the data: (1) support by CHWs could be beneficial for people with SCD; (2) using existing CHW networks for SCD services would be best; and (3) funding of expanded CHW network might be a problem. We advocate for the mobilization of resources to expand the current network of CHWs to include a focus on SCD in Kumasi, Ghana. Participants believe that it is feasible to use CHWs to improve care outcomes of people with SCD. There is potential for findings from this exploratory project to be adapted and implemented in other settings throughout sub-Saharan Africa, as well as areas of higher income countries where there are higher proportions of people living with sickle cell. [ABSTRACT FROM AUTHOR]

The aim of this study is to explore the impact of the COVID-19 pandemic on pregnant women's anxiety and identify factors most strongly associated with greater changes in anxiety. An anonymous, online, survey of pregnant women (distributed April 3–24, 2020) included a modified pregnancy-related anxiety scale (PRAS) reflecting respondents' perception of pregnancy anxiety before COVID-19 and a current assessment of pregnancy-related anxiety. The difference between these scores was used as the outcome variable. Data were analyzed using bivariate and multivariate linear regression analyses. Two thousand seven hundred forty pregnant women from 47 states completed the survey. 25.8% (N = 706) stopped in-person visits, 15.2% used video visits (N = 415), and 31.8% (N = 817) used phone visits for prenatal care as a result of COVID-19. Those planning a hospital birth dropped from 2641 (96.4%) to 2400 (87.7%) following COVID-19. More than half of women reported increased stress about food running out (59.2%, N = 1622), losing a job or household income (63.7%, N = 1745), or loss of childcare (56.3%, N = 1543). More than a third reported increasing stress about conflict between household members (37.5%, N = 1028), and 93% (N = 2556) reported increased stress about getting infected with COVID-19. Slightly less than half of respondents (either selves or family members) were healthcare workers (41.4%, N = 1133) or worked in essential services (45.5%, N = 1246). In multivariate analysis, those reporting higher agreement with COVID-19-related stressors had greater changes in pre- to post-COVID-19 pregnancy-related anxiety. The COVID-19 pandemic is profoundly affecting pregnant women's mental health, and factors independent of pregnancy appear to be driving changes in pregnancy-specific anxiety. [ABSTRACT FROM AUTHOR]

Sexual coercion refers to strategies that result in an individual engaging in sexual activity against his or her will. Ecological factors influence the way sexual interactions occur; however, the relationship between these factors and sexual coercion has not been explored among university students in Ghana. The purpose of this study was to examine sexual coercion among university students in Ghana by specifically examining individual-level factors (age, gender, sexual debut, age differential with first partner, being in an intimate relationship, history of abortion, and past experiences with transactional sex) and the experience of forced and coerced sex. Residential students at the University of Cape Coast were invited to participate and completed a survey on a tablet computer. Questions included demographics; sexual and reproductive health experiences and knowledge; and attitudes and experiences with abortion. Bivariate and multivariate analyses were used to examine individual-level factors associated with experiences of sexual coercion and forced sex. There were 480 females and 556 males that completed the survey; 26.3 and 16.4% reported having had intercourse either because they were forced or coerced, or when they were 'very unwilling'. These students were more likely to be female (OR 3.5), to have had an abortion (OR 2.9), and to have engaged in transactional sex (OR 1.9). Many University of Cape Coast students are experiencing forced or coerced sex. Programs targeting both female and male students as both victims and perpetrators of sexual violence in this population are sorely needed. Primary prevention of sexual violence is one promising field. [ABSTRACT FROM AUTHOR]

To explore the impact of social factors on place of delivery in northern Ghana. We conducted 72 in-depth interviews and 18 focus group discussions in the Upper East Region of northern Ghana among women with newborns, grandmothers, household heads, compound heads, community leaders, traditional birth attendants, traditional healers, and formally trained healthcare providers. We audiotaped, transcribed, and analyzed interactions using NVivo 9.0. Social norms appear to be shifting in favor of facility delivery, and several respondents indicated that facility delivery confers prestige. Community members disagreed about whether women needed permission from their husbands, mother-in-laws, or compound heads to deliver in a facility, but all agreed that women rely upon their social networks for the economic and logistical support to get to a facility. Socioeconomic status also plays an important role alone and as a mediator of other social factors. Several 'meta themes' permeate the data: (1) This region of Ghana is undergoing a pronounced transition from traditional to contemporary birth-related practices; (2) Power hierarchies within the community are extremely important factors in women's delivery experiences ('someone must give the order'); and (3) This community shares a widespread sense of responsibility for healthy birth outcomes for both mothers and their babies. Social factors influence women's delivery experiences in rural northern Ghana, and future research and programmatic efforts need to include community members such as husbands, mother-in-laws, compound heads, soothsayers, and traditional healers if they are to be maximally effective in improving women's birth outcomes. [ABSTRACT FROM AUTHOR]

To explore the need for faculty development among Chinese medical educators. Leaders at each medical school in China were asked to complete a 123-item survey to identify interest in various topics and barriers and perceived benefits of participating in faculty development programs. Interest levels were high for all topics. Experience with Hospital Management and Research positively correlated with interest in learning more ( p < 0.001). Ninety-two percent believe that international experiences are very or extremely important to medical educators’ career advancement. Chinese medical education faculty members have a strong interest in faculty development programs. [ABSTRACT FROM AUTHOR]

Despite the explosion of online communication in the community, its use between patients and their health care providers remains low. However, rapidly growing patient and provider interest in using online communication has motivated organizations to consider options for deploying these new tools in clinical practice. In this paper, we describe the barriers and challenges health care providers and their organizations must address in developing and deploying these new tools. We formulate lessons from early experiences with e-mail and web-based communication in clinical settings. Finally, we provide a roadmap for developing and deploying these new tools in clinical practice. Health care providers and their organizations will need to consider issues related to technology, data management, operations, communication management, and financial support in order to successfully deploy online services and communication for patients in clinical settings. J GEN INTERN MED 2004;19:978 – 983. [ABSTRACT FROM AUTHOR]

Objectives: E-mail communication between patients and their providers has diffused slowly in clinical practice. To address concerns about the use of this technology, we performed a randomized controlled trial of a triage-based e-mail system in primary care. DESIGN AND PATIENTS/PARTICIPANTS: Physicians in 2 university-affiliated primary care centers were randomized to a triage-based e-mail system promoted to their patients. E-mails from patients of intervention physicians were routed to a central account and parsed to the appropriate staff for response. Control group physicians and their patients did not have access to the system. We collected information on patient e-mail use, phone calls, and visit distribution by physician over the 10 months and performed physician and patient surveys to examine attitudes about communication.Results: E-mail volume was greater for intervention versus control physicians (46 weekly e-mails per 100 scheduled visits vs 9 in the control group at the study midpoint; P <.01) but there were no between-group differences in phone volume (67 weekly phone calls per 100 scheduled visits vs 55 in the control group; P =.45) or rates of patient no-shows (5% in both groups; P =.77). Intervention physicians reported more favorable attitudes toward electronic communication than did control physicians but there were no differences in attitudes toward patient or staff communication in general. There were few between-group differences in patient attitudes toward electronic communication or communication in general.Conclusions: E-mail generated through a triage-based system did not appear to substitute for phone communication or to reduce visit no-shows in a primary care setting. Physicians' attitudes toward electronic communication were improved, but physicians' and patients' attitudes toward general communication did not change. Growth of e-mail communication in primary care settings may not improve the efficiency of clinical care. [ABSTRACT FROM AUTHOR]

One hundred and twenty three outpatients with compensated chronic hepatitis C (CHC) completed the SF-36, BSI, and questions regarding the expected impact of CHC on their health. Respondents were categorized as optimists (N = 17, 13.8%), realists (N = 98, 79.6%), and pessimists (N = 8, 6.5%). Pessimism was associated with lower scores on nearly all SF-36 subscales (p < .001–.03) and higher scores on 6 BSI subscales indicative of greater emotional distress (p < .05). Pessimism was not associated with demographics, liver disease severity, substance abuse, or comorbid medical conditions. However, pessimism was associated with the presence of a psychiatric comorbidity and self-reported health status (p < .05). We conclude that optimism/pessimism may be an important determinant of QOL and emotional status in CHC patients and that additional studies of cognitive predispositions and coping skills in CHC patients are warranted. [ABSTRACT FROM AUTHOR]

OBJECTIVES: Chronic hepatitis C (CHC) patients selected for entry into treatment trials have been reported to have impaired health-related quality of life (HRQOL). However, these trials have an inherent selection bias, and HRQOL in CHC patients may have been underestimated because of the exclusion of patients with comorbid illness. The aim of this study was to assess HRQOL in an unselected group of CHC patients and to identify factors associated with impairment in HRQOL. METHODS: A total of 220 consecutive eligible CHC patients were enrolled from a hepatology clinic. HRQOL was assessed by the short form 36 (SF-36) and comorbid illnesses were assessed by an interview. RESULTS: CHC patients had significantly lower SF-36 scores in all subscales and in the summary scales when compared to those of the healthy general population in the United Stales (p < 0.001). Compared to CHC patients entering treatment trials, our patients had lower SF-36 scores on five subscales (p < 0.001). The presence of comorbid illness was the most important predictor of HRQOL in CHC patients. However. CHC alone resulted in significantly lower SF-36 scores in all subscales and summary scales (p ≤ 0.003) compared to those of the healthy U.S. population. There was no correlation between SF-36 scores and history of i.v. drug use or dependence, alcohol dependence, and serum aminotransferase levels. CONCLUSIONS: We conclude that unselected CHC patients presenting for medical evaluation have a reduced HRQOL, which is lower than that reported for CHC patients entering treatment trials. CHC alone is associated with significant impairment in HRQOL, but the presence of comorbid illness leads to further diminution in HRQOL. [ABSTRACT FROM AUTHOR]

OBJECTIVES: Patients with chronic hepatitis C (HCV) consistently report a reduction in multiple domains of health-related quality of life (HRQOL) that does not correlate with liver disease severity. This may in part be due to the use of insensitive HRQOL instruments or extrahepatic factors that independently influence HRQOL. We hypothesized that a past history of substance abuse or active medical and psychiatric comorbidities would correlate with HRQOL scores. METHODS: In 107 patients who had failed previous interferon therapy, HRQOL was measured by using the modified SF-36. a disease-specific instrument, and the Health Utilities Index (HUI) Mark III, a generic instrument. RESULTS: Multiple SF-36 subscale and summary scores as well as the HUI Mark III attributes of emotion and pain were significantly reduced in the study population compared with healthy controls (p < 0.001). Serum alanine aminotransferase and HCV RNA levels, HCV genotype, liver histology, and HCV risk factors as well as demographic variables did not correlate with modified SF-36 and HUI scores. In addition, a history of alcohol abuse or dependency and intravenous drug use or dependency, identified in 52 and 51% of participants, respectively, did not correlate with HRQOL scores. However, the presence of one or more active medical comorbidities, defined as a chronic medical condition requiring treatment and monitoring, was significantly associated with both the modified SF-36 scores and HUI attribute deficits (p < O.001). In particular, painful medical comorbidities or depressed mood requiring treatment were significantly associated with modified SF-36 scores and with HUI attribute deficits and utility scores (p < 0.001). CONCLUSIONS: Active medical and psychiatric comorbidities may account for some of the reduction and variability in HRQOL scores in patients with chronic HCV who have failed previous interteron therapy. Future studies that control for the presence of active comorbidities in large groups of treatment naive patients with varying severity of chronic HCV are needed to confirm these findings. [ABSTRACT FROM AUTHOR]