Mixed-methods study of integration of housing and medical data systems for enhanced service coordination of people with HIV

Introduction

Housing is a determinant of HIV-related medical outcomes. Care coordination has been successfully used to treat patients with HIV and can be improved through electronic exchange of patient data, including housing data.

Methods

Primary data were collected from four sites across the U.S., each comprising partnerships between local HIV medical and housing providers. Between March 2017 and May 2018, we conducted a mixed-methods evaluation, focusing on preparatory activities, implementation of tasks related to data integration, and service coordination. Nineteen focus group discussions were conducted with providers, organizational leaders, and clients. Ten interviews were conducted with data system vendors and administrators. Site visits, logs, and progress reports provided information about data integration progress and other activities.

Results

Key activities included changes to client consent, setting up data use agreements, and planning with data system vendors. Sites selected one of three models: one-way data transmission between two systems, bidirectional transmission between two systems, and integration into one data system. Focus group discussion themes included: challenges of using existing data systems; concerns about the burden of learning a new data system; and potential benefits to providers and client, such as having more time to spend delivering client services.

Discussion

Using health information technologies to share data has widespread support, but uptake is still met with resistance from end users. The additional level of complexity differentiating this study from others is the exchange of data between service providers and care providers, but sites were able to accomplish this goal by navigating extensive barriers.

[Processing of interaural time differences in normal-hearing subjects and cochlear implant users with FSP and HDCIS coding strategy]

BACKGROUND

Sound localization is necessary for social interaction and remains challenging for bilateral cochlear implant (CI) users. This study investigated the influence of fine structure processing (FSP) coding strategies on temporal accuracy and source localization. The ability to discriminate between different interaural time differences (ITD) was measured objectively and compared.

MATERIALS AND METHODS

Fifteen normal-hearing subjects and five CI users participated in this study. Electrophysiological recording of mismatch negativity (MMN) and psychoacoustic tests with headphones and loudspeakers were conducted to measure and compare the discrimination of ITDs.

RESULTS

In normal-hearing subjects the discrimination threshold for ITD was 83-117 µs. Localization ability in a free sound field was below the limit of resolution. A significant MMN was measured. CI users showed a mean angle detection error of more than 30° and a discrimination threshold between 1100 and 2100 µs. Due to artifacts, no clear MMN component could be recorded.

CONCLUSION

This study shows that MMN can be used as an objective measure of ITD discrimination in normal-hearing participants. An indication that improvements in directional hearing can be achieved with the transfer of fine structure could not be provided by this study.

The Social Life of Class Clowns: Class Clown Behavior Is Associated With More Friends, but Also More Aggressive Behavior in the Classroom

A dimensional rather than a typological approach to studying class clown behavior was recently proposed (Ruch et al., 2014). In the present study, four dimensions of class clown behavior (class clown role, comic talent, disruptive rule-breaker, and subversive joker) were used to investigate the associations between class clown behavior and indicators of social status and social functioning in the classroom in a sample of N = 300 students attending grades 6 to 9 (mean age: 13.09 years, 47.7% male). Participants and their teachers completed measures of class clown behavior, and peer nominations of peer acceptance, mutual friends as well as social behavior in the classroom (popular-leadership, aggressive-disruptive, sensitive-isolated, and prosocial behaviors) were collected. The results showed that overall, class clown behavior was positively related to peer acceptance, the number of mutual friends in the classroom and peer-perceived social status. Overall, it was also positively related to peer-rated popular-leadership and aggressive-disruptive behaviors, as well as negatively related to prosocial behaviors. When considering the four dimensions of class clown behavior, comic talent was particularly relevant for the relationship with social status and with popular-leadership behaviors, but also with aggressive-disruptive behaviors. Aggressive-disruptive behaviors were also particularly related to the class clown dimension disruptive rule-breaker. The results underline the significance of class clown behavior for the social status and functioning of students and may help further understand the phenomenon in its multidimensional nature.

Understanding barriers to uptake of 17 alpha-hydroxyprogesterone caproate (17-OHP) in women with history of preterm birth

Background: Premature birth is responsible for approximately 38% of infant deaths as well as a host of complications, including abnormal lung development, infection, and long-term disabilities. For women with a history of spontaneous preterm birth in a singleton pregnancy, use of 17 alpha-hydroxyprogesterone caproate (17-OHP) can reduce the risk of a recurrent preterm birth by up to 42%. However, less than half of eligible women currently receive 17-OHP.Objectives: The purpose of this study was to understand the barriers to access and acceptability of 17-OHP use from the patient perspective.Study design: A qualitative study was conducted of women with a history of a prior spontaneous, singleton preterm birth who were eligible for 17-OHP during a subsequent singleton pregnancy. Researchers recruited 118 eligible women during the Spring and Summer of 2018 from a safety-net hospital in Denver, CO, USA, a hospital that provides healthcare for individuals regardless of their insurance status or ability to pay. Responses from 35 participants were analyzed, looking at themes surrounding knowledge of and counseling received regarding 17-OHP, hesitations, and barriers toward receiving the treatment.Results: Among respondents (34.0% response rate), the mean age was 31.5 years and mean gestational age at delivery was 32.1 weeks. Major themes from interviews included reasons that encouraged women to use 17-OHP, such as the desire to do anything for the health of their baby and reasons that women felt discouraged from using 17-OHP, including unknown complications and lack of information. Other barriers to this treatment method included the time commitment, specifically the length of clinic appointments and concerns about the safety of the 17-OHP injection.Conclusions: One of the strongest reasons for women choosing to use 17-OHP was a desire to do anything possible to support their babies. Somewhat surprisingly, there was not a significant relationship with the participants between gestational age of prior preterm deliveries and subsequent use of 17-OHP. There were two important reasons women cited most frequently for choosing not to use 17-OHP. One was feeling that they lacked information or knowledge about 17-OHP to make an informed decision, which is crucial because the study also showed that all eligible women are not being appropriately counseled on the option of 17-OHP. In terms of time commitment, it was the length of individual appointments, rather than frequency that was a barrier to receiving weekly injections.

A feasibility study of trauma-sensitive obstetric care for low-income, ethno-racial minority pregnant abuse survivors

PURPOSE

This study evaluated the feasibility and acceptability of an integrated (psychological and obstetric) intervention for pregnant abuse survivors with posttraumatic stress symptoms (PTS) from low-income, ethno-racial minority backgrounds.

METHODS

Trauma-sensitive obstetrics to promote control, anxiety-reduction and empowerment (TO-CARE) offers cognitive-behavioral therapy (CBT) coping skills delivered over six sessions by therapists, coupled with trauma-sensitive obstetric care from specially-trained obstetric physicians.

RESULTS

Participants were 21 women who completed at least three sessions of CBT, totaling 51.2% of eligible participants. Participants received approximately one-third (M = 2.29; SD = 2.15) of their prenatal visits with obstetric residents trained in trauma-sensitive care. Nearly all participants (95%) reported that they benefited from the intervention. Although most participants demonstrated improvement in PTS, only four demonstrated reliable improvement, and two demonstrated reliable improvement in depression symptoms. These improvements appeared to be maintained at postpartum follow-up for two of the participants.

CONCLUSIONS

Our findings suggest that TO-CARE was acceptable to pregnant abuse survivors and may be a promising intervention to reduce symptoms of distress. Implications of the low retention rate for the CBT (51.2%) are discussed in the context of interventions for low-income minority pregnant women. Limitations regarding feasibility of the integrated intervention are discussed.