Internet Use for Health Information among American Indians: Facilitators and Inhibitors

Our research team explored Internet use among a heterogeneous American Indian (AI) population to determine Internet use in relation to health information seeking behaviors. Participants examined an AI culturally-tailored tobacco website as an example to explain what they wanted in an AI Internet health site. Using community-based participatory research, we conducted 10 focus groups with non-college AI men and women (N=96), stratified by age (18-29, 30-49, and 50 and over) to better understand their perceptions of Internet use and health information needs. We found that Internet use varied greatly among all strata. Participants referenced WebMD© more than any other website, but participants were not pleased with the design and navigation. When examining the sample website, participants across strata stressed that recreational and traditional tobacco use should be discussed. Participants in all strata desired a simple website design with easy to read text accompanied by images. In order to gain and maintain cultural respect, participants stated that web designers should be aware that some images hold cultural meaning, particularly tobacco. Baseline data are needed for AI’s use of the Internet to obtain health information; this research is helpful to address health inequalities among AI, particularly access to web-based health information

Speech perception in the elderly: errors analysis

OBJECTIVE: To analyze the errors made in a speech test in the presence of background noise for the elderly. METHOD: We performed a retrospective study with data collected from medical records of 55 elderly patients divided into control group (CG) and study group (SG), considering the tests Percentage Index of Speech Recognition (PISR) and Speech in Noise (S/R). RESULT: articulatory exchanges were more frequent test in the SG and in the /R test. Overall, there were more omissions of phonemes in initial position (/p/ and /b/) and final (/s/) of words, especially with the noise. There were omissions of words only in the SG. The words more exchanged in the CG were rir, dil, lhe, faz and rol, and in the SG, rir, dil, lhe, faz, pus and rol. CONCLUSION: the presence of normal pure tone thresholds did not prevent errors that occur in speech recognition and noise interfered negatively in this recognition, especially in the elderly with hearing loss. The phonemes / p /, / b / and / s / were most frequently omitted, especially in the presence of noise. The words rir, dil, lhe, faz and rol were the most confused in the groups, mainly in the presence of noise.OBJETIVO: analisar os erros apresentados em um teste de fala na presença de ruído competitivo de idosos. MÉTODO: foi realizado estudo retrospectivo com levantamento de dados de prontuário de 55 idosos divididos em grupo controle (GC) e grupo estudo (GE), considerando os testes Índice Percentual de Reconhecimento de Fala (IPRF) e Fala com Ruído (F/R). RESULTADO: as trocas articulatórias foram mais frequentes no GE e no teste F/R. De maneira geral, ocorreram mais omissões de fonemas na posição inicial (/p/ e /b/) e final (/s/) dos vocábulos, principalmente com o ruído. Houve omissões de vocábulos somente no GE. Os vocábulos mais trocados no GC foram rir , dil , lhe , faze rol , e no GE, rir , dil , lhe , faz , pue rol . CONCLUSÃO: a presença de limiares tonais normais não impediu que ocorressem erros no reconhecimento de fala e o ruído interferiu negativamente neste reconhecimento, principalmente no idoso com perda auditiva. Os fonemas /p/, /b/ e /s/ foram os mais frequentemente omitidos, principalmente na presença do ruído competitivo. Os vocábulos rir , dil , lhe , faze rolforam os mais trocados para os grupos avaliados, sobretudo na presença do ruído.Universidade Federal de São Paulo (UNIFESP) Curso de Pós-Graduação em Distúrbios da Comunicação HumanaPontifícia Universidade Católica de São Paulo Departamento de Clínica FonoaudiológicaUNIFESP, Curso de Pós-Graduação em Distúrbios da Comunicação HumanaSciEL

Performance of elderly in a speech in noise test

BACKGROUND: speech perception of elderly, in silence and in the presence of background noise. AIM: to characterize and compare the hearing abilities of elderly in a monaural speech perception test, in the presence and absence of background noise (Speech Discrimination Test - SDT and Speech Perception in Noise - SPIN). METHOD: Participants of this study were 55 subjects of both genders, 60 years old or above, distributed in two groups: Control Group (CG), constituted by elders with no hearing loss and Study Group (SG), constituted by elders with symmetrical sensorineural hearing loss. The SPIN test was used, initially with the presentation of a word list in silence and later in the presence of Speech Noise. RESULTS: no difference was observed between genders in the SDT and the SPIN test. Correlation with age was observed only in the SDT for SG. A significant difference was observed when comparing the performance of the groups in the SDT and SPIN test. Regarding the presence of substitutions in the articulation of words, it was observed that it occurred in both groups and was more frequent in SPIN test, especially for the SG. CONCLUSION: the presence of the noise during the production of speech sounds is disadvantageous for elders, independently of the presence of hearing loss, but having a higher impact for those with hearing loss problems.TEMA: percepção de fala no silêncio e na presença de ruído em idosos. OBJETIVO: caracterizar e comparar as habilidades auditivas de idosos em um teste monótico de percepção de fala, sem e com a presença de ruído competitivo (Índice Perceptual de Reconhecimento de Fala - IPRF e Fala com Ruído - F/R). MÉTODO: foram avaliados 55 sujeitos de ambos os sexos, com idade a partir de 60 anos distribuídos em grupos: Grupo Controle (GC), constituído de idosos sem perda auditiva e Grupo Estudo (GE), constituído de idosos com perda auditiva neurossensorial simétrica. Foi utilizado o Teste de Fala com Ruído, com a apresentação de uma lista de palavras primeiramente sem a presença de ruído e depois na presença de ruído do tipo Speech Noise. RESULTADOS: não houve diferença entre homens e mulheres para os testes IPRF e F/R e correlação da idade somente para o IPRF no GE. Também foi observada diferença significativa no desempenho entre os grupos nos testes IPRF e F/R. Com relação à presença das trocas articulatórias, foi observado que elas ocorreram nos dois grupos estudados, sendo mais freqüente no teste F/R e, principalmente, para o grupo estudo. CONCLUSÃO: a presença do ruído juntamente com os sons de fala é prejudicial para os idosos, independente da presença da perda auditiva, sendo o impacto maior para aqueles que a possuem.Universidade Federal de São Paulo (UNIFESP)Pontifícia Universidade Católica de São Paulo Departamento de Clínica FonoaudiológicaSanta Casa de Misericórdia de São Paulo Faculdade de Ciências MédicasCentro de Estudos dos Distúrbios da AudiçãoUNIFESPSciEL

Barriers to colorectal cancer screening among American Indian men aged 50 or older, Kansas and Missouri, 2006-2008

American Indian (AI) men have some of the highest rates of colorectal cancer (CRC) in the United States but among the lowest screening rates. Our goal was to better understand awareness and discourse about colorectal cancer in a heterogeneous group of AI men in the Midwestern United States. Focus groups were conducted with AI men (N = 29); data were analyzed using a community-participatory approach to qualitative text analysis. Several themes were identified regarding knowledge, knowledge sources, and barriers to and facilitators of screening. Men in the study felt that awareness about colorectal cancer was low, and people were interested in learning more. Education strategies need to be culturally relevant and specific

Ensuring Healthy American Indian Generations for Tomorrow through Safe and Healthy Indoor Environments

A grant from the One-University Open Access Fund at the University of Kansas was used to defray the author’s publication fees in this Open Access journal. The Open Access Fund, administered by librarians from the KU, KU Law, and KUMC libraries, is made possible by contributions from the offices of KU Provost, KU Vice Chancellor for Research & Graduate Studies, and KUMC Vice Chancellor for Research. For more information about the Open Access Fund, please see http://library.kumc.edu/authors-fund.xml.American Indians (AI) have the highest rate of severe physical housing problems in the U.S. (3.9%). Little information exists about the environmental hazards in AI homes. The purposes of this paper are to discuss challenges that were encountered when recruiting AI for a home-and employment-based environmental health assessments, highlight major successes, and propose recommendations for future indoor environmental health studies. The Center for American Indian Community Health (CAICH) and Children’s Mercy Hospital’s Center for Environmental Health and Allergy and Immunology Research Lab collaborated to provide educational sessions and healthy home assessments for AI. Through educational trainings, more than 240 AI were trained on the primary causes of health problems in homes. A total of 72 homes and places of employment were assessed by AI environmental health specialists. The top three categories with the most concerns observed in the homes/places of employment were allergens/dust (98%), safety/injury (89%) and chemical exposure (82%). While some information on smoking inside the home was collected, these numbers may have been underreported due to stigma. This was CAICH’s first endeavor in environmental health and although challenges arose, many more successes were achieved

Internet All Nation Breath of life (I-ANBL) a Tribal College Student Engaged Development of an Internet-based Smoking Cessation Intervention

Background: Compared to non-Hispanic white college students, American Indian (AI) tribal college students have the highest smoking prevalence in the U.S. (~34%). Culturally-tailored smoking cessation programs have proven to be successful in reducing smoking rates but may require new methods to reach college students. Currently, there is little documentation on the development and success of Internet-based smoking interventions for AI tribal college students. Objectives: To develop an Internet-based smoking cessation program (Internet-All Nations Breath of Life or I-ANBL) with tribal college students. Methods: We conducted six focus groups (n=41) at a tribal college. Focus groups included tribal college students who smoked and groups were stratified by sex. Transcripts were analyzed using insider and outsider perspectives. After analysis, an Internet-based smoking cessation program was developed, based on insight gained. Results: Numerous suggestions for creating the program were offered. There was consensus on the need for a variety of visuals including cultural images, videos, and interactive content. The students also suggested the integration of familiar platforms such as FacebookTM. Conclusion: When culturally tailoring a web-based smoking cessation program for tribal college students, it is important to incorporate cultural aspects and recognize gender differences. One important aspect is to recognize that for many AI, tobacco is a sacred plant and images of tobacco should be respectful. Now that this intervention has been developed, next we will test it for efficacy in a randomized controlled trial. Keywords: American Indians, tribal college, tobacco, program development, smoking cessation, community-based participatory researc

Implantação da mudança organizacional: proposta de artefato a partir de uma aplicação em uma instituição do setor de imunobiológicos

The research object of this investigation is the planning of organizational changes. Moreover, the main objective of the study is the proposal of an artifact for planning organizational changes. To this end, the Design Science Research is used as a research method. The study was conducted through a literature review that supported the first version of the artifact proposal, followed by the application of the method in a real case, an organization of immunobiological sector that is facing the planning of transferring operations to a new material warehouse. The method was evaluated through focus groups and the results were satisfactory. A detailed description of the artifact after refinements is presented, including the sequence of steps and outputs. The contributions of the work involve the proposition of the method itself and the advancement of researches in Change Management and Design Science. Keywords: Change Management, Design Science Research, planning change.Esta pesquisa tem como objeto o planejamento de mudanças organizacionais e possui como foco central a proposição de um artefato, especificamente, um método de planejamento de mudanças organizacionais. Por esse motivo, foi utilizada a Design Science Research como método de pesquisa. O estudo foi conduzido por meio de uma revisão da literatura que subsidiou a proposição da primeira versão do artefato, seguida da aplicação do mesmo em um caso real, em uma organização do setor de imunobiológicos que enfrenta uma situação de planejamento da transferência das operações para um novo almoxarifado de materiais. O método foi avaliado por meio de grupos focais e os resultados foram satisfatórios. Uma descrição detalhada do artefato, após a incorporação dos refinamentos, é apresentada, incluindo a apresentação da sequência de etapas e do conjunto de passos e saídas que as compõem. As contribuições do trabalho envolvem a proposição do método propriamente dita e o avanço das pesquisas em gestão da mudança e em Design Science.Palavras-chave: gestão da mudança, Design Science Research, planejamento de mudança

Efeitos do Programa Mais Médicos na Atenção Primária e seus impactos na saúde: uma revisão sistemática rápida

The distribution of doctors in Brazil is marked by inequalities, hindering full and universal access to healthcare, fundamental to SUS. The Mais Médicos Program (PMM) reached peak of emergency provision in 2016, with 18,800 doctors allocated to 4,509 municipalities, one of the largest interventions of its type. A rapid systematic review was carried out to gather evidence of the Program’s impacts on primary healthcare and on the assisted population’s health. 570 studies were extracted and the final selection included 32 articles. Regarding the Program’s effects, there was a rapid expansion in primary healthcare coverage, an improvement in comprehensiveness and humanization of healthcare, as well as significant impact on hospitalizations for primary healthcare sensitive conditions, which resulted in an approximate reduction of 23 thousand hospitalizations throughout three years, saving R$30 million for SUS. Critical points that undermined the Program’s potential impact were also identified: focus deviations; changes in priority criteria and undue replacement of hired doctors by PMM physicians, in addition to the disruption caused by the departure of 8,500 Cuban doctors in November 2018. It is estimated that the relaunch of the Mais Médicos Program, in 2023, especially based on existing evidence, will promote the continued progress of the Program.La distribución de médicos en Brasil es desigual, lo que dificulta el acceso pleno y universal a la salud, fundamental para el SUS. El Programa Mais Médicos (PMM) alcanzó su pico en 2016, con 18.088 médicos asignados a 4.509 municipios, una de las mayores intervenciones de su tipo en el mondo. Se llevó a cabo una revisión sistemática rápida para recopilar evidencia de los efectos del programa de Atención Primaria de Salud (APS) y sus impactos en la salud de la población atendida. Se extrajeron 570 estudios y fueran seleccionados 32 artículos. Acerca de los efectos del Programa, hubo una rápida ampliación de cobertura en APS, mejora en la integralidad y humanización de la atención de salud, así como un impacto en las hospitalizaciones a lo largo de tres años, ahorrando R$30 millones para el SUS. Puntos críticos que socavaban el impacto potencial del Programa fueran identificados: desviaciones en el enfoque; cambios en criterios de prioridad y sustitución indebida de médicos, además del trastorno provocado por la salida de 8.500 médicos cubanos en noviembre de 2018. Se estima que el relanzamiento del Programa Mais Médicos en 2023, especialmente con base en la evidencia existente, promoverá el progreso continuo del Programa.A distribuição de médicos no Brasil é marcada por desigualdades, prejudicando o acesso integral e universal à saúde, basilar para o SUS. O Programa Mais Médicos (PMM) atingiu o auge do provimento emergencial em 2016, com 18.088 médicos em 4.509 municípios, uma das maiores intervenções desse tipo no mundo. Realizou-se uma revisão rápida e sistemática para coletar evidências dos efeitos do Programa na Atenção Primária à Saúde (APS) e impactos na saúde da população atendida. Extraíram-se 570 estudos e a seleção final incluiu 32 artigos. Quanto aos efeitos do Programa, verificaram-se rápida expansão na cobertura da APS, melhoria na integralidade e humanização da atenção à saúde e impacto significativo nas internações por condições sensíveis à APS, gerando aproximadamente 23 mil internações ao longo de três anos, economizando R$ 30 milhões para o SUS. identificaram-se também pontos críticos que prejudicaram o potencial de impacto do Programa: desvios na focalização; mudanças nos critérios de prioridade e substituição indevida de médicos já contratados por outros do PMM, além da ruptura causada pela saída de 8.500 médicos cubanos em novembro de 2018. Estima-se que o relançamento do Programa Mais Médicos em 2023, principalmente a partir de evidências já existentes, promoverá a continuidade dos progressos do Programa