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Health care providers play an essential role in public health emergency preparedness and response. We conducted a 4-year randomized controlled trial to systematically compare the effectiveness of traditional and mobile communication strategies for sending time-sensitive public health messages to providers.
Subjects (N=848) included providers who might be leveraged to assist with emergency preparedness and response activities, such as physicians, pharmacists, nurse practitioners, physician’s assistants, and veterinarians. Providers were randomly assigned to a group that received time-sensitive quarterly messages via e-mail, fax, or cell phone text messaging (SMS) or to a no-message control group. Follow-up phone interviews elicited information about message receipt, topic recall, and perceived credibility and trustworthiness of message and source.
Our main outcome measures were awareness and recall of message content, which was compared across delivery methods. Per-protocol analysis revealed that e-mail messages were recalled at a higher rate than were messaged delivered by fax or SMS, whereas the as-treated analysis found that e-mail and fax groups had similar recall rates and both had higher recall rates than the SMS group.
This is the first study to systematically evaluate the relative effectiveness of public health message delivery systems. Our findings provide guidance to improve public health agency communications with providers before, during, and after a public health emergency. (Disaster Med Public Health Preparedness. 2016;10:98–107)
Lifetime reproductive histories of a 1984–85 nationally representative sample of 870 women aged 25–59 years provided data to describe the evolution of fertility, contraception, breast-feeding, and natural fecundability in Costa Rica between 1960 and 1984. The contraceptive prevalence rate increased from 23% in 1965 to 58% in 1975 and 66% in 1984. Duration of breast-feeding was stable during the 1960s, decreased in the early 1970s, and increased after about 1976. Fecundability among women who did not practise contraception was lower than expected and declined between 1960 and 1975, probably because of selection effects. Despite a high consistency between estimations from the reproductive histories and other sources of data, some suggestion of omissions of short periods of contraceptive use in the distant past was detected. The survey may have reduced recall errors by using a calendar that summarizes major life events together. The analysis demonstrated the feasibility and usefulness of asking for lifetime reproductive histories in fertility surveys in developing countries.
This paper presents data from two recent maternal–child health (MCH) and family planning surveys in Guatemala and Panama and examines the extent to which the use of contraception is influenced by the use of MCH services as compared with the influence of an increase in parity. The findings suggest that utilization of MCH services and parity independently are associated with a woman's decision to use contraception. The study also found two groups that appear to be particularly in need of both MCH and family planning services: high parity women and Indians. In both Guatemala and Panama, improved health care services for these two groups should be a priority.
In birth certificate data for Massachusetts resident births from 1978 to 1982, 12–27% of births purportedly under 31 weeks of gestation were probably misclassified, i.e. had birthweight ≥2500g. Correcting for maldistribution of births removed 34% and 23%, respectively, of black and white births with reported gestational ages <36 weeks but with implausible weights. Percentages of unknown and incomplete reports of last menstrual period were also significantly higher for blacks. After adjustment, preterm black infants weighed less than whites at each gestational age. The proportion of infants <2500g born at term (≥37 weeks gestation) was higher (although not significantly) among blacks. These findings are consistent with hypotheses that low socioeconomic status negatively affects the rate of intrauterine growth.
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