Health Information Services Research Articles

Surveillance of Leishmaniasis: Inventory and Seasonal Fluctuation of Phlebotomine Sandflies (Diptera: Psychodidae), at the Prefecture of Meknes (Center of Morocco)

Phlebotomine sandflies are bloodsucking insects responsible for the transmission of leishmaniasis. The average annual incidence in Morocco, of this pathology, was approximately estimated in 2014 as 7.8 per 100.000 inhabitants according to the Moroccan health information service records. The study of the composition of the Phlebotomian community and its seasonal dynamics are essential for determining the appropriate and adequate means of control at the prefecture of Meknes in Central Morocco. It is with this in mind that two capture sessions per month using sticky paper traps were conducted at the sites of sandflies. A total of 982 sandflies were captured. The identification of the specimens found via the Moroccan key revealed a percentage of 73.3% belonging to the subgenus Paraphlebotomus, 6.3% to the Phlebotomus subgenus, 16.2% to Larroussius, and 4.2% of Sergentomia subgenus. Phlebotomus sergenti, vector of human cutaneous leishmaniasis, was found as the more abundant with 73.3% followed by Larroussius longicuspis with 8.2%. The largest number of species was harvested in July and September with, respectively, 44.8 ph/m2/night and 48.7 ph/m2/night. This study also unveiled that the two high-risk Leishmanian months are July and September, hence, the need to strengthen efforts to monitor and control this disease during the vector activity period.

Psychological Influence and Intention to Use Web Based Health Information Service

Building on the Health Belief Model, the study attempts to examine the roles of outcome expectations, internal cues and external cues in predicting health consumers intention to use MyHEALTH Portal which is the Malaysian National Web based Health Information Service. Based on the results of the structural model, there are evidences for outcome expectations and internal cues to predict the health consumers intention to use MyHEALTH Portal. The findings provide valuable insights for the Malaysia Ministry of Health in identifying significant psychological factors in promoting the portal usage behaviour, which ultimately, help to achieve their long-term goal.

Biometric information database and service modelling in digital patch system

Recently, the bio-sensing information systems for collecting and analysing human body information of a patient in real time in the field of medical information and healthcare information service are continuously increasing. Specially, various wearable devices such as a wrist, a garment, and a skin attachment type for supporting health information of a mobile user are rapidly increasing. Until now, there is no patch-type biometric information service model. Therefore, this paper presents a biometric information system model and the application examples to support biometric information sensing and health information service of mobile user with digital patch system as a new biometric information system. As a result, through this research, research issues based on digital patch system are searched to suggest the direction of continuous research.

Primary health information standard system based on semantic interoperability

BackgroundTo realize semantic interoperability for Primary Health Information System (PHIS), this study analyzes and applies existing health information data standards in China. This research aims to establish a Primary Health Information Standard System (PHISS), and achieve the semantic level interoperability and application of primary health information.MethodsFirst, the PHISS in accordance with the structural standards of national information standards system in China was constructed. Second, application of semantic interoperability level with reference to the interoperability model was standardized. Thirdly, referring to the data element model, PHIS data element dictionary with good interoperability is developed by standardizing data element attributes of identifiers, names, definitions and permissible value. Fourthly, based on PHIS data element dictionary, PHIS dataset is developed following the relevant rules for health information datasets.ResultsPHISS is composed of basic class standards, data class standards, technical class standards, security and privacy class standards, management class standards. In this study, we reorganized the data class standards that meet the requirements of PHIS, also develops and adds PHIS data element, PHIS data element dictionary and PHIS dataset. PHIS data element dictionary includes 16 parts and PHIS dataset includes 22 parts, which satisfies the data standardization requirements of PHIS.ConclusionsThe establishment of the PHISS can meet the needs for the interconnection of the residents’ basic health service information and realize the semantic level interoperability of various information services. The key steps of this method are based on semantic interoperability. Relevant data elements and datasets with semantic interoperability are selected. Moreover, an information standard system is constructed, and the information standardization requirements of the PHIS are met.

Effective coverage as a new approach to health system performance assessment: a scoping review

BackgroundDelivering interventions is the main task of health systems whose accurate measurement is an essential input into tracking performance. Recently, the concept of effective coverage was introduced by World Health Organization to incorporate into health system performance assessment. The aim of present scoping review was mapping the key elements and steps of effective coverage assessment in practical efforts including kinds of interventions, criteria for selecting them and the need, use and quality estimation approaches and strategies of each intervention.MethodsWe conducted a scoping review of health system/program assessments which assessed effective coverage till May 2017. Seven databases were systematically searched with no time and language restriction through applying combined keyword of “effective coverage”.ResultsEighteen studies contributed findings on monitoring effective coverage of health interventions and they all were included in the review. Only 4 contributed findings on health system and the others were related to specific intervention(s) assessment. The interventions monitored by effective coverage were mainly in child health, prenatal and antenatal care and delivery, and chronic conditions areas. Potential impact on the burden of disease, leading causes of mortality and morbidity, and high occurrence and prevalence rate were among the main intervention selection criteria. Availability of data was the critical prerequisite, especially, in all of the studies applied ex post approach in estimating effective coverage. Estimation based on a norm, self- reporting from surveys and biomarkers were the main strategies and methods of need, utilization and quality measurement, respectively.ConclusionsMore studies are needed to contribute to the ongoing improvement in the development of effective coverage concept and increasing practical efforts, especially through defining prospective approaches and strategies into estimation of composite measures based on the effective coverage framework. Also, further attention needs to be paid to quality measures of effective coverage in a manner that better conceptualizes and measures the connection between coverage rates and interventions’ effectiveness. At the administrative system level, more innovation is needed to develop data systems in order to enhance capacity of routine health service information.

OPTIMALISASI BIDAN DESA DALAM PENYEBARAN INFORMASI KESEHATAN BAGI MASYARAKAT DI KABUPATEN BANDUNG (Studi Kasus tentang Pemanfaatan Bidan Desa Dalam Penyebaran Informasi Kesehatan bagi Masyarakat di Kabupaten Bandung)

Village midwives are a very important source in the therapeutic communication process in rural areas. This communication process can be seen in the distribution of health information and health services provided by the local village apparatus. In this research location in Kertasari sub-district, Bandung district, the authors found one area that optimizes the role of village midwives in the dissemination of health information for the surrounding community, namely Tarumajaya village. This phenomenon is interesting to study because this condition is not necessarily found in all regions. Therefore, the author wants to explain the use of village midwives in the dissemination of health information for the community in the village of Tarumajaya. This study uses a qualitative approach to the case study method. The author also selected 4 informants who met the research criteria. The data collection techniques used are observation, in-depth interviews, and documentation studies from several literatures that are relevant to the research topic of the author. The results obtained showed that the use of village midwives in the dissemination of health information for the community in Tarumajaya village included: (1) The existence of village midwives in Tarumajaya Polindes as a credible source / communicator and very helpful in the process of distributing health information; (2) There are messages in the form of various health information delivered by village midwives through various health programs in the village; (3) The coordination of village midwives with other health workers in the nearest health center to facilitate the implementation of health programs; (4) Support from village officials in carrying out health programs; (5) Full trust given by the local community, in terms of being a communicant, to the village midwife, thus supporting the smooth process of disseminating existing health information. Keywords: Utilization, Village Midwives, Information, Health, Kertasari District, Bandung Regency

Harnessing Smartphone Technology to Improve Patient Engagement: Codesigning and Testing The SecondEars Consultation Audio Recording App for People With Cancer

Background: Oncology consultations can be overwhelming and information-dense. Consultation audio recordings are an effective method to promote patient participation, improve patients' recall and understanding of medical information, and can increase engagement and support through sharing with family and friends. Innovative m-health technologies such as the SecondEars consultation audio recording mobile app provide a patient-designed and controlled audio recording solution while ensuring security and legal protection for clinicians. To ensure the SecondEars app meets the needs of patients, family, clinicians and hospital administrators, the opinions of stakeholders and end users are integral to the concept and study creation, design, and testing processes. Aim: To use key elements of codesign methodology to develop and test SecondEars, a mobile app that allows patients to audio record their consultations within a clinical oncology setting. Methods: The SecondEars app concept began with consumer suggestions that consultation audio recording be used as standard practice of care using patient-driven (use is controlled/determined by patients) technologies. An app solution was conceived and the concept discussed through engagement of consumers as part of the project and research codesign team. Key health service stakeholders comprising representatives from: legal, information technology (IT), clinical service leads, digital strategy, and health information services (HIS), provided project oversight and core legal and data management requirements. The Scrum management framework was used to structure the codesign process during the development and testing phase. Six workshops were run to facilitate further user input with regard to specific app functionality and design. A wireframe version was developed and tested by the codesign team in the final workshop. Feedback was incorporated into a prototype which was circulated for acceptance testing. Results: Twenty people participated in the stakeholder engagement and workshops, comprising: oncology consumers, researchers, IT, HIS, app developers, and oncology health professionals. Key specifications necessitated that SecondEars be patient-driven, secure and confidential, have clear legal guidelines regarding audio recording sharing, be integrated with medical records, and require minimal upfront and ongoing resources. Seven people tested the prototype app during user acceptance testing and gave positive and constructive feedback. A final version of the app was then made available for clinical testing. Conclusion: The SecondEars consultation audio recording app has been successfully created by and for patients. This app gives patients permission and autonomy to audio record and share their consultations responsibly, while maintaining legal protection for clinicians. This app is currently being tested in a clinical setting prior to conducting an implementation study.

Symptomatic Presentation, Diagnostic Delays and Advanced Stage Among Cervical Cancer Patients in Mexico

Background: Even though cancer of the cervix uteri is a preventable and highly curable disease, in Mexico it is the second cause of cancer mortality among women. According to the last National Survey of Health and Nutrition (2012) , Papanicolaou test screening coverage in Mexico is estimated at 45%. Additionally, studies have revealed quality problems in the taking and interpretation of Papanicolaou test tests and a lack of follow-up in ∼60% of women with positive Pap smears. To date there is no information on the time intervals of care for cervical cancer patients in Mexico. Aims: To quantify the intervals of care from the detection of a possible cervical cancer to the beginning of cancer treatment, describe the form of presentation and identify perceived barriers to timely care. Methods: We surveyed 427 patients that received a new cervical cancer diagnosis between 6.01.16 and 5.31.17 in the 2 largest public hospitals located in Mexico City available for uninsured cancer patients. Approximately 2/3 patients reside in Mexico City metropolitan area and 1/3 in surrounding states. All patients signed informed consent. Participants' medical files were reviewed. We gathered data on: dates necessary to estimate the intervals of care, sociodemographic characteristics, form of cancer identification (symptoms vs screening), perceived barriers of care and cancer clinical stage. Results: Clinical stages at diagnosis were: 9.5% in situ, 16.9% stage I, 25.2% stage II, 20.2% stage III, 17.8% stage IV and 10.5% not known. The median duration of the patient interval (time between symptom discovery and first medical consultation) was 24 days (IQR = 5.5-72), in comparison with 175 days (IQR = 101-272) for the health system interval (time between first medical consultation and treatment start). The diagnosis interval (first consultation to diagnosis) had a median duration of 99 days (IQR = 43-204) and the treatment interval (time between diagnosis and treatment start) a median of 57 days (IQR = 37-78). Only 15% (64/427) patients identified the problem through screening. The most common symptom of presentation was vaginal bleeding in 65.9% (236/363) cases. The main perceived barriers of diagnostic delay were: lack of information of available health services (63%), long waiting times between appointments (52%) and diagnostic medical errors in the first services consulted (38%). Conclusion: The vast majority of cervical cancer cases among uninsured women in the Mexico City metropolitan area have symptomatic presentations. Additionally, these patients face delays of ∼6 months between the first medical consultation and the confirmation of cancer. Low coverage of screening and diagnostic delays are the most likely explanations of the high mortality rates of cervical cancer that persist in Mexico despite the 30-year implementation of the national screening program.

Integrating Cervical Cancer Screening and Syndromic Management of Sexually Transmitted Infections in Resource-Limited Settings in India

Background: In India, annually, there are more than 120,000 women diagnosed with cervical cancer and more than half of them die of the disease. The link between cervical cancer and high-risk type of human papilloma virus (HPV) is well-established. In addition to this, low-risk type HPV can lead to sexually transmitted infections (STIs). It is believed that 6% of Indian adult population is affected by one or more STIs. However, due to geographical and socioeconomic barriers, rural and poor women do not always have access to updated sexual and reproductive health (SRH) information and relevant services, resulting in the delay of treatment. To address these challenges and to strengthen the existing health system, Family Planning Association of India (FPA India), a national level voluntary organization, integrated cervical cancer and STIs services into a 2-year project and delivered it in urban slums and rural areas. Aim: To evaluate the impact of integrated cervical cancer and STIs services in the resource-limited settings in India. Methods: FPA India implemented the integrated package through six branch health facilities to raise people's awareness and build institutional capacity for the screening of women. All detailed process is summarized in Fig 1. Data, such as the number of cervical cancer screening and syndromic treatment, was collected. Results: More than 14,000 people were reached and 14 service providers including midlevel providers were trained. The number of services significantly improved in the selected 6 branches and in all branches of FPA India. The numbers for syndromic treatment of STIs almost doubled in the selected 6 branches and showed a 50% rise in all the branches. The number of cervical cancer screenings was 2938 and 9862, before and after the project, respectively in the selected 6 branches. The progress nearly doubled at the whole association level. Additionally, in this project, the progress of visual inspection of the cervix with acetic acid (VIA) and Lugol´s iodine (VILI) was remarkable whether in 6 selected branches or in all branches. At the end of project implementation, VIA/VILI accounted for 90% of all cervical cancer screenings. Data are summarized in Table 1. Conclusion: This study presents FPA India's operational experience in carrying out integrated cervical cancer and STIs services, in urban slums and rural areas. This project reaffirms that raising people's awareness and building institutional capacity are core approaches to deliver certain SRH information and services as well as achieve better SRH outcomes. The shift from Papanicolaou test to VIA/VILI may be related to VIA/VILI's sensitivity, quick results and affordability. However, more studies are needed to explain this change.[Figure: see text][Table: see text]

모바일 건강정보서비스에서 지각된 상호작용성의 매개효과 분석

모바일 건강정보서비스에서 지각된 상호작용성의 매개효과 분석

Factors Influencing Access to Reproductive Health Information Services among Young Aged 15-24 in Garissa Municipality, Kenya

Young people face severe threats to their health and general well being. They are vulnerable to sexual assault and prostitution, too-early pregnancy and childbearing, unsafe abortion, malnutrition, female genital cutting, infertility, anemia, and reproductive tract infections (RTIs) including STIs and HIV/AIDS (NCPD, 2006). Close to a half of women aged 15-19 in Kenya are sexually active and by age 20-24 years, almost all (90%) are sexually exposed, and that 84% of the women aged 15-19 are single girls, then a large proportion of never-married girls are in their sexually active period (KDHS,2003).
 This study was designed to look into demographic, economic, cultural, health factors and the knowledge, attitude and practices influencing the access to Sexual Reproductive Health (SRH) information services amongst the youth of Garissa. The qualitative and quantitative data were collected through structured face to face interviews, focus group discussions and key informant. Data was analyzed using SPSS (version 17). The data from the qualitative methods were analyzed by using the thematic framework analysis. Independent variables influencing the access to SRH information among the youth were determined using multiple logistic regressions.
 In conclusion the overall access to SRH information by the youth in Garissa Municipality was low and was mostly influenced by the economic factors, cultural, religious and societal norms that marginalize the youth and the overall lack of access and programs to address youth friendly SRH information. To address the challenges in the access to youth friendly reproductive health information in this setting it is our recommendation that improve the Clinical services to offer the youths with Contraceptive and STI prevention services, antenatal, perinatal, and postnatal care, STI diagnosis and treatment and lastly empower youths with RH and rights and HIV information and life skills education through community outreach programmes.

Developing a generic tool to routinely measure the impact of health libraries.

Health libraries contribute to many activities of a health care organisation. Impact assessment needs to capture that range of contributions. To develop and pilot a generic impact questionnaire that: (1) could be used routinely across all English NHS libraries; (2) built on previous impact surveys; and (3) was reliable and robust. This collaborative project involved: (1) literature search; (2) analysis of current best practice and baseline survey of use of current tools and requirements; (3) drafting and piloting the questionnaire; and (4) analysis of the results, revision and plans for roll out. The framework selected was the International Standard Methods And Procedures For Assessing The Impact Of Libraries (ISO 16439). The baseline survey (n=136 library managers) showed that existing tools were not used, and impact assessment was variable. The generic questionnaire developed used a Critical Incident Technique. Analysis of the findings (n=214 health staff and students), plus comparisons with previous impact studies indicated that the questionnaire should capture the impact for all types of health libraries. The collaborative project successfully piloted a generic impact questionnaire that, subject to further validation, should apply to many types of health library and information services.

Source of Health Information and Unmet Healthcare Needs in Asian Americans

Background: Responding to the disparities in accessing and obtaining health information and healthcare among immigrant populations, the present study focused on Asian Americans. Using a sample that reflects Asian Americans’ cultural and linguistic diversities, the goal was to explore the typologies of health information source and their predictability to unmet healthcare needs (i.e., the experience of not being able to get needed medical care).Methods: Data were drawn from the 2015 Asian American Quality of Life Survey (N = 2,592), conducted using culturally and linguistically sensitive approaches. Latent class analysis on nine sources of health information across interpersonal networks (family members, close friends, acquaintances, and health professionals) and Internet-based communication technologies (mobile apps, email listservs, social networking sites, online communities, and health websites) identified six classes: ‘resource-heavy,’ ‘human-oriented,’ ‘expertise-focused,’ ‘family-dominant,’ ‘resource-scarce,’ and ‘health professional-dominant.’ Results: Compared to the resource-heavy group, the odds of having an unmet healthcare need were 2.94 times greater in the family-dominant group and 4.13 times greater in the resource-scarce group.Discussion: Findings provide implications for interventions with respect to subgroups to be prioritized and areas to be targeted in efforts to promote access and acquisition of health information and health services in Asian Americans.

Integrating electronic health records from different sources across the UK: lessons from a record linkage study

BackgroundHarmonisation of different data sources from various electronic health records (EHRs) across systems enhances the potential scope and granularity of data available to health data research.
 ObjectiveTo describe data harmonisation of routine electronic healthcare records in Wales and Scotland linked to a UK longitudinal birth cohort, the Millennium Cohort Study (MCS).
 MethodsComparable secondary care data was linked, with parental consent, to MCS information for 1838 and 1431 children participating in MCS and residing in Wales and Scotland, by assigning, respectively, unique Anonymised Linkage Fields to personbased records in the privacy protecting Secure Anonymised Information Linkage (SAIL) databank at Swansea University, and by the National Health Service (NHS) Information Standards Division. Survey and non-response weights were created to account for the clustered sample, sample attrition and consent to linkage. Heterogeneous variables from the Patient Episode Dataset for Wales, Emergency Department Data Set for Wales, Scottish Medical Record 01 and Accident and Emergency dataset for Scotland were harmonised enabling data to be pooled and standardised for research.
 FindingsOverall linkage to harmonised health care data was achieved for 98.9% (99.9% for Wales and 97.6% for Scotland) of consented MCS participants. 66% of children experienced at least one hospital admission (total 5747 hospital admissions) up totheir 14th birthday, while 60% attended A&E departments at least once (total 5221 attendances) between their 9th and 14th birthday. We managed date granularity by generating random dates of birth, standardising periods of data collection,identifying inconsistencies and then mapping and bridging differences in definitions of periods of care across countries and datasets.
 ConclusionsCombining and harmonising data from multiple sources and linking them to information from a longitudinal cohort create useful resources for population health research. These methods are reproducible and can be utilised by other researchersand projects.

The Health and Retirement Study: Analysis of Associations Between Use of the Internet for Health Information and Use of Health Services at Multiple Time Points.

BackgroundThe use of the internet for health information among older people is receiving increasing attention, but how it is associated with chronic health conditions and health service use at concurrent and subsequent time points using nationally representative data is less known.ObjectiveThis study aimed to determine whether the use of the internet for health information is associated with health service utilization and whether the association is affected by specific health conditions.MethodsThe study used data collected in a technology module from a nationally representative sample of community-dwelling older Americans aged 52 years and above from the 2012 Health and Retirement Study (HRS; N=991). Negative binomial regressions were used to examine the association between use of Web-based health information and the reported health service uses in 2012 and 2014. Analyses included additional covariates adjusting for predisposing, enabling, and need factors. Interactions between the use of the internet for health information and chronic health conditions were also tested.ResultsA total of 48.0% (476/991) of Americans aged 52 years and above reported using Web-based health information. The use of Web-based health information was positively associated with the concurrent reports of doctor visits, but not over 2 years. However, an interaction of using Web-based health information with diabetes showed that users had significantly fewer doctor visits compared with nonusers with diabetes at both times.ConclusionsThe use of the internet for health information was associated with higher health service use at the concurrent time, but not at the subsequent time. The interaction between the use of the internet for health information and diabetes was significant at both time points, which suggests that health-related internet use may be associated with fewer doctor visits for certain chronic health conditions. Results provide some insight into how Web-based health information may provide an alternative health care resource for managing chronic conditions.

Exploring diffusion strategies for mHealth promotion using evolutionary game model

Mobile health (mHealth) is an emerging healthcare practice that provides public health information and medical care services using mobile communication devices, such as smartphones and tablet computers. Given the service convenience and the great potential in reducing medical expense, the promotion of mHealth has become an indispensable component of healthcare reform in China. While Chinese government has shown strong support in promoting mHealth, the behaviors of different participants in mHealth have not been well studied, which prevents its fast diffusion in China. In this paper, by analyzing the current status of mHealth in China, we leverage the evolutionary game theory to build a novel model to capture the behaviors of two key participants, e.g., hospitals and patients, in mHealth. We analyze the payoff matrix between hospitals and patients such that a replicator dynamic system can be built. We validate the proposed model with detailed simulations. Our observations benefit not only the mHealth participants but also the government policy makers.

Indicators to assess the functionality of clubfoot clinics in low-resource settings: a Delphi consensus approach and pilot study

BackgroundThis study aims to determine the indicators for assessing the functionality of clubfoot clinics in a low-resource setting.MethodsThe Delphi method was employed with experienced clubfoot practitioners in Africa to rate the importance of indicators of a good clubfoot clinic. The consistency among the participants was determined with the intraclass correlation coefficient. Indicators that achieved strong agreement (mean≥9 [SD <1.5]) were included in the final consensus definition. Based on the final consensus definition, a set of questions was developed to form the Functionality Assessment Clubfoot Clinic Tool (FACT). The FACT was used between February and July 2017 to assess the functionality of clinics in the Zimbabwe clubfoot programme.ResultsA set of 10 indicators that includes components of five of the six building blocks of a health system—leadership, human resources, essential medical equipment, health information systems and service delivery—was produced. The most common needs identified in Zimbabwe clubfoot clinics were a standard treatment protocol, a process for surgical referrals and a process to monitor dropout of patients.ConclusionsPractitioners had good consistency in rating indicators. The consensus definition includes components of the World Health Organization building blocks of health systems. Useful information was obtained on how to improve the services in the Zimbabwe clubfoot programme.

Development of Saudi e-health literacy scale for chronic diseases in Saudi Arabia: using integrated health literacy dimensions.

ObjectiveHealth literacy has become a global issue, and it is important that patients and individuals are able to use information technology to access health information and educational services. The research objective is to develop a Saudi e-health literacy scale (SeHL) for measuring e-health literacy among Saudis suffering from non-communicable diseases (NCD).MethodsOverall, 14 relevant papers in related interdisciplinary fields were reviewed to select the most useful literacy dimensions. From these articles, we extracted the most common dimensions used to measure e-health literacy across the disciplines. Multiple workshops with multidisciplinary team members reviewed and evaluated items for SeHL.ResultsFour key aspects of e-health literacy—use of technology/media, information-seeking, usefulness and confidence—were identified and integrated as e-health literacy dimensions. These will be used to measure e-health literacy among Saudi patients with NCDs. A translation from Arabic to English was performed in order to ensure that translation process was accurate. A SeHL scale was developed to measure e-health literacy among Saudi patients. By understanding e-health literacy levels, we will be able to create a patient-education system to be used by patients in Saudi Arabia.ConclusionsAs information technology is increasingly used by people of all ages all over the world, e-health literacy has been identified as a key factor in determining health outcomes. To date, no comprehensive scale exists to assess e-health literacy levels among speakers of Arabic, particularly among people with NCD such as diabetes, cardiovascular diseases and hypertension.

Psychological Influence towards Health Consumers Intention to use A Malaysia National Web based Health Information Service

Drawing upon Health Belief Model, the study investigated the psychological predictors that determine the usage intention of the Malaysian web-based health information service, MyHEALTH Portal. The results of the measurement model show the evidences of outcome expectations and internal cues as the predictors to the portal usage, while external cues was found to be insignificant. The findings would help the Malaysia Ministry of Health in identifying significant psychological factors that influence the portal usage. This would allow them to re-strategize the portal’s marketing and promotional works effectively thus to be maximally used by the public while achieving its long-term goal.

Referral gynecological ambulatory clinic: principal diagnosis and distribution in health services

BackgroundThe association between gynecological diagnoses and their distribution in the health sectors provides benefits in the field of women’s health promotion and in medical and interdisciplinary education, along with rationalization according to level of care complexity. Thus, the objective is analyze the clinical-demographic characteristics, main diagnoses in gynecological ambulatory care, and their distribution in health services.MethodThis is a research project of retrospective audit study design with a chart review of data from 428 women treated at University Ambulatory Clinic of Women’s Health, the facility in gynecology and training for Family and Community Medical Residents, São Paulo, Brazil, from 2012 to 2014. Clinical and demographic information, gynecological diagnoses (International Classification of Diseases), and distribution of health services (primary, secondary, and tertiary) were described.ResultsThe female patients present non-inflammatory disorders of the female genital tract (81.07%, n = 347) and diseases of the urinary system (22.66%, n = 97) among the gynecological diagnoses. The chances of having benign breast disease and non-inflammatory disorders of the female genital tract during the reproductive period corresponds to being 3.61 (CI 1.00–16.29) and 2.56 times (CI 1.58–4.16) higher, respectively, than during the non-reproductive period. The non-inflammatory disorders of the female genital tract (93.33%, n = 28) are most related to the tertiary sector. The distribution in health services was the following: 71.30% (n = 305) in the primary sector, 21.70% (n = 93) in the secondary sector and 7% (n = 30) in the tertiary sector.ConclusionThe studied women presented non-inflammatory disorders of the female genital tract and diseases of the urinary system as determined by gynecological diagnoses. Low-assistance complexity followed in most cases.