No abstract

Objective: This study evaluated the longitudinal impact of the Teen Outreach Programme (TOP) on adolescent pregnancy, sexual behaviour, risky sex and sexual intentions in non-metropolitan high schools. Design: Pair-matched, cluster randomised controlled trial. Setting: Non-metropolitan public high schools in Florida, USA. Methods: TOP was evaluated against the standard school health curriculum content. Young people ( N = 3,836) enrolled in 26 schools were surveyed at baseline (2012), immediate post-programme (2013) and at 1-year follow-up (2014). Most youth were 14 years old and in ninth grade at baseline. Missing data were imputed using a sequential imputation procedure and analysis took place using generalised linear mixed-effects models with logit link function. Results: Post-programme, young people in the treatment group were less likely to report ever having sex, recent sex, recent sex without a condom or intention to have sex in the next year. At 1-year follow-up, programme participants were less likely to report ever having been pregnant or having got someone pregnant. When examining treatment effects by gender, statistically significant differences were found only for female programme participants. Conclusion: Although many protective factors dissipated by second follow-up and were primarily found among female programme participants, TOP has the potential to decrease risky sexual behaviour.

Historically, African Americans (AAs) have been underrepresented as blood donors. Having a lack of racially diverse blood donors contributes to transfusion complications, particularly in patients with sickle cell disease, who are both disproportionately AA and the recipients of frequent transfusions. Increasing AA blood donation is a complex public health issue. This review article serves to fill a gap in translating research regarding known hindrances and facilitators of AA blood donation to improve real-world donation practice and ultimately, patient outcomes. We incorporate findings from a literature review to develop a tool that blood centers, provider organizations, and patient advocacy groups can use to aid strategic planning efforts aimed at increasing AA blood donation.

Chronic transfusion, used to manage clinically significant forms of thalassemia, carries complication risks including iron overload, alloimmunization, and allergic or hemolytic reactions. Dissemination and implementation of evidence-based guidelines for minimizing these risks are complicated by the small numbers and increasing dispersion of the thalassemia population. This elevates patients' role in understanding and communicating with providers about treatment. The present study sought to assess thalassemia patients' knowledge of transfusion, complications, and guidelines; their experience of clinicians' following guidelines; and their perspectives on ways to store and share personal transfusion data. A convenience sample of 32 patients participated in structured interviews. Most, if not all, understood iron overload, chelation therapy, blood typing, and cross-matching. Awareness of each of five of evidence-based transfusion guidelines that were discussed ranged from 72 to 88%. Patients expressed privacy concerns about each of three data storage options, slightly less for a registry than for a wallet card or smartphone app. The registry also avoided concerns that the other options placed extra burden on patients. Recommendations include increased education on the meaning and significance of packed, washed red blood cells, leuko-reduction, and detailed cross-matching, and implementation of a nationwide registry to make transfusion data available to providers anywhere at the point of care. Registry implementation should be sensitive to patients' privacy and security concerns, but also help them appropriately weigh those against safety benefits. These actions could help reduce transfusion complications in thalassemia by improving patient efficacy and increasing adherence to evidence-based guidelines.

Patient voice and perspective were needed to inform effective, comprehensive strategies for reducing preventable transfusion-associated complications. This report presents the results of interviews with sickle cell disease (SCD) patients and implications for strategies to reduce transfusion complications in this population. Twenty-two participants were recruited from 2 comprehensive SCD treatment centers in Georgia and interviewed regarding knowledge about transfusions and potential complications, attitudes about data storage and sharing, and the transfusion experience. Participants had general knowledge of physiology, blood products, and blood transfusions, including knowing the risk of complications, but varied in comprehension of complex health information and level of misinformation. Patients also varied in preferences for how they would like their transfusion information stored. They saw both advantages and disadvantages to wallet cards, smartphone applications, and registries. There is a need for a patient-centered approach that involves transfusion education and shared decision-making. Education should range from essential and simple to more in-depth to accommodate varying education and comprehension levels. Multiple tracking methods should be offered to store sensitive patient information.