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    ABSTRACT: Resumption of sex before complete wound healing after male circumcision may increase risk of post-operative surgical complications, and HIV acquisition and transmission. We aimed to determine the effect of text messaging to deter resumption of sex before 42 days post-circumcision. We conducted a randomized trial where men >18 years old who owned mobile phones and had just undergone circumcision were randomized to receive a series of text messages (n=600) or usual care (n=600). The primary outcome was self-reported resumption of sex before 42 days. Sex before 42 days was reported by 139/491 (28.3%) men in the intervention group and 124/493 (25.2%) in the control group (relative risk=1.13, 95% CI 0.91-1.38, p=0.3). Men were more likely to resume early if they were married or had a live-in sexual partner (adjusted relative risk [aRR] 1.57, 95% CI 1.18-2.08, p<0.01); in the month before circumcision had one (aRR 1.50, 95% CI 1.07-2.12, p=0.02) or >1 (aRR 1.81, 95% CI 1.24-2.66, p<0.01) sexual partner(s); had primary school or lower education (aRR 1.62, 95% CI 1.33-1.97, p< 0.001); were employed (aRR 1.35, 95% CI 1.05-1.72, p=0.02); or were 21-30 years old (aRR 1.58, 95% CI 1.01-2.47, p=0.05); 31-40 (aRR 1.91, 95% CI 1.18-3.09, p<0.01) or >40 years old (aRR 1.76, 95% CI 1.04-2.97, p=0.03) compared to <21 years old. Text messaging as used in this trial did not reduce early resumption of sex after circumcision. We identified key risk factors for early resumption that need to be considered in circumcision programs.
    JAIDS Journal of Acquired Immune Deficiency Syndromes 07/2013; 65(2). DOI:10.1097/QAI.0b013e3182a0a050 · 4.56 Impact Factor
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    ABSTRACT: The Internet is commonly used to seek health-related information, but little is known about the quality of websites on developmental disabilities. Therefore, we sought to evaluate the characteristics and quality of websites located by searching ten common terms related to developmental disabilities and explore relations between website characteristics and website quality in order to make recommendations on ways to ensure locating good online information. We located 208 unique websites in our November 2012 US searches of Google and Bing. Two independent coders evaluated 10 characteristics of the websites and two different coders assessed the quality of the websites. From the 208 websites, 104 (50%) provided relevant information about the disability being searched. Of these 104 websites, those found to be of highest quality were least likely to be a sponsored result, contain advertisements, be from a for-profit company, and did contain references to peer-reviewed publications or had a top-level domain of .gov or .org. Individuals with developmental disabilities and their family members who choose to obtain disability-related information online should remain vigilant to ensure that they locate high-quality and accurate information and should not replace information obtained from health-care professionals and educational specialists with information found online.
    Research in developmental disabilities 07/2013; 34(10):3077-3083. DOI:10.1016/j.ridd.2013.06.013 · 4.41 Impact Factor
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    ABSTRACT: Rehabilitation for sensorimotor impairments aims to improve daily activities, walking, exercise, and motor skills. Monitoring of practice and measuring outcomes, however, is usually restricted to laboratory-based procedures and self-reports. Mobile health devices may reverse these confounders of daily care and research trials. Wearable, wireless motion sensor data, analyzed by activity pattern-recognition algorithms, can describe the type, quantity, and quality of mobility-related activities in the community. Data transmission from the sensors to a cell phone and the Internet enable continuous monitoring. Remote access to laboratory quality data about walking speed, duration and distance, gait asymmetry and smoothness of movements, as well as cycling, exercise, and skills practice, opens new opportunities to engage patients in progressive, personalized therapies with feedback about the performance. Clinical trial designs will be able to include remote verification of the integrity of complex physical interventions and compliance with practice, as well as capture repeated, ecologically sound, ratio scale outcome measures. Given the progressively falling cost of miniaturized wearable gyroscopes, accelerometers, and other physiologic sensors, as well as inexpensive data transmission, sensing systems may become as ubiquitous as cell phones for healthcare. Neurorehabilitation can develop these mobile health platforms for daily care and clinical trials to improve exercise and fitness, skills learning, and physical functioning.
    Current opinion in neurology 10/2013; 26(6). DOI:10.1097/WCO.0000000000000026 · 5.31 Impact Factor
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