Community Health Workers and Use of mHealth: Improving Identification of Pregnancy Complications and Access to Care in the Dominican Republic.

This article presents the feasibility and acceptability of using mobile health technology by community health workers (CHWs) in San Juan Province, Dominican Republic, to improve identification of pregnancy complications and access to care for pregnant women. Although most women in the Dominican Republic receive four antenatal care visits, poor women and adolescents in remote areas are more likely to have only one initial prenatal visit to verify the pregnancy. This community-based research began when community leaders raised concern about the numbers of their mothers who died in childbirth annually; San Juan's maternal mortality rate is 144/100,000 compared to the Caribbean rate of 85/100,000. Eight CHWs in three communities were taught to provide third-trimester antenatal assessment, upload the data on a mobile phone application, send the data to the local physician who monitored data for "red flags," and call directly if a mother had an urgent problem. Fifty-two pregnant women enrolled, 38 were followed to delivery, 95 antenatal care postintake were provided, 2 urgent complications required CHW home management of mothers, and there were 0 deaths. Stakeholders endorsed acceptability of intervention. Preliminary data suggest CHWs using mobile health technology is feasible, linking underserved and formal health care systems with provision of primary care in mothers' homes.

Prostate cancer early detection practices among men with a family history of disease.

OBJECTIVES: Genetic studies of familial prostate cancer, which is often asymptomatic until advanced stages, rely on correct designation of affection status. In this pilot study, we set out to determine the proportion of unaffected men whose families are participating in a study of hereditary prostate cancer who have been tested for prostate cancer with serum prostate-specific antigen (PSA) measurement and digital rectal examination (DRE). METHODS: Participants were identified from the University of Michigan Prostate Cancer Genetics Project, a family-based study of inherited prostate cancer susceptibility. Of the 141 eligible affected and unaffected sons of men with prostate cancer, 124 (88%) completed a mailed questionnaire regarding serum PSA testing and DRE history. RESULTS: Among unaffected men, 95% reported ever having had a PSA test, and 97% ever having had a DRE, with most initial tests occurring between the ages of 40 and 60 years. No significant difference in the mean age at first PSA test or DRE between the affected and unaffected men was observed. Affected men were significantly more likely than unaffected men to have a first PSA level greater than 2.5 ng/mL (P = 0.006), but not greater than 4.0 ng/mL (P = 0.614). CONCLUSIONS: Most men with a family history of prostate cancer are undergoing early detection testing. The differences in early detection testing practices do not appear to account for the difference in affection status among the sons of men with prostate cancer.