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2021

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Articles 31 - 60 of 133

Full-Text Articles in Medicine and Health

Senior Center Response To Covid-19: Technology, Ceara Somerville, Saralyn Collins, Caitlin Coyle, Jan Mutchler, Center For Social And Demographic Research On Aging, University Of Massachusetts Boston Aug 2021

Senior Center Response To Covid-19: Technology, Ceara Somerville, Saralyn Collins, Caitlin Coyle, Jan Mutchler, Center For Social And Demographic Research On Aging, University Of Massachusetts Boston

Center for Social and Demographic Research on Aging Publications

The COVID-19 pandemic has made the use of technology critical to remain socially connected with others while remaining physically distance. Senior centers in Massachusetts have had to think outside of the box and adapt their programs and services to be provided remotely, by phone, email, social media, and video calls. Moreover, senior centers have become responsible for helping older adults overcome their hesitations with using technology to keep them engaged and connected while physical gathering spaces have been closed.


Senior Center Response To Covid-19: Social Engagement And Outreach, Ceara Somerville, Saralyn Collins, Caitlin Coyle, Jan Mutchler, Center For Social And Demographic Research On Aging, University Of Massachusetts Boston Aug 2021

Senior Center Response To Covid-19: Social Engagement And Outreach, Ceara Somerville, Saralyn Collins, Caitlin Coyle, Jan Mutchler, Center For Social And Demographic Research On Aging, University Of Massachusetts Boston

Center for Social and Demographic Research on Aging Publications

Social isolation can have devastating effects on an individual’s mental and physical wellbeing. The COVID-19 outbreak has put older adults at greater risk of isolation and has pushed efforts to address isolation to the forefront of public health in Massachusetts. Senior centers have been working to end isolation in their communities long before COVID-19 and have continued that work in the face of a global pandemic. This fact sheet describes what Massachusetts senior centers are doing during the pandemic to address isolation among older community members.


The Emergence Of The Legitimacy Of Religious Healing Knowledge In Taiwan, Wei-Cheng Chiu Aug 2021

The Emergence Of The Legitimacy Of Religious Healing Knowledge In Taiwan, Wei-Cheng Chiu

LSU Doctoral Dissertations

This dissertation investigates how religious healing knowledge has been defined and used by scholars, physicians, and New Agers and how religious healing knowledge emerged as a legitimate area of knowledge in Taiwan. The key position of religious healing knowledge within the entanglement between religion and spirituality is also examined. After the martial law was lifted in 1987, Taiwan’s society had rapidly diversified, and its religions were at the transition point between the old and the new. Meanwhile, the new spirituality culture was introduced into Taiwan in the 1980s and got popular in the 1990s, and it inherited the trend of …


African Immigrants' Mental Health In Canada, Jessica O. Omorodion Aug 2021

African Immigrants' Mental Health In Canada, Jessica O. Omorodion

Undergraduate Student Research Internships Conference

African immigrants are the fastest growing immigrant population in Canada. However, they are still extremely under-researched especially in regards to their understandings and experiences with mental health. This is important to look at due to the stark differences between Canadian African views on mental health. Current literature shows that while African immigrants are self-reporting as having above average mental health, there are still taboos and discriminatory concerns that exist as a barrier to transparency with it. This research will utilize the Stata software to analyze the Canadian Community Health Survey (2017) to further look at African mental health in order …


The Experiences Of Healthcare Workers And Lawyers Engaging In Remote Work, Desha Puri, Tracey L. Adams Dr. Aug 2021

The Experiences Of Healthcare Workers And Lawyers Engaging In Remote Work, Desha Puri, Tracey L. Adams Dr.

Undergraduate Student Research Internships Conference

This study aims to compare the experiences of healthcare workers and lawyers engaging in remote work during the Covid-19 pandemic. The research poster presents a content analysis of the current research on the experiences of professions in the two fields mentioned above. In engaging in content analysis, the study advances a select number of thematic value codes that effectively characterize the similarities and differences between the two professions. With these thematic values codes, it has been found that the healthcare profession and law profession have had a similar experience working from home. With these similarities and differences, one can propose …


The Athletic Body: Eating Disorders In Canadian Sport History, Kimberly Callander Aug 2021

The Athletic Body: Eating Disorders In Canadian Sport History, Kimberly Callander

Undergraduate Student Research Internships Conference

Eating disorders in Canadian sport are and have been an ongoing issue for some time. In recent years, more research and education programs directed at athletes and their peers have been implemented. However, the topic has never been subjected to thorough historical analysis, specifically in Canadian history. The purpose of this research was to gain a complete understanding of sport-related eating disorder development in Canada.

To construct a social history analysis of eating disorders in Canadian sport, the exploration of Canadian policy statements, archived media sources, general history of eating disorders, and autobiographical accounts by Canadian athletes was conducted. The …


Associations Of Hair Dye And Relaxer Use With Breast Tumor Clinicopathologic Features: Findings From The Women’S Circle Of Health Study, Rohan Rao, Jasmine A. Mcdonald, Emily Barrett, Patricia Greenberg, Dede K. Teteh, Susanne B. Montgomery, Bo Qin, Yong Lin, Chi-Chen Hong, Christine B. Ambrosone, Kitaw Demissie, Elisa V. Bandera, Adana A.M. Llanos Aug 2021

Associations Of Hair Dye And Relaxer Use With Breast Tumor Clinicopathologic Features: Findings From The Women’S Circle Of Health Study, Rohan Rao, Jasmine A. Mcdonald, Emily Barrett, Patricia Greenberg, Dede K. Teteh, Susanne B. Montgomery, Bo Qin, Yong Lin, Chi-Chen Hong, Christine B. Ambrosone, Kitaw Demissie, Elisa V. Bandera, Adana A.M. Llanos

Health Sciences and Kinesiology Faculty Articles

Background

Building upon our earlier findings of significant associations between hair dye and relaxer use with increased breast cancer risk, we evaluated associations of select characteristics of use with breast tumor clinicopathology.

Methods

Using multivariable-adjusted models we examined the associations of interest in a case-only study of 2998 women with breast cancer, overall and stratified by race and estrogen receptor (ER) status, addressing multiple comparisons using Bonferroni correction.

Results

Compared to salon application of permanent hair dye, home kit and combination application (both salon and home kit application) were associated with increased odds of poorly differentiated tumors in the overall …


Can I Buy My Health? A Genetically Informed Study Of Socioeconomic Status And Health, Jennifer W. Robinette, Christopher R. Beam, Tara L. Gruenewald Aug 2021

Can I Buy My Health? A Genetically Informed Study Of Socioeconomic Status And Health, Jennifer W. Robinette, Christopher R. Beam, Tara L. Gruenewald

Psychology Faculty Articles and Research

Background

A large literature demonstrates associations between socioeconomic status (SES) and health, including physiological health and well-being. Moreover, gender differences are often observed among measures of both SES and health. However, relationships between SES and health are sometimes questioned given the lack of true experiments, and the potential biological and SES mechanisms explaining gender differences in health are rarely examined simultaneously.

Purpose

To use a national sample of twins to investigate lifetime socioeconomic adversity and a measure of physiological dysregulation separately by sex.

Methods

Using the twin sample in the second wave of the Midlife in the United States survey …


Accessing Healthcare In The Intermountain West During The Age Of Precarious Labor, Jordan Hammon Aug 2021

Accessing Healthcare In The Intermountain West During The Age Of Precarious Labor, Jordan Hammon

All Graduate Theses and Dissertations, Spring 1920 to Summer 2023

This research aims to improve our understanding about the association between precarious employment and healthcare access. Using the framework of neoliberalism and the history of welfare reform in the United States, this thesis investigates the relationship between precarious labor and two outcomes associated with health insurance access, namely Medicaid utilization, and being uninsured. I also examine one potential consequence of Medicaid utilization and lack of insurance, having a usual place of health care in the context of the Intermountain West region of the United States.

Using new survey data and quantitative methodologies, this research shows how economic changes, particularly related …


Deaths Of Despair In The United States, Amin Etemadifar Aug 2021

Deaths Of Despair In The United States, Amin Etemadifar

All Graduate Theses and Dissertations, Spring 1920 to Summer 2023

Life expectancy is one of the most important indicators of public health and is an indication of overall health status in a population. Thanks to public health and medical advancements over recent decades, the life expectancy of all nations has significantly increased, and that is more true for developed nations like the United States. However, the most recent data shows the longevity of Americans has become stagnant since 2010. So the first question that comes to mind is why that is happening, and the main goal of this dissertation is to answer that question.

In order to address that question, …


Assessing The Contribution Of Different Causes Of Death To Life Expectancy Disparities In The United States, Max Tyler Roberts Aug 2021

Assessing The Contribution Of Different Causes Of Death To Life Expectancy Disparities In The United States, Max Tyler Roberts

All Graduate Theses and Dissertations, Spring 1920 to Summer 2023

Life expectancy is not the same for all people in the United States. While some enjoy life expectancies of more than 80 years, others are at risk of dying much sooner. The following studies investigate how different causes of death such as homicide, diabetes, heart disease, and drug poisoning contribute across the life span to: 1) life expectancy gaps across different sex, racial, ethnic, and education groups, and 2) life expectancy change over time for different sex, racial, ethnic, and education groups. Each study focuses on a different area of the U.S., with Chapter 2 focusing on the national-level, Chapter …


Self-Reported Health Among Sexual Minorities In The United States, Christopher Burton Aug 2021

Self-Reported Health Among Sexual Minorities In The United States, Christopher Burton

Electronic Theses and Dissertations

Previous literature on LGBTQ+ people (lesbian, gay, bisexual, transgender, queer/questioning, and other sexual minorities) reports that this community experiences greater health problems than heterosexuals. LGBTQ+ people experience higher rates of chronic conditions, STIs, addiction, poor mental health, and cancer, which highlights the importance of capturing data regarding health. A growing concern is that social surveys fail to find meaningful ways to gather gender and sexuality data to understand possible health disparities for LGBTQ+ people. This study uses data from the General Social Survey to examine the physical and mental health outcomes of LGB people compared to straight people in a …


Addressing Diabetes Distress In Self-Management Programs: Results Of A Randomized Feasibility Study, Ranjita Misra, Samantha Shawley-Brzoska, Raihan Khan, Brenna O. Kirk, Sijin Wen, Usha Sambamoorthi Jul 2021

Addressing Diabetes Distress In Self-Management Programs: Results Of A Randomized Feasibility Study, Ranjita Misra, Samantha Shawley-Brzoska, Raihan Khan, Brenna O. Kirk, Sijin Wen, Usha Sambamoorthi

Journal of Appalachian Health

Background: West Virginia ranks 1st nationally in the prevalence of hypertension (HTN; 43.8%) and diabetes (16.2%). Patients with type 2 diabetes mellitus (T2DM) are distressed over physical and psychological burden of disease self-management.

Methods: This study investigated the effectiveness of an intervention to reduce diabetes distress and outcomes [glycemic control, blood pressure (BP)] among T2DM adults with comorbid HTN. Participants were randomized to a 12-week diabetes and hypertension self-management program versus a 3-month wait-listed control group. Trained health coaches and experts implemented the lifestyle program in a faith-based setting using an adapted evidence-based curriculum. Twenty adults with T2DM and HTN …


Rural Re-Entry And Opioid Use: Identifying Health-Related Predictors Of Relapse Among Formerly Incarcerated Women In Appalachia, Joseph M. Calvert, Megan F. Dickson, Martha Tillson, Erika Pike, Michele Staton Jul 2021

Rural Re-Entry And Opioid Use: Identifying Health-Related Predictors Of Relapse Among Formerly Incarcerated Women In Appalachia, Joseph M. Calvert, Megan F. Dickson, Martha Tillson, Erika Pike, Michele Staton

Journal of Appalachian Health

Introduction: Despite improved knowledge of the health care needs of formerly incarcerated women, there exists a gap regarding the relationship between health, health care access, and relapse among rural women returning to the community during the opioid epidemic.

Purpose: With an emphasis on health care access, this study examined health-related factors associated with opioid relapse among women reentering the community in rural Appalachia.

Methods: As part of a larger study, 400 rural women reporting a history of substance use were recruited from three Appalachian jails in Kentucky. Analyses focused on participants reporting a history of illicit opioid use prior to …


"Divide, Divert, & Conquer” Deconstructing The Presidential Framing Of White Supremacy In The Covid-19 Era, Vivian Louie, Anahi Viladrich Jul 2021

"Divide, Divert, & Conquer” Deconstructing The Presidential Framing Of White Supremacy In The Covid-19 Era, Vivian Louie, Anahi Viladrich

Publications and Research

Based on the analysis of President Donald J. Trump’s social media, along with excerpts from his speeches and press releases, this study sheds light on the framing of white supremacy during the first months of the COVID-19 pandemic in the United States. Our findings reveal that the triad of divide, divert, and conquer was crucial to Trump’s communications strategy. We argue that racist nativism—or racialized national threats to American security—is key to comprehending the external divisiveness in this strategy. When Trump bitterly cast China as the cause of America’s pandemic fallout and Mexico as the source of other key American …


Neighborhood Safety Concerns And Daily Well-Being: A National Diary Study, Jennifer W. Robinette, Jennifer R. Piazza, Robert S. Stawski Jul 2021

Neighborhood Safety Concerns And Daily Well-Being: A National Diary Study, Jennifer W. Robinette, Jennifer R. Piazza, Robert S. Stawski

Psychology Faculty Articles and Research

People living in unsafe neighborhoods often report poor health. The reasons for this are multi-faceted, but one possibility is that unsafe neighborhoods create a situation of chronic stress, which may deplete people's resources to cope with the daily stressors of life. How people respond to daily stressors (e.g., with increased self-reported negative affect and physical symptoms) is positively associated with health problems and may thus be one pathway linking perceptions of neighborhood safety to poor health. The current study investigated the relationship between neighborhood safety concerns, daily stressors, affective well-being, and physical health symptoms in a national sample of adults …


Black And White Health Disparities: Racial Bias In American Healthcare, Yasmeen Almomani Jul 2021

Black And White Health Disparities: Racial Bias In American Healthcare, Yasmeen Almomani

Bridges: An Undergraduate Journal of Contemporary Connections

This paper explores the historical implications of race in American society that have led to implicit racism in the healthcare system. Racial bias in healthcare against Black people is a factor in the health disparities between Black and white people in America, such as the gap in life expectancy, infant death, and maternal mortality. Black people are more likely to report racial discrimination from healthcare providers, which is a reason for the decreased quality of care received. The past justifications of slavery, the Tuskegee syphilis study, and the medical experimentations on Black women are horrifying but were considered acceptable in …


An Intersectional Approach To Time Poverty: A Pilot Study Of Time Poverty And Black Women’S Perceived Health Based On Semi-Structured Interviews, Lauriane Ngaya Fonkou Jul 2021

An Intersectional Approach To Time Poverty: A Pilot Study Of Time Poverty And Black Women’S Perceived Health Based On Semi-Structured Interviews, Lauriane Ngaya Fonkou

McNair Scholars Program

The term “time poor” describes people disproportionately burdened by responsibilities and inflexible work schedules resulting in little to no discretionary time. Time poverty was brought to my attention via the social media app TikTok where Black women creators expressed how time poverty affects them. Given that Black women are an especially vulnerable population in terms of health, I became curious about the relationship between time poverty and Black women’s health. However, the existing sociomedical science literature on time poverty does NOT adequately account for Black women’s subjectivity because the research considers mediators of class OR gender OR race but does …


Vulnerability To And Protection Against Covid-19 Fear, Threat, And Worry, Marsha Kim Huh Jul 2021

Vulnerability To And Protection Against Covid-19 Fear, Threat, And Worry, Marsha Kim Huh

Graduate Theses and Dissertations

Drawing from a sample of 10,368 adults living in the U.S., the current study examines the role of social and psychological resources in lowering COVID-related fear, threat, and worry, controlling for a number of social vulnerabilities (e.g. gender, race/ethnicity, and presence of children). The impact of social location, particularly in regards to race, and how one accesses and/or utilizes social and psychological resources is also examined through disaggregated regression models. Results demonstrate that some social and psychological resources impact COVID-specific distress (fear/threat/worry), but depending on the resource, relationships vary in direction and significance. The strength of social ties and mastery …


Special Report On Covid-19 Vaccination Trends Among Older Adults In Singapore, Micah Tan, Paulin T. Straughan, Wensi Lim, Grace Cheong Jul 2021

Special Report On Covid-19 Vaccination Trends Among Older Adults In Singapore, Micah Tan, Paulin T. Straughan, Wensi Lim, Grace Cheong

ROSA Research Briefs

This report examines trends in vaccination among older adults in Singapore to better understand why segments of older adults continue to resist vaccination against COVID-19. We find that individuals who were most likely to still be waiting to vaccinate or to not want to be vaccinated as of June 2021; are relatively older (aged 71-75), are of lower socioeconomic status (lower education levels and living in 1-3 room HDB flats), were the least likely to rely on Newspapers and Government Sources as sources of information for COVID-19 related news in November 2020, were least trusting of all sources of information, …


Design For Living Jun 2021

Design For Living

DePaul Magazine

With health care increasingly moving online, DePaul has emerged as a leader in cutting-edge digital technology leveraged for the greater good. From harnessing design as a vehicle for social change to creating an app to help close racial inequity gaps in care, 21st-century advances with an eye toward Vincentian values are unfolding every day at DePaul thanks to the inventiveness and ingenuity of its faculty, staff and students.


Science In Service Of Man: Towards An Understanding Of Medicine As An Institution Of Control, Amanda M. Strother Jun 2021

Science In Service Of Man: Towards An Understanding Of Medicine As An Institution Of Control, Amanda M. Strother

University Honors Theses

This paper applies the theoretical work of Frantz Fanon to discuss healthcare as an institution that upholds the will of the dominant authority in the contemporary United States. The use of Fanon's work outside of its original context is justified by applying the internal colonialism theory. Correctional healthcare is discussed as an area of overtly controlling and dehumanizing medical care, highlighting caregiver loyalty to correctional authority and reciprocal distrust between prison physicians and patients. This inquiry proposes that clinical healthcare displays the same power relationships through loyalty to the business of healthcare and the reciprocal distrust between physicians and patients …


Plotting The Literature On Precautionary Measures Of Covid-19: A Scientometric Analysis Of Web Of Science, Muhammad Shoaib, Nusrat Ali, Abeel Naseer Jun 2021

Plotting The Literature On Precautionary Measures Of Covid-19: A Scientometric Analysis Of Web Of Science, Muhammad Shoaib, Nusrat Ali, Abeel Naseer

Library Philosophy and Practice (e-journal)

This study attempted to evaluate the scholarly publications on COVID-19, social distance, physical distance, social isolation, and self-isolation employing the scientometric analysis technique from 2020 to 2021. The main purpose was to consolidate the published scholarship on the COVID-19 in the Web of Science indexed documents. A total of 635 publications were found. The results indicated that social distance and COVID-19 was the top topic along with the article as a type of document, and the majority were published in the English language in 2021. The name of Gimenez-Llort L was at top of the list of authors, along with …


Research Visualization Of Different Treatment Modalities To Treat Covid-19 Infection: Bibliometric Analysis Of Pubmed Database, Abeel Naseer, Muhammad Shoaib, Nusrat Ali, Imtiaz Ahmad Jun 2021

Research Visualization Of Different Treatment Modalities To Treat Covid-19 Infection: Bibliometric Analysis Of Pubmed Database, Abeel Naseer, Muhammad Shoaib, Nusrat Ali, Imtiaz Ahmad

Library Philosophy and Practice (e-journal)

This paper designed to examine research published in PubMed indexed journals of different treatment modalities to treat COVID -19 infection employing bibliometric analysis technique from 2020 to 2021. The purpose was to consolidate the published scholarly work in the PubMed database on different treatment modalities including vaccine, oxygen supplementation, dexamethasone or steroids, aspirin, heparin, remdesivir, zinc, vitamin c or ascorbic acid, oxygen, anti-malarial like chloroquine and hydroxychloroquine, and azithromycin or macrolides. We employed a bibliometric analysis technique and found a total of 3043 published documents. The study findings depicted that vaccine and COVID-19 top was at the top of the …


The Embodiment Of Discovery: An Adapted Framework For Qualitative Analysis Of Lived Experiences, Helen B. Hernandez, Laurie P. Dringus Jun 2021

The Embodiment Of Discovery: An Adapted Framework For Qualitative Analysis Of Lived Experiences, Helen B. Hernandez, Laurie P. Dringus

The Qualitative Report

We reflect on our process of working with an adapted framework as an effective strategy for analyzing and interpreting the results of our qualitative study on the lived experiences of insulin pump trainers. Interpretative Phenomenological Analysis (IPA) was applied as the overarching research methodology and was encapsulated into a framework adapted from Bonello and Meehan (2019) and from Chong (2019). We describe this framework as the “embodiment of discovery” to posit the researcher’s tangible experience of discovering the meaning of data that also brought transparency to the researcher’s process for data analysis and interpretation. We present challenges the doctoral student …


Characteristics And Predictors For Students Classified With Emotional And Behavioral Disorder Who Have Also Experienced Maltreatment, Richard E. Mattison, Gregory J. Benner, Skip Kumm Jun 2021

Characteristics And Predictors For Students Classified With Emotional And Behavioral Disorder Who Have Also Experienced Maltreatment, Richard E. Mattison, Gregory J. Benner, Skip Kumm

Educational Considerations

Though experiencing maltreatment (abuse or neglect) appears to be common in students with the special education label of emotional and behavioral disorders (EBD), little research has been devoted to this topic by EBD educators. This paper uses archived file drawer data from 1992 that focuses on 149 students newly classified with EBD for whom a wide range of enrollment variables was collected, and who were subsequently followed up on an average of 8 years later to assess their educational outcomes. At enrollment, experiences of maltreatment were determined to have occurred in 57.7% of these participants. The group who experienced maltreatment …


Decisions Are More Than Skin Deep: Exploring Correlations Between Self-Esteem And The Decision To Have Bariatric Surgery, Penny Fox, James Maples Jun 2021

Decisions Are More Than Skin Deep: Exploring Correlations Between Self-Esteem And The Decision To Have Bariatric Surgery, Penny Fox, James Maples

Kentucky Journal of Undergraduate Scholarship

Bariatric surgery is now a commonplace approach to addressing obesity. One insightful area of research is examining how bariatric decision relates to self-esteem. Of particular interest is correlations between self-esteem levels and the reason the surgery was selected, the source of the decision to get the surgery, and if the surgery recipient experienced a major life change following the event. In this study, the researchers examine a convenience sample of persons receiving bariatric surgery (n=31) and their motivations for having the surgery along with a pre-post measure of having the surgery. Results show respondents who indicated having the surgery was …


Different Hollers, Different Outcomes: Differences In Health Outcomes Among Appalachian And Non-Appalachian Counties In Kentucky, Allexys Krasnopolsky, James N. Maples Jun 2021

Different Hollers, Different Outcomes: Differences In Health Outcomes Among Appalachian And Non-Appalachian Counties In Kentucky, Allexys Krasnopolsky, James N. Maples

Kentucky Journal of Undergraduate Scholarship

This study examines difference in health outcomes, health insurance, and doctor access between Kentucky’s Appalachian and non-Appalachian counties. Using 2018 data curated by the Robert Wood Johnson Foundation, this study analyzes differences in means in overall health outcomes, health insurance, and the number of primary care physicians at the county level for Appalachian and non-Appalachian counties in Kentucky .This study finds that persons living in Appalachian Kentucky counties have statistically-different and worse overall health outcomes, health insurance access, and physician access compared to those living in non-Appalachian Kentucky counties.


Female Infertility In The United States And India: An Analysis Of Treatment Barriers And Coping Strategies, Devneet Singh Jun 2021

Female Infertility In The United States And India: An Analysis Of Treatment Barriers And Coping Strategies, Devneet Singh

Honors Theses

This research studies barriers to accessing fertility treatment in the United States (U.S.) and India, as well as the coping strategies infertile women use. Barriers include reproductive health knowledge, cost, and politics, while coping is affected by cultural stigma, family, and religion. These two countries were chosen for their different cultural contexts, healthcare systems, and political infrastructure. Ten fertility specialists across both countries were interviewed as expert informants. Reproductive health knowledge was the most important barrier to accessing care in both countries, with similar gaps in understanding when and what type of care to utilize, though social media can educate …


The Medical Treatment Of Obesity: On The Page & In The Office, Shayla J. Staley May 2021

The Medical Treatment Of Obesity: On The Page & In The Office, Shayla J. Staley

University of New Orleans Theses and Dissertations

This paper sought out the causes of weight discrimination in healthcare. Through content analysis of medical journals, the study illuminated several causes. These causes were used to create a concept matrix surrounding the medicalization of fatness that illustrated how these concepts are defined relationally, as well as how they combine to form the medical conception of the “obesity epidemic”. The concept matrix carries an indirect influence upon weight stigma that can lead to weight discrimination when fat folks seek out healthcare.