Public Health Commons^™

Disparities In Hiv Clinical Stages Progression Of Patients At Outpatient Clinics In Democratic Republic Of Congo, Raimi Ewetola, Gulzar H. Shah, Lievain Maluantesa, Gina D. Etheredge, Kristie C. Waterfield, Astrid Mulenga, Apolinaire Kilundu

Health Policy & Community Health: Faculty Publications

Context: In this era of patient-centered care, it is increasingly important for HIV/AIDS care and treatment programs to customize their services according to patients’ clinical stage progression and other risk assessments. To enable such customization of HIV care and treatment delivery, the research evidence explaining factors associated with patients’ clinical stages is needed. Objectives: The primary objective of this study was to produce such scientific evidence by analyzing the most recent data for patients at outpatient clinics in the provinces of Kinshasa and Haut-Katanga and to examine the patient characteristics associated with WHO stages of disease progression. Methods: Using a …

The Relationships Between Stress, Psychosocial Resources, And Mental Health And Adherence Outcomes Among Perinatally Hiv-Infected Adolescents In South Africa, Thabani Nyoni

Brown School Graduate Student Theses and Dissertations

Adolescents living with perinatally acquired HIV (APHs) in sub-Saharan Africa (SSA) constitute a significant population group that is experiencing poor HIV treatment outcomes (CIPHER Global Cohort Collaboration, 2018). Compared to younger children and older adults within the SSA sub-region, APHs experience poorer health outcomes, including retention in care, virologic treatment failure, and mortality rates (Anderson et al., 2019). Among countries in the SSA sub-region, South Africa has 360,000 adolescents living with HIV (ages 10-19), a disproportionate burden, accounting for 20% of the global adolescents living with HIV (UNAIDS, 2019a). The public health costs of suboptimal antiretroviral treatment (ART) adherence in …

Risk Factors For Tb/Hiv Coinfection And Consequences For Patient Outcomes: Evidence From 241 Clinics In The Democratic Republic Of Cong, Gulzar H. Shah, Raimi Ewetola, Gina D. Etheredge, Lievain Maluantesa, Kristie C. Waterfield, Elodie Engetele, Apolinaire Kilundu

Health Policy & Community Health: Faculty Publications

(1) Background: In resource-limited countries, patients with tuberculosis (TB)/HIV coinfection commonly face economic, sociocultural, and behavioral barriers to effective treatment. These barriers manifest from low treatment literacy, poverty, gender inequality, malnutrition, societal stigmas regarding HIV, and an absence of available care. It is critical for intervention programs to understand and assist in overcoming these barriers and any additional risks encountered by patients with TB/HIV coinfection. This study analyzes variation in TB/HIV coinfection and risks of negative outcomes among patients with TB/HIV coinfection compared to those without coinfection. (2) Methods: This quantitative study used data from 49,460 patients receiving ART from …

Measuring The Impact Of The Affordable Care Act Medicaid Expansion On Access To Primary Care Using An Interrupted Time Series Approach, Elizabeth A. Brown, Brandi M. White, Walter J. Jones, Mulugeta Gebregziabher, Kit N. Simpson

Health and Clinical Sciences Faculty Publications

BACKGROUND: The Patient Protection and Affordable Care Act of 2010, commonly referred to as the Affordable Care Act (ACA), was created to increase access to primary care, improve quality of care, and decrease healthcare costs. A key provision in the law that mandated expansion of state Medicaid programme changed when states were given the option to voluntarily expand Medicaid. Our study sought to measure the impact of ACA Medicaid expansion on preventable hospitalization (PH) rates, a measure of access to primary care.

METHODS: We performed an interrupted time series analysis of quarterly hospitalization rates across eight states from 2012 to …

Medicare Support For Dental And Podiatry Graduate Medical Education Programs., Candice Chen, Yoonkyung Chung, Geoffrey Broadbent, Elizabeth Mertz

Health Policy and Management Faculty Publications

Importance: Oral health care faces ongoing workforce challenges that affect patient access and outcomes. While the Medicare program provides an estimated $14.6 billion annually in graduate medical education (GME) payments to teaching hospitals, including explicit support for dental and podiatry programs, little is known about the level or distribution of this public investment in the oral health and podiatry workforce.

Objective: To examine Medicare GME payments to teaching hospitals for dental and podiatry residents from 1998 to 2018, as well as the distribution of federal support among states, territories, and the District of Columbia.

Design, Setting, and Participants: This cross-sectional …

The Human Services Workforce Crisis: Moving Forward With Intention In Massachusetts, Suzanne Gray Henderson

School of Professional Studies

The human services field is growing rapidly in Massachusetts as it is across the country, and the Commonwealth does not have enough qualified staff to fill vacancies. The workforce shortage has risen to crisis levels due to high turnover, insufficient training, low wages, and a lack of recognition and appreciation for direct support professionals. The individuals receiving services in Massachusetts deserve quality and stability. The state budget – strained by inefficient service models and reactive fixes – also demands systemic change. The human services workforce crisis impacts a variety of stakeholders. Individuals served are directly affected, as are the direct …

Moving From Shelter To A Housing First Reponse, Robyn Kennedy

School of Professional Studies

Massachusetts is a right to shelter state for families who experience homelessness. Based on decisions made several decades ago, the state assigned the response to families who experience homelessness to the Department of Welfare (now the Department of Transitional Assistance) and a shelter, rather than a housing response was adopted. Following national best practice, the state has decided to transition the system to a Housing First response. Through this research, I will be evaluating the trends in the industry and assessing what Massachusetts needs to do to achieve a Housing First approach to serving families who are experiencing homelessness. Unless …

Group Living Environment Responses To Pandemic: A Case Study Of Advocates, And The Covid-19 Crises, Nicole K. Atchue

School of Professional Studies

The literature will take a deeper look in the personal lives of developmentally disabled members and their staff who experienced COVID-19 pandemic in a group living environments. The holistic approach of understanding will navigate the history of care and the level care needed as well as external factors that played a larger role in explanation for the support provided.

The Global Impact Of The Covid-19 Pandemic On Women’S Careers, Allison Bach

School of Professional Studies

This paper explores the impact that the COVID-19 pandemic has had on women’s careers on a global scale in the past year. It begins by focusing on the many pre-existing barriers that existed in realizing gender equality in the workplace prior to the pandemic, such as inadequate access to proper childcare, uneven participation in household labor between the genders, and pay inequality. The paper then continues to examine the impact that the pandemic has had on women’s careers across a variety of industries, countries, and specific groups. It was hypothesized that the COVID-19 crisis had created worse effects for women’s …

Title Ix: Perceptions And Utilization On U.S. College Campuses, Emma Narkewicz

School of Professional Studies

The research study investigated student perceptions and utilization of Title IX services on U.S. university and college campuses, testing the hypothesis that if students hold negative perceptions of Title IX offices, then they will not report campus sexual violence they experience to Title IX offices. There are currently high rates of sexual violence on college campuses but very low rates of reporting. Current or former U.S. college students aged 18-30 (N = 47) completed a mixed methods anonymous survey composed of Likert scale and open response questions. Participants were asked about prior interactions with Title IX offices and their perceptions …

Bail Discrimination: Racial Disparities In The United States Bail Determination Process, Collin Porter

School of Professional Studies

Nationwide, there is a systemic problem with bail determination: the process that a citizen goes through after they are arrested and before they go to trial to determine guilt or innocence for the crime they have been accused of committing. The United States leads all other countries with approximately half a million individuals detained before trial each year, a number nearly double the next highest country (China) (Nejdl, 2017). The high rate of pre-trial detention in the United States is due to both widespread use of monetary bail and the limited financial resources of most defendants; specifically, African American men. …

A Comprehensive Analysis Of Food Insecurity And Solutions In Worcester, Massachusetts, David Sullivan

School of Professional Studies

Worcester, Massachusetts is a postindustrial city with high levels of potential that faces the persistent obstacle of food insecurity for its low-income and ethnic minority communities. This research thesis examines food insecurity in general and explores data and trends in Worcester, then combines this with conceptual frameworks which explain how socioeconomic factors play into food security. It also explains the systemic inequalities present as a result of food insecurity and critiques academic assumptions surrounding food insecurity. One of these assumptions is that food deserts on their own can explain food insecurity in Worcester and elsewhere, though it has been found …

Happening In Plain Sight: An Evaluation Of Sexual Harassment In Municipal Government Through A Case Study Of Newark, New Jersey, Hoween R. A. Flexer, Caitlin R. Louie

School of Professional Studies

In the city of Newark, New Jersey, Sebrevious Scott, a participant in the New Jersey Reentry program was hired as part-time office assistant in the city's re-entry office. After being transferred to the city’s Parks and Grounds Departments, she started being sexually harassed, inappropriately touched and propositioned by her supervisor, Richard Kirkland. Scott made repeated attempts to report these actions through the appropriate channels. She was met with dismissal, resistance, and later retaliation. While working in this hostile environment she was also pursuing a full-time employment opportunity with the city upon the completion of the reentry program. Unfortunately, this never …

Understanding Modern History Of International Food Law Is Key To Building A More Resilient And Improved Global Food System, Michael T. Roberts

Journal of Food Law & Policy

This article advocates the need for a history of the development of modern international food law and suggests an analytical approach to complement the chronicling of events. Comprehension of this history will help elucidate the evolution of a complicated modern global food system, including its resiliency and vulnerability as demonstrated by Covid-19, thereby providing valuable context for change in the system where needed. This essay makes the case for such a history in three parts. First, it briefly demonstrates the need for a historical perspective through a critical examination of a journal article that speaks to Covid-19 food security in …

A Comparative Study Of Recovery Ecosystems For Opioid Use Disorder In Portugal And Appalachia, Jonathan David Mullins

Undergraduate Honors Theses

A comparison of the structure and effectiveness of recovery ecosystems for opioid use disorder in Portugal and Appalachia, with a focus on identifying areas for improvement within the Appalachian region.

Factors Associated With Health Coverage Gaps And Cost Barriers To Health Services In U.S. Adults Before And After The Aca, Danielle Kilchenstein

Loma Linda University Electronic Theses, Dissertations & Projects

Background

Health law known as the Affordable Care Act (ACA) was passed in 2010 and implemented in 2014 in the U.S. It was intended to reduce cost burdens to health coverage and care.

Purpose

Self-reported health coverage gaps and cost barriers to physical, mental, dental care, and prescription medications of U.S adults before and after the implementation of the ACA in 2014 were examined to determine impacts of health reform on marginalized populations.

Methodology

Cross-sectional secondary data analysis was conducted using National Health Interview Survey Data from the Integrated Public Use Microdata Set (2010-2017). The 140,341 surveys represented an average …

Increasing Mississippi’S Hpv Vaccination Rate: A Proposal Based On Providers’ Insights, Madison N. Thornton

Honors Theses

Despite high childhood vaccination rates for required vaccinations for kindergarten, including the MMR vaccine, Mississippi has the lowest HPV vaccination rate in the nation. This is so even though the HPV vaccine can prevent multiple cancers, including cervical cancer, of which Mississippi has the nation’s highest mortality rate. This study seeks to understand the factors surrounding Mississippi’s low HPV vaccination rate as well as potential policy solutions to increase this rate. To accomplish this, the author conducted interviews with 13 Mississippi physicians in various specialties to gather qualitative data. As a result of these interviews, the author found that the …

Marketing To Food Insecure College Students: An Investigation Into The University Of Mississippi’S Food Pantry, Dandridge Parks

Honors Theses

College students are documented to suffer food insecurity at a high rate, and student-run food pantries have aimed to alleviate some of this burden. However, these pantries operate inefficiently and struggle to adequately meet student needs. In particular, many students are unaware of the pantry or have barriers to use. Research has found that only 14% of food insecure college students use their campus food pantries. The objective of the following work is to improve future marketing for campus run food pantries, with a specific focus on the University of Mississippi’s pantry.

In the last year, the University of Mississippi’s …

Mortalidad Por Accidente Cerebrovascular En Guatemala 2018: Patrones E Inequidades, Alejandro Cerón, Gila Goldstein

Anthropology: Faculty Scholarship

El presente estudio busca analizar la mortalidad por accidente cerebrovascular (ACV) en Guatemala con el propósito de identificar posibles criterios epidemiológicos que orienten la priorización de acciones de salud pública. El riesgo de morir de ACV en Guatemala muestra marcadas desigualdades por departamento, las que son aún más marcadas al comparar por municipio. El riesgo de morir es también más alto en personas mestizas o ladinas, en niveles educativos bajos, y en personas que se dedican a ocupaciones elementales. Deberían implementarse medidas de salud pública orientadas a los municipios y grupos en mayor riesgo de morir de ACV. Este estudio …

Testing Of Patients First In A Real-World Setting, As A Patient Experience Accreditation Tool For Hospitals And Clinics, Carlos Bezos, Rosa M. Salazar, María Caballero

Patient Experience Journal

Many healthcare providers are developing patient experience strategies and investing in this area. Yet, patients have no means to know if a hospital is following proper patient experience standards. For this reason, it is important to certify that hospitals and clinics follow own a patient experience policy and apply patient experience standards. This is the reason why the accreditation Patients First was developed. The goal of this study is to test the accreditations’ feasibility in a real-life environment. The accreditation was tested at the Guadarrama Hospital, nearby Madrid in Spain. A mixed team between Guadarrama staff and the Institute for …

Patient And Provider Perspectives Regarding Criteria For Patient Prioritization In Two Specialized Rehabilitation Programs, Julien Déry, Angel Ruiz, François Routhier, Marie-Pierre Gagnon, André Côté, Daoud Ait-Kadi, Valérie Bélanger, Marie-Eve Lamontagne

Patient Experience Journal

To increase fairness and equity in access to rehabilitation services, a strategy emerging from the literature is patient prioritization. Selecting explicit prioritization criteria is a complex task because it is important to simultaneously consider the objectives of all stakeholders. The of this study was to compare service users’ and service providers’ perspectives regarding patient prioritization criteria in two rehabilitation programs. We conducted a multiple case study in two rehabilitation programs, i.e., a driving evaluation program and a compression garment manufacturing program. We sent a web-based survey asking two groups (patients and providers) to individually produce a set of criteria, then …

Exploring Mental Health Experience In Individuals Living With Temporomandibular Disorders, Wafaa Safour, Richard Hovey

Patient Experience Journal

Despite the evidence supporting deteriorating mental health because of temporomandibular disorders (TMDs) conditions, there is limited evidence of TMD patients' experience regarding how their mental health is affected by the disorders. As a sequence of these conditions, TMD patients suffer from physical and mental complications, not to mention the loss of food enjoyment. In this study, we aim to explore TMD patients' lived experiences who had changed their dietary habits concerning their mental health. Six participants were interviewed to answer open-ended questions during semi-structured interviews regarding their mental health experiences with TMD-related food routine changes. These interviews were held face-to-face …

Co-Production Of The Quality Of Patient-Centered Outcomes Research Partnerships Instrument For People With Mental Health Conditions, Karen L. Fortuna, Amanda Myers, Jessica Brooks, Caroline Collins-Pisano, Skyla Marceau, Sarah Pratt, Kathy Lyons, Robert Walker, Shavon Thompson, Kaycie Greene, Willie Pringle, Katina Carter

Patient Experience Journal

Mounting scientific evidence over the past decades in the field of psychiatry has shown community engagement in research produces more relevant research, increased uptake of research findings, and better clinical outcomes. Despite the need for the integration of community engagement methodologies into the scientific method, doctoral and master's level competencies in the field of psychiatry commonly do not include dedicated training or coursework on community engagement methodologies. Without appropriate training or research experience, attempts to facilitate community engagement are often ineffective and burdensome and leave stakeholders feeling disenfranchised. The goal of this study was to co-produce an instrument designed to …

The Experiences Of Rural British Columbians Accessing Surgical And Obstetrical Care, Aria Jazdarehee, Anshu Parajulee, Jude Kornelsen

Patient Experience Journal

The attrition of small volume surgical and maternity services in rural Canada over the past three decades has made access to these services especially challenging for rural citizens. While many of these closures have occurred as consequences of regionalization, a strategy to regionally centralize healthcare services, many studies investigating outcomes of regionalization have focused on costs and medical endpoints rather than the direct experiences of the rural patients affected. In this study, we aimed to understand and document the experiences of rural residents accessing procedural and maternity care both locally and away from home. This study is part of a …

Needle Phobia: How To Improve The Child's Experience During Blood Drawing, Maria D. Navarro, Helena Illera, Bonaventura Ruíz, Montserrat Naudó, Núria Serrallonga, Sonia Tordera, David Kornmehl, Lola Crevillén, Ana Bosque, David Nadal, Mercedes Jabalera

Patient Experience Journal

Pediatric diseases, pain and hospitalization have an important impact on children and their families. This is especially significant when considering common invasive procedures, such as blood drawing. The objectives of the study were to assess the experience of children and families during the blood drawing procedure and suggest methods for improvement. The study was conducted in a children’s hospital in Barcelona, Spain, between 2018 and 2020. A mix-method design or combination of qualitative and quantitative methodologies was developed. We carried out a search of the literature, a design thinking approach, and a survey. Results from the qualitative approach identified areas …

Surveying Pediatric Caregivers’ Readiness For Dyad Isolation In The Hospital During Covid-19, Shanqing Yin, Mei Zi Quek, Celestine Mun Ting Yeo, Sylvia Mun, Ronghui Li, Derrick Chan

Patient Experience Journal

The onset of any emerging outbreak is stressful for everyone. Singapore was one of many countries affected early by COVID-19. In response, many precautionary measures were quickly initiated, including the isolation of suspected COVID-19 pediatric cases, and their caregivers were isolated together with their hospitalized children as a result. Caregivers play an important role in facilitating their child’s health in the hospital. Rooming in with their children during hospitalization promotes the benefits of parental presence and reduces separation effects. However, sudden admission with strict movement restrictions poses stress to these caregivers too. This study ran a 3-part paper-based survey to …

Patients’ And Family Caregivers’ Perceptions Of Doctor-To-Doctor Advice And Electronic Referral Notifications In Alberta, Yong Li, Annabelle Wong

Patient Experience Journal

Effective communication between health professionals and patients is essential to patient safety and quality care. Primary care providers seeking specialist advice to manage patients’ conditions in the community has recently been adopted to improve timely access to specialty care and increase the efficacy of the referral process. To understand patients’ and family caregivers’ perceptions on doctor-to-doctor advice for non-urgent clinical questions and electronic referral communications with patients in Alberta, a mixed method online survey was conducted by Alberta Health Services’ Access Improvement team. A total of 1,422 patients and family caregivers living in Alberta were included in the quantitative and …

The Association Between An Established Chief Experience Officer Role And Hospital Patient Experience Scores, William Breen, Seongwon Choi, Kristina "Ria" Hearld, Stephen J. O'Connor, Edward Rafalski, Nancy Borkowski

Patient Experience Journal

The healthcare industry is currently reacting to multiple stakeholders demanding improvements to the patient experience. Some healthcare organizations are implementing new management structures, i.e., the role of Chief Experience Officer (CXO). This study statistically reviewed descriptors associated with hospitals that have and have not created and filled the role of CXO and, more importantly, measured the association between the CXO role and results of patients’ perceptions of their experience of care as measured by publicly reported Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) results. This study was conducted utilizing data gather on hospitals in three states, California, Florida, …

Safety Participation At The Direct Care Level: Results Of A Patient Questionnaire, Lenora Duhn, Nathaniel Gumapac, Jennifer Medves

Patient Experience Journal

Understanding how patients can be engaged in safety-related activities at the direct care level is of current relevance given global efforts to reduce harm in hospitals. As part of a multiphase study, including a descriptive, exploratory qualitative study (Duhn & Medves, 2018), patients were asked to respond to a brief questionnaire to quantify how they viewed their patient-reported safety participation behaviours while in hospital. This paper is a summary of those responses. The 8-item questionnaire was, in part, used to help address a secondary research question of the larger qualitative study, specifically: What behaviours do patients report in promoting their …

An Evidence-Based Tool (Pe For Ps) For Healthcare Managers To Assess Patient Engagement For Patient Safety In Healthcare Organizations, Ursulla Aho-Glele, Marie-Pascale Pomey, Maiana Regina Gomes De Sousa, Khayreddine Bouabida

Patient Experience Journal

In 1999, the Institute of Medicine had already warned that medical errors caused between 44,000 and 98,000 avoidable deaths per year in the United States. A similar situation was subsequently in 2000, documented in Canadian hospitals. According to a Canadian Patient Safety Institute report (2016), incidents in both acute and home care settings resulted in additional costs of $2.75 billion each year. Research suggests that Patient Engagement (PE) for Patient Safety (PS) can help address this issue. However, the use of PE in various strategies to promote PS has yet to be fully integrated across healthcare systems in OECD countries. …