Public Health Commons^™

Access To Healthcare For The Poor: Will The Affordable Care Act Address Income-Related Health Disparities In The United States?, Sonya Fabricant

Independent Study Project (ISP) Collection

Background: Low-income populations live shorter and less healthy lives in the United States due to a complexity of social, environmental and behavioral factors. These populations also face significant barriers in accessing health services. In 2010, the Patient Protection and Affordable Care Act (PPACA) passed, marking the first major reform of the American healthcare system since the 1960s. This paper evaluates its potential to address health disparities through changes to medical care delivery. Methodology: Results were compiled from government documents, reports from research institutes, journal articles, and an expert interview. A section-analysis was also performed, evaluating the strengths and weaknesses of …

Can Kawasaki Disease Be Managed?, Alberto Coustasse, Julius Larry, Doohee Lee

Management Faculty Research

Kawasaki Disease (KD) is the leading cause of acquired cardiovascular disease among children, but management of KD has received relatively little attention. In the US alone, about 5500 cases were estimated in 2009. KD is most common among Asian and Pacific Islander children but can affect all ethnicities and races. Timely and accurate diagnosis remains critical, but difficult: the etiology of KD is unknown, and no accurate diagnostic laboratory test has been developed. Continuing medical education can help physicians, clinicians, and nurse practitioners accurately diagnose and treat KD. A registry specific to KD or a surveillance system may be necessary …

Conocimientos Y Conductas Sexuales En Trabajadores Migrantes (Arica, Chile), Anna Conley

Independent Study Project (ISP) Collection

Background: The HIV/AIDS epidemic continues to be prevalent and to expand in Chile, as in many other regions of Latin America and around the world. Furthermore, it continues to concentrate in distinct, vulnerable populations. Migrant workers represent one such vulnerable population. The HIV/AIDS epidemic disproportionately impacts migrant workers because of the social, economic, and psychological factors that are involved in both migratory behaviors and disease construction.

Aim: This study identified sexual health knowledge and sexual health behavior in the migrant laborer population of Arica, Chile. More specifically, it identified risk factors for HIV/AIDS and explored possible strategies for a preventative …

Early Intervention Of Psychosis And Re! Ections For Programmes In India, Amresh Srivastava

Data and Test Instruments

Mental illness is perhaps the most common and most debilitating among non-communicable diseases. Schizophrenia, for example, normally occurs before the age of 25, affect the most productive years of life. The World Economic Forum graphically illustrates that mental illnesses will be a major contributor to the erosion of gross domestic product over the next 20 years. The developed world has established programs that have proven to be clinically and economically effective and sustainable.[1] Early intervention has played an important role in demonstrating that outcome can be improved if patients are treated in the early phase of illness. It is believed …

Developing Unique Engineering Solutions To Improve Patient Safety, Bradley Watts, Douglas Van Citters, Brian Shiner, Peter Mills

Dartmouth Scholarship

Many efforts to improve healthcare safety have focused on redesigning processes of care or retraining clinicians. Far less attention has been focused on the use of new technologies to improve safety. We present the results of a unique collaboration between the VA National Center for Patient Safety (NCPS) and the Thayer School of Engineering at Dartmouth College. Each year, the NCPS identifies safety problems across the VA that could be addressed with newly-engineered devices. Teams of Thayer students and faculty participating in a senior design course evaluate and engineer a solution for one of the problems. Exemplar projects have targeted …

Conflict Situation For Health Care Workers: A Case Study Of The Occupational Challenges In Kasangati Health Centre Iv And Their Implications For Patient Care., Shannon Mcdowell

Independent Study Project (ISP) Collection

Many factors influence a country’s ability to provide quality health services for its people. Particularly, quality health care hinges upon the availability of properly trained and equipped health care workers (HCWs) to deliver effective care. Resource-strained countries committed to the Millennium Development Goals are confronting the reality that shortages and uneven distribution of HCWs threaten their capacities to encourage and establish healthy communities. A scarcity in HCWs is one challenge of public health initiatives and places stress on existing HCWs. Other challenges faced by HCWs severely affect performance, motivation, and overall care-giving ability.

This study aims to examine the particular …

Preventing Hepatitis B-Induced Liver Cancer: Implications For Eliminating Health Disparities, Moon S. Chen Jr.

Journal of Health Disparities Research and Practice

If the definition of eliminating of a health disparity were signified by the absence of any differences in incidence or mortality between a population’s experiences with a health problem, then the only health disparity that has ever been eliminated is smallpox because with zero cases of smallpox in the world, no health disparities exist because of smallpox. The eradication of smallpox is perhaps the only historical example where the elimination of a health disparity has been achieved. Principles and lessons learned, particularly through the intersection of science and policy that could be applied to the elimination of other health disparities …

Perceptions Of Healthcare, Health Status, And Discrimination Among African-American Veterans, Nathaniel Rickles, Silvia Dominguez, Hortensia Amaro

Journal of Health Disparities Research and Practice

The Institute of Medicine identified access to healthcare and race-based discrimination as important barriers to quality healthcare that contributes to health disparities. This study (1) describes African-American veterans’ perceptions of healthcare services and perceived discrimination in healthcare and (2) investigates the relationship between perceived discrimination and patient perceptions of care, satisfaction with healthcare, and health status. A convenience sample of 141 African-American veterans in Boston completed surveys from May to June 2006.

Respondents reported an average of 16 lifetime experiences of discrimination and over half recalled a situation when they experienced discrimination in healthcare. Modest ratings of perceived quality of …

Determinants Of Depressive Symptoms Among Women On Public Assistance In Louisiana, Theresa C. Davidson, Joachim Singelmann

Journal of Health Disparities Research and Practice

Depression can be a significant barrier in the welfare-to-work transition of poor women. Fortunately, support from social networks can lessen symptoms and facilitate entry into the workplace. Inconsistency in the literature concerning the effects of social networks on the poor suggests further research is needed. Thus, we examine the level and determinants of depressive symptoms among participants in the Temporary Assistance to Needy Families program. Having a good job, being in good health, married, and black, and living in rural areas inhibit symptoms of depression. Remaining on TANF and having several children increases symptom levels. Those who report that they …

A Health Needs Assessment Of Arab-Americans In The Washington, Dc Area, Reem N. Ghoneim, Amita N. Vyas

GW Research Days 2012 and Earlier

Although Arab-Americans often face various health challenges due to the stress associated with immigration, cultural conflict in the U.S., and limited knowledge of the complex U.S. health system, there is a paucity of research examining health risks and behaviors among this ethnic group. This cross-sectional study assessed the health needs among Arabs living in the Washington, DC metropolitan area. Participants were recruited to take the survey online, reporting on health care access and utilization, risk behaviors, and health status. It also measured for associations between reported depression, discrimination, acculturation, and health. Quantitative analysis showed correlations between age and current tobacco …

Multistate Assessment Of Public Health Surveillance Relevant To American Indians And Alaska Natives, 2007, Jeanne Bertolli, Ed Chao, Michael Landen, Eden Wells, John M. Hayes, Zeenat Mahal, Ralph T. Bryan

Journal of Health Disparities Research and Practice

Improving the health of American Indian and Alaska Native (AI/AN) populations involves multiple agencies, levels of government, and jurisdictions. We assessed collaboration between state health departments and AI/AN Tribes and agencies through an online survey of State Epidemiologists. Frequencies and percentages of responses were examined by univariate and bivariate analyses. Among 39 states with federally recognized or state-recognized Tribes or federally funded urban Indian health centers, 25 (64%) participated. Nineteen had discussed public health surveillance with an AI/ AN government or nongovernment entity in the past 2 years (10 (53%) of these had ongoing, regular discussions about public health surveillance; …

Application Of A Re-Aim Framework To Assess The Impact Of The Southwest American Indian Collaborative Network, Michelle Chino, Carolee Dodge Francis

Journal of Health Disparities Research and Practice

In response to a Request for Proposals from the National Cancer Institute (NCI), the Inter Tribal Council of Arizona (ITCA) along with health care partners from the Phoenix Indian medical Center (PIMC) and academic partners from the Arizona Cancer Center (ACC) at the University of Arizona (UA), and the University of Nevada Las Vegas (UNLV) established a Community Network Program entitled the Southwest American Indian Collaborative Network (SAICN). The ultimate goal of the SAICN project was to “eliminate cancer health disparities by closing the gap between the health needs of the community and cancer prevention and control made possible by …

Asthma Management: An Ecosocial Framework For Disparity Research, Robin A. Evans-Agnew

Journal of Health Disparities Research and Practice

Background: Asthma management disparities (AMD) between African and White Americans are significant and alarming. Various determinants have been suggested by research frameworks that affect the unfair distribution of resources for asthma management to groups who are more or less advantaged socially. Ecosocial models organize determinants into individual/family, healthcare, community, and sociocultural levels. Multilevel interventions can affect AMD through simultaneous actions on different levels and pathways between determinants.

Objective: Provide a comprehensive summary of the known determinants of AMD.

Method: Peer reviewed research frameworks of AMD from 1998-2009 were retrieved from PubMed/ Web of Science databases using (“Socioeconomic Factors”[Mesh] OR (“Healthcare …

Race And Hepatitis C Management Within The Veterans Administration, Joahd Toure, Joshua Metlay, Sandford Schwartz, Knashawn Morales, David Kaplan, Peter Groeneveld

Journal of Health Disparities Research and Practice

Objective: To examine black-white differences in hepatitis C treatment within the Veterans Administration (VA) and determine whether racial variation in specialty consultation explains differences in hepatitis C treatment between blacks and whites.

Methods: We performed a retrospective cohort study of 1040 veterans meeting VA eligibility criteria for hepatitis C treatment. We used multiple imputation to handle missing race data. Specialty consultation was determined from the VA outpatient medical dataset and hepatitis C treatment was determined from the VA decision support system. Conditional logistic regression was used to examine the association between race and hepatitis C treatment as well as race …

Results Of Universal Prenatal Screening For Hepatitis C Infection In A Remote American Indian Primary Care Population, Christine Dubray, John T. Redd, Cecile M. Town, Kathy K. Byrd, Supriya Janakiraman, Anindya K. De, James E. Cheek

Journal of Health Disparities Research and Practice

BACKGROUND: Although chronic liver disease remains a major area of health disparity for American Indian (AI) people, the epidemiology of hepatitis C virus (HCV) infection among AI people is poorly documented. Because of suspected high local prevalence, two remote AI clinics in the Northern Plains implemented universal prenatal HCV screening in 2005. When this screening program reported an unexpectedly high prenatal anti-HCV (anti-HCV antibody) positivity rate, we conducted a case-control study to determine risks for infection and opportunities for community intervention.

MAIN FINDINGS: The clinics screened a total of 205 pregnant women (median age, 22 years). Of these 205 women, …

Value Of Community Partnership For Understanding Stress And Coping In Rural Yup’Ik Communities: The Canhr Study, Inna D. Rivkin, Ellen Lopez, Tonie M. Quaintance, Joseph Trimble, Scarlett Hopkins, Candace Fleming, Eliza Orr, Gerald V. Mohatt

Journal of Health Disparities Research and Practice

Stress and trauma can compromise physical and mental health. Rural Alaska Native communities have voiced concern about stressful and traumatic events and their effects on health. The goal of the Yup’ik Experiences of Stress and Coping Project is to develop an in-depth understanding of experiences of stress and ways of coping in Yup’ik communities. The long-range goal is to use project findings to develop and implement a community-informed and culturally grounded intervention to reduce stress and promote physical and mental health in rural Alaska Native communities. This paper introduces a long-standing partnership between the Yukon-Kuskokwim Regional Health Corporation, rural communities …

Community Health Centers: The Challenge Of Growing To Meet The Need For Primary Care In Medically Underserved Communities, Peter Shin, Sara J. Rosenbaum, Julia Paradise

Geiger Gibson/RCHN Community Health Foundation Research Collaborative

No abstract provided.

Does Access To A Family Physician Matter For Adolescents?, Bridget L. Ryan, Moira Stewart, M. Karen Campbell, John J. Koval, Amardeep Thind

CRDCN Research Highlight/RCCDR en évidence

No abstract provided.

Post-Acute Care Payment Reform Demonstration: Final Report Volume 4 Of 4, Barbara Gage, Melvin Ingber, Laura Smith, Anne Deutsch, Tracy Kline, Jill Dever, Judith Abbate, Richard Miller, Brieanne Lyda-Mcdonald, Cynthia Kelleher, Danielle Garfinkel, Joshua Manning, Christopher M. Murtaugh, Margaret Stineman, Trudy Mallinson

Clinical Research and Leadership Faculty Publications

This is the Final Report for the Post-Acute Care Payment Reform Demonstration (PAC-PRD), authorized by section 5008 of the Deficit Reduction Act of 2005, Public Law 109-171. The report has 12 sections, which are divided into four volumes: Volume 1: Executive Summary. Volume 2: Sections 1-4 (Section 1: Introduction; Section 2: Underlying Issues of the PAC-PRD Initiating Legislation; Section 3: Developing Standardized Measurement Approaches: The Continuity Assessment Record and Evaluation (CARE); Section 4: Demonstration Methods and Data Collection) Volume 3: Sections 5-6 (Section 5: Framework for Analysis; Section 6: Factors Associated with Hospital Discharge Destination) Volume 4: Sections 7-12; References …

Post-Acute Care Payment Reform Demonstration: Final Report Volume 3 Of 4, Barbara Gage, Melissa Morley, Laura Smith, Melvin Ingber, Anne Deutsch, Tracy Kline, Jill Dever, Richard Miller, Brieanne Lyda-Mcdonald, Cynthia Mckeller, Danielle Garfinkel, Joshua Manning, Christopher M. Murtaugh, Margaret Stineman, Trudy Mallinson

Clinical Research and Leadership Faculty Publications

This is the Final Report for the Post-Acute Care Payment Reform Demonstration (PAC-PRD), authorized by section 5008 of the Deficit Reduction Act of 2005, Public Law 109-171. The report has 12 sections, which are divided into four volumes: Volume 1: Executive Summary. Volume 2: Sections 1-4 (Section 1: Introduction; Section 2: Underlying Issues of the PAC-PRD Initiating Legislation; Section 3: Developing Standardized Measurement Approaches: The Continuity Assessment Record and Evaluation (CARE); Section 4: Demonstration Methods and Data Collection) Volume 3: Sections 5-6 (Section 5: Framework for Analysis; Section 6: Factors Associated with Hospital Discharge Destination) Volume 4: Sections 7-12; References …

Post-Acute Care Payment Reform Demonstration: Final Report Volume 1 Of 4, Barbara Gage, Melissa Morley, Laura Smith, Melvin Ingber, Anne Deutsch, Tracy Kline, Jill Dever, Judith Abbate, Richard Miller, Brieanne Lyda-Mcdonald, Cynthia Kelleher, Danielle Garfinkel, Joshua Manning, Christopher M. Murtaugh, Margaret Stineman, Trudy Mallinson

Clinical Research and Leadership Faculty Publications

This is the Final Report for the Post-Acute Care Payment Reform Demonstration (PAC-PRD), authorized by section 5008 of the Deficit Reduction Act of 2005, Public Law 109-171. The report has 12 sections, which are divided into four volumes: Volume 1: Executive Summary. Volume 2: Sections 1-4 (Section 1: Introduction; Section 2: Underlying Issues of the PAC-PRD Initiating Legislation; Section 3: Developing Standardized Measurement Approaches: The Continuity Assessment Record and Evaluation (CARE); Section 4: Demonstration Methods and Data Collection) Volume 3: Sections 5-6 (Section 5: Framework for Analysis; Section 6: Factors Associated with Hospital Discharge Destination) Volume 4: Sections 7-12; References …

Treating Methicillin-Resistant Staphylococcus Aureus With The Drug Vancomycin In A Home Infusion Therapy Setting, Joshua L. Webb, Alberto Coustasse, Dennis Emmett

Management Faculty Research

The basic purpose of this paper is to examine the effects the home infusion therapy has on the cost, duration of, and effectiveness of treatment between those individuals under 60 and those 60 and over. The results show that those 60 and over had a slightly higher cost/day. The older age group had slightly smaller treatment duration, then the younger group. The number of adverse effects was small. The results suggest that home infusion therapy appears to be a viable alternative to hospitalization.

Protecting Pakistan's Health During The Global Economic Crisis, Rashid Jooma, A Khan, A A. Khan

Section of Neurosurgery

The world is facing an unprecedented global economic crisis, with many countries needing to reconsider their level of health care spending. This paper explores the many consequences of the global economic turndown on Pakistan's health, including reduced government and donor spending and increased poverty with the consequent diversion of funds away from health. Nevertheless, these challenges may provide opportunities not only to mitigate the adverse effects of the economic crisis but also to institute some much-needed reforms that may not receive political support during more affluent times. Our suggestions focus on setting priorities based on the national disease burden, prioritizing …

Examining Cancer-Related Pain And Study Enrollment Challenges In The Home Care Setting, Linda G. Alley Phd, Rn, Hannah D. Paxton Rn, Mph, Michelle D. Flores Bsn, Rn, Carol A. Foltz Phd, Jen Wike Mph, Mba, Vickie Cunningham Bsn, Rn, Jeffrey Etchason Md

Department of Community Health and Health Studies

No abstract provided.

Health Status Of Children Entering Kindergarten: Results Of The 2011-2012 (Year Four) Nevada Kindergarten Health Survey, Nevada Institute For Children's Research And Policy Reports, Amanda Haboush, Tara Phebus, Brian Neau, Taylor Oliver, Enrique Lopez

Nevada Institute for Children's Research and Policy Reports

Academic achievement for children is vital to their success in life. Those that do well in school have greater opportunities for post-secondary education, and later have better prospects for employment. One of the major factors that can affect a child’s academic achievement is his or her health status. Academic outcomes and health conditions are consistently linked in the literature (Taras & Potts-Datema, 2005). Children with poor health status, and especially those with common chronic health conditions, have increased numbers of school absences and more academic deficiencies (Taras & Potts-Datema, 2005). In a study concerning excused versus unexcused absences, children with …

Care Of The Dying Patient: A Neglected Issue In Pakistani Context, Waris Qidwai

Department of Family Medicine

No abstract provided.

Post-Acute Care Payment Reform Demonstration: Final Report Volume 2 Of 4, Barbara Gage, Melissa Morley, Laura Smith, Melvin Ingber, Anne Deutsch, Tracy Kline, Jill Dever, Judith Abbate, Richard Miller, Brieanne Lyda-Mcdonald, Cynthia Kelleher, Danielle Garfinkel, Joshua Manning, Christopher M. Murtaugh, Margaret Stineman, Trudy Mallinson

Clinical Research and Leadership Faculty Publications

This is the Final Report for the Post-Acute Care Payment Reform Demonstration (PAC-PRD), authorized by section 5008 of the Deficit Reduction Act of 2005, Public Law 109-171. The report has 12 sections, which are divided into four volumes: Volume 1: Executive Summary. Volume 2: Sections 1-4 (Section 1: Introduction; Section 2: Underlying Issues of the PAC-PRD Initiating Legislation; Section 3: Developing Standardized Measurement Approaches: The Continuity Assessment Record and Evaluation (CARE); Section 4: Demonstration Methods and Data Collection) Volume 3: Sections 5-6 (Section 5: Framework for Analysis; Section 6: Factors Associated with Hospital Discharge Destination) Volume 4: Sections 7-12; References …

Estimating Medical Cost Offsets Attributable To Public Health Spending, Glen P. Mays

Health Management and Policy Presentations

Uncertainty about the magnitude and timing of economic returns associated with spending on public health services has contributed to policy debates about the optimal role of the federal government in financing these services.

Perbedaan Pelayanan Kesehatan Ibu Dan Anak Di Perkotaan Dan Daerah Terpencil, Sori M. Sarumpaet, Bisara L. Tobing, Albiner Siagian

Kesmas

Perbaikan pelayanan kesehatan masyarakat di Indonesia berjalan lamban dan tidak merata. Mutu layanan kesehatan sangat bervariasi karena distribusi tenaga kesehatan yang tidak merata. Penelitian ini bertujuan untuk mengetahui mutu layanan kesehatan ibu dan anak di daerah pedesaan dan perkotaan. Survei ini dilakukan di wilayah kerja Puskesmas Mogang yang mewakili daerah terpencil dan Puskesmas Buhit yang mewakili wilayah perkotaan di Kabupaten Samosir. Mutu layanan kesehatan dinilai dengan metode Services Quality. Hasil penelitian menunjukkan bahwa rata- rata skor harapan untuk semua dimensi mutu layanan kesehatan di Puskesmas Buhit dan Puskemas Mogang tinggi. Persepsi pelayanan ke- sehatan oleh pasien di Puskemas Buhit dan …

Recent Proposals To Limit Medigap Coverage And Modify Medicare Cost Sharing, Kathryn Linehan

National Health Policy Forum

As policymakers look for savings from the Medicare program, some have proposed eliminating or discouraging “first-dollar coverage” available through privately purchased Medigap policies. Medigap coverage, which beneficiaries obtain to protect themselves from Medicare’s cost-sharing requirements and its lack of a cap on out-of-pocket spending, may discourage the judicious use of medical services by reducing or eliminating beneficiary cost sharing. It is estimated that eliminating such coverage, which has been shown to be associated with higher Medicare spending, and requiring some cost sharing would encourage beneficiaries to reduce their service use and thus reduce program spending. However, eliminating first-dollar coverage could …