Health Services Research Commons^™

Pola Rujukan Penyakit Saluran Pernapasan Di Fasilitas Kesehatan Tingkat Pertama: Tantangan Gatekeeper Program Jaminan Kesehatan Nasional Di Jakarta, Syarif Rahman Hasibuan, Melrose Holy Natasha, Fatih Jihadi Ramadan

Jurnal Biostatistik, Kependudukan, dan Informatika Kesehatan

Program Jaminan Kesehatan Nasional yang diselenggarakan oleh Badan Penyelenggara Jaminan Sosial (BPJS) Kesehatan mewajibkan Fasilitas Kesehatan Tingkat Pertama (FKTP) untuk menyeleksi kasus yang memerlukan rujukan. Penyakit saluran pernapasan yang menjadi penyebab utama kunjungan ke FKTP memiliki pola rujukan yang masih belum banyak diteliti. Oleh karena itu, dilakukan penelitian untuk melihat pola rujukan penyakit saluran pernapasan di FKTP dan mengetahui faktor yang berasosiasi dengan keputusan rujukan. Penelitian potong lintang ini dilakukan terhadap 89.225 klaim FKTP di Jakarta pada periode 2017-2023, dengan kriteria inklusi semua kunjungan dengan diagnosis ICD-10 diseases of the respiratory system. Uji regresi logistik dilakukan untuk mengidentifikasi faktor …

Self-Management Interventions For Adults With Type 2 Diabetes Mellitus In Thai Primary Care And Community Settings: A Scoping Review, Sansanee Seetangkham, Supaluk Seetunya, Subhawan Yodprong

Kesmas

Diabetes mellitus is a leading cause of mortality and economic burden, with significant impacts on health outcomes and quality of life. Effective self-management is crucial for controlling Type 2 Diabetes Mellitus (T2DM). Thailand has implemented diverse self-management interventions for adults with T2DM in primary care and community settings, but the components, delivery, duration, and outcomes of these interventions have not been synthesized. Following the Arksey and O’Malley framework, Joanna Briggs Institute guidance, and PRISMA-ScR, five databases were searched from inception to June 2025. Eligible English-language intervention studies involved Thai adults with T2DM in primary care or community settings. Study characteristics …

Cost-Effectiveness Evaluation Of Artificial Intelligence-Assisted Chest Radiograph Interpretation For Tuberculosis Screening In Rural Health Units In The Philippines, Harold Henrison C. Chiu, Bryan Christopher C. Lao, Gloanne C. Adolor

Graduate School of Business Publications

Background: Tuberculosis remains a major public health burden in the Philippines, where diagnostic delays are amplified by limited radiology capacity in rural health units (RHUs) and geographically isolated and disadvantaged areas (GIDAs). Computer-aided diagnosis (CAD) using artificial intelligence (AI)-assisted chest radiograph interpretation may shorten the screening pathway and reduce reliance on scarce specialist readers. However, its economic value for RHUbased tuberculosis screening has not been fully evaluated.
Methods: We developed a decision-tree cost-effectiveness model in Microsoft Excel 365 to compare AI-assisted chest radiograph interpretation with conventional manual radiologist or teleradiology interpretation among a theoretical annual cohort of 1,000 presumptive tuberculosis …

Quantifying Black Carbon Concentrations In Georgia And Analyzing Associated Public Health Risks, Khloe R. Osborne

Honors Theses

Quantifying Black Carbon Concentrations in Georgia and Analyzing Associated Public Health Risks

One of the most daunting challenges of the industrial world is air pollution. Within this broad spectrum, there is an inhalable particle group named PM2.5, which contains black carbon. Black carbon has evidence that supports the generation and worsening of adverse health impacts, which may include birth complications, cognitive deficits in children, pulmonary aggravation, asthma, cardiovascular issues, neurological degenerative patterns, and cancer risk. This is especially seen in vulnerable populations, like children, elderly, and those who already suffer from weakened health, many of which reside in the southern …

The Role Of Gynecologic Oncologists In Improving Survival Outcomes Of Epithelial Ovarian Cancer: A Retrospective Cohort Study, Widyorini Lh Hanafy, Bambang Dwipoyono, Asri C. Adisasmita, Yosephine E. Regina, Airine S. Lians, Oktaviani P. Rahayu, Jane G. Auwelia

Kesmas

Epithelial ovarian cancer (EOC) is a leading cause of gynecological cancer mortality and is often diagnosed at an advanced stage, resulting in poor survival outcomes. Access to specialized gynecological oncology services has been associated with improved prognosis; however, data on its impact in Indonesia remain limited. This study aimed to evaluate the association between gynecologic oncologist (GO) services and disease-free survival (DFS) in patients with EOC. This retrospective cohort study included 76 patients with EOC who were treated at a national cancer hospital in Jakarta between 2015 and 2018. Patient data were obtained from medical records and followed for three …

Short-Term Survival And Prognostic Factors In Cervical Cancer Patients Requiring Hemodialysis: A Retrospective Cohort Study, Muhammad Trihatmowijoyo Bundjali, Maruhum Bonar Hasiholan Marbun, Wulyo Rajabto, Ikhwan Rinaldi, Hamzah Shatri, Dwi Lestari Partiningrum, Dadang Makmun, Pringgodigdo Nugroho, Sukamto Koesnoe, Pradana Soewondo

Kesmas

Cervical cancer is a common gynecological malignancy, particularly in developing countries, where it coexists with renal impairment in over one-third of patients. This disease typically presents acutely and progresses rapidly. Consequently, kidney replacement therapy, including hemodialysis (HD), is commonly required. To assess survival rates and associated factors, this retrospective cohort study analyzed the medical records of 252 cervical cancer patients who began HD across a three-month follow-up period. Kaplan–Meier analysis indicated a median short-term survival duration of 71.5 days (range: 7–90), with 1-, 2-, and 3-month survival rates of 56%, 51%, and 49%, respectively. Multivariate Cox regression identified post-HD systolic …

Trends Among Suspected Opioid Overdose Emergency Medical Service (Ems) Incidents In Georgia From 2019-2023, Ashton Harris

College of Graduate Studies: Theses & Dissertations

Opioid overdoses remain a problem in the United States, underscoring the need for additional surveillance tools to monitor trends in opioid overdoses. Emergency Medical Services (EMS) data is a timely surveillance method that captures more potential overdoses than hospitals by representing the pre-hospital setting. Research questions in the study assess EMS responses to suspect opioid overdose incidents from 2019-2023 in Georgia to encompass the following characteristics: timeframe (pre, during, post-pandemic), urban versus rural counties, race/ethnicity, categorical type of first responder, mean dosage of naloxone in milligrams administered, and death. 84,359 records meeting the inclusion criteria were initially retrieved from the …

Exploring The Impact Of Adverse Childhood Experiences On Preventive Healthcare Utilization In Rural Georgia, Ryan R. Traylor

College of Graduate Studies: Theses & Dissertations

This study examines the relationship between Adverse Childhood Experiences (ACEs) and preventive healthcare use among adults in Georgia, specifically within rural populations facing structural barriers. Using 2023 Georgia Behavioral Risk Factor Surveillance System (BRFSS) data, the research analyzes associations between ACE exposure, rural residence, and preventive care outcomes, including physical exams and flu vaccinations. Guided by an intersectionally adapted version of Andersen’s Behavioral Model of Health Services Use, the study evaluates how predisposing factors, enabling resources, and perceived barriers relate to healthcare engagement. Logistic regression analyses assess the correlation of ACE exposure, cost barriers, provider access, and sociodemographics with preventive …

Assessing And Advancing Pandemic Emergency Preparedness In New York City's Hospitals: A Strategic Management Toolkit Integrating Policy Analysis, Risk Assessment, And Stakeholder Insight, Irrem Jamal

College of Graduate Studies: Theses & Dissertations

This dissertation examines pandemic emergency preparedness in New York City hospitals, which were severely strained during COVID-19, revealing critical gaps between documented plans and operational readiness. Using a multimethod approach combining a survey of 20 stakeholders across city hospitals, semi-structured interviews, and document analysis of policy frameworks and after-action reports, the study identifies a persistent "documentation-execution paradox": while 80% of respondents confirmed clear pandemic plans, only 45% expressed confidence in staffing adequacy, 55% in surge planning realism, and just 45% confirmed regular drills. Qualitative analysis revealed workforce as the single greatest yet most underinvested vulnerability, supply chain fragility rooted in …

On Burden Of Diseases, Prevention, Medical Research And Health Service Delivery: Grampian Case Study, Seshadri S. Vasan, Sudarshan Anand, Miae Lee, Nicholas C. Fluck

Research outputs 2022 to 2026

Burden of diseases measured as disability-adjusted life years (DALYs) per 100,000 people can be mined from public domain data, when they are made available by population health surveillance systems. This can be analysed to allow insightful comparisons with the national average, and to understand differences in trends between the sexes, age groups, time periods, geographic regions, and sub-regions. In this illustrative case study, we have analysed the Scottish burden of disease database to understand what ailed the population of the Grampian region before the COVID-19 pandemic. We have identified that selected cancers, ischaemic heart disease, Alzheimer’s disease and other dementias …

Public Perception About Covid-19 Vaccine Hesitancy In South Central Nebraska, Rita Nnenne Oparaocha

Biology Theses, Dissertations, and Student Creative Activity

The COVID-19 pandemic created a shift in the trajectory of vaccination hesitancy, altering risk perceptions and vaccination attitudes among individuals in rural communities. The 5C framework highlights confidence, complacency, constraints, calculation, and collective responsibility as influencing factors of vaccine hesitancy. This study assessed the proportion of adults who refused COVID-19 vaccination and identified the individual reasons for hesitancy among those who refused the COVID -19 vaccines in South Central Nebraska. Data was analyzed from a local cross-sectional public health survey administered to 2,034 adult participants over a six-month period (March-August 2024), including 91 respondents who were from outside the seven-county …

Documentation And Referral Of Social Determinants Of Health In New Mexico’S Emergency Departments: International Classification Of Disease, Tenth Revision, Clinical Modification, “Z Codes” (Z55-Z65), Samuel L. Swift, Maya Stefanovic, Roselyn Thalathara

Population Health Research and Scholarship

No abstract provided.

Obesity Severity And Cancer Screening In Us Adults, Florina Corpodean, Michael Kachmar, Shengping Yang, Michael W. Cook, Philip R. Schauer, Vance L. Albaugh

School of Medicine Faculty Publications

No abstract provided.

A Modern Analytical Method To Forecast Cerebrovascular Diseases (Cd), And Heart Diseases (Hd) Using Multivariate Time Series Model Utilizing The Cdc Provisional Mortality Data, Aditya Chakraborty, Mohan Pant

Cardiovascular Research Symposium

Background: In this study, a new analytical approach was introduced to answer specific questions related to mortalities due to cerebrovascular diseases, heart diseases, and the association of these mortalities with twelve other causes of death (COD).

Methods: A multivariate time series forecasting model was developed utilizing each of the CODs by taking the weekly and yearly seasonality into account, and the mortality counts were forecasted using the most recent CDC weekly mortality count data. A new COD data matrix was structured for all CODs as a function of weeks by combining the observed and predicted values of the mortality counts. …

A Cancer Education Needs Assessment: Informing Middle-Aged Female Patients About The Relationships Between Obesity And Women’S Health Concerns In The Reproductive System, Breast, And Endometrial Health, Batul Mirza

MUSC Theses and Dissertations

Obesity significantly impacts women’s health, particularly among middle-aged women, by increasing the risk of hormone-sensitive cancers such as breast, endometrial, and reproductive system cancers. This study examines the educational needs of this demographic group regarding obesity-related cancer risks and explores effective intervention strategies. Obesity-induced mechanisms – hormonal imbalances, chronic inflammation, and insulin resistance – drive cancer susceptibility, emphasizing the need for targeted health education. The study employs a qualitative design, which includes interviews with subject matter experts (SMEs) and surveys of middle-aged women. The goal is to assess awareness, perceived barriers, and preferred learning methods. Findings suggest that with many …

Using The Observational Medical Outcomes Partnership Common Data Model For A Multi-Registry Intensive Care Unit Benchmarking Federated Analysis: Lessons Learned, Aasiyah Rashan, Daniel P Püttmann, Nicolette F De Keizer, Dave A Dongelmans, Ronald Cornet, Otavio Ranzani, Wangari Siika, Matthew Smith, Steve Harris, Abi Beane

Anaesthesiology, East Africa

Objective: Federated analysis is a method that allows data analysis to be performed on similar datasets without exchanging any data, thus facilitating international research collaboration while adhering to strict privacy laws. This study aimed to evaluate the feasibility of using federated analysis to benchmark mortality in 2 critical care quality registry databases converted to the Observational Medical Outcomes Partnership (OMOP) Common Data Model (CDM), describing challenges to and recommendations for performing federated analysis on data transformed to OMOP CDM.

Materials and Methods: To identify as many challenges as possible and to be able to complete the benchmarking phase, …

Intersectoral Interventions: Integration For Impact On Preterm Birth, Etienne V. Langlois, Maria El Bizri, Kelly Thompson, Amy Reid, Merette Khalil, Giulia Gasparri, Joy E. Lawn, Teesta Dey, Judith Robb-Mccord, Marleen Temmerman

Centre of Excellence in Women and Child Health

Progress: The last two decades have seen a growing focus on intersectoral interventions to improve maternal and newborn health and well-being outcomes, as refected in eforts to achieve the Millennium Development Goals (MDGs) and advance the Sustainable Development Goals (SDGs). Preterm births are linked to cross-sectoral determi‑ nants that afect health outcomes and human capital across the life-course, necessitating an intersectoral approach that addresses these multifaceted challenges.

Programmatic priorities: Recognizing that social, biological and economic determinants signifcantly infuence health outcomes, it is critical that robust health systems are reinforced by a comprehensive intersectoral approach. Evidence suggests that the factors infuencing …

Exposure To Second-Hand Smoke In Homes And Respiratory Symptoms Among Non-Smoking Adults In Depok, Indonesia 2025, Faraz Ali, Budi Hartono

Journal of Indonesian Health Policy and Administration

Second-hand smoke (SHS) exposure in the home environment has become a public health emergency, especially in countries with very high smoking rates, such as Indonesia. SHS exposure has already presented evidence of symptoms of the respiratory category, like a cough and shortness of breath. This study aimed to assess the association between exposure to SHS at home and the presence of respiratory symptoms among non-smoking adults in Depok, Indonesia. Convenience sampling was adopted for enrolling 108 non-smoking adults aged 18-30 who were jointly exposed to SHS in their homes for a cross-sectional study. Data aggregations of gatherings were performed using …

Racial Disparity And Environmental Influences On Perinatal Health In Jefferson County, Kentucky., Felicia A Pugh

Electronic Theses and Dissertations

Background: Severe maternal morbidity (SMM) risk has tripled over the past 30 years. Adverse infant birth outcomes in the U.S. have also increased with substantial Black-White disparities. Objectives: This work compares the frequency of adverse maternal and infant birth outcomes by maternal race (Black vs White) and examines associations between maternal ambient heavy metal exposures and birth outcomes in Jefferson County, Kentucky, 2017-2022. Methods: Jefferson County inpatient hospital delivery and birth certificate records of self-identified Black or White birthing parents were used. Incidence of SMM, stillbirth, preterm birth (PTB), and small for gestational age (SGA) with 95% confidence intervals (CI) …

Socio-Medical Factors Associated With Neurodevelopmental Disorders On The Kenyan Coast, Patricia Kipkemoi, Jeanne E. Savage, Joseph Gona, Kenneth Rimba, Martha Kombe, Paul Mwangi, Collins Kipkoech, Beatrice Mkubwa, Amina Abubakar, Charles Newton

Institute for Human Development, East Africa

Neurodevelopmental disorders (NDDs) are a group of conditions with their onset during the early developmental period and include conditions such as autism and intellectual disability. Occurrence of NDDs is thought to be determined by both genetic and environmental factors, but data on the role of environmental factors for NDD in Africa is limited. This study investigates environmental influences on NDDs in children from Kenya. This case-control study compared children with NDDs and typically developing children from two studies on the Kenyan coast. We included 172 study participants from the Kilifi Autism study and 151 from the NeuroDev study who had …

Knowledge, Attitudes, And Practices Regarding Antimicrobial Resistance And Antimicrobial Stewardship Among Healthcare Workers In Outpatient Medical Centers In Kenya: A Qualitative Study, Mary Kaniu, Wahu Gitakah, Rupali Jain, Ann Munyare, Rodney Adam, Aliza Monroe Wise

Paediatrics and Child Health, East Africa

Objective: Antimicrobial resistance (AMR) is a major global health threat with a projected 10 million deaths globally by 2050. Antimicrobial stewardship (AMS) programs are coordinated efforts involving doctors, nurses, pharmacists, and other healthcare providers. Understanding knowledge, attitudes, and practices of health providers is pivotal for implementing strategies to curb the spread of AMR. The aim of this study was to evaluate knowledge, attitudes, and practices surrounding AMR and AMS among healthcare workers in Kenya.

Design: A qualitative study using in-depth semi-structured interviews

Setting: 12 private outpatient clinics in Kenya.

Participants: Healthcare workers including administrators and clinicians. …

The Perception Of Waiting Times On Patient Satisfaction And Patient Care: A Cross-Sectional Study At A Tertiary Health Care Institution In Kenya, Soud Seif, Jasmit Shah, Ali Chandani, Sayed Karar

Internal Medicine, East Africa

Introduction: Patients often spend significant time waiting for care, which influences patient satisfaction, perceived quality, access to care, and utilization of various health care services. Waiting time and resulting implications remain understudied in low- and middle-income countries like Kenya. This study aimed to describe the impact on the perception of waiting times on patient satisfaction and care at a tertiary healthcare institution in Kenya.

Method: We conducted a prospective cross-sectional study between the first of April 2023 and the thirty-first of August 2023 at the Emergency Room (ER) at Aga Khan University Hospital, Nairobi. Data was collected through a structured …

Health Literacy, Health Perception, And Influencing Factors Among Immigrants, Canan Birimoglu Okuyan, Ebru Deveci, Fatma Karasu

Makara Journal of Health Research

Background: Individuals living in rural areas face several healthcare disadvantages, including limited access to medical facilities and specialists during emergencies. This study examines healthy lifestyle behaviors, health perceptions, and influencing factors among immigrants in a rural region of southern Türkiye.

Methods: This cross-sectional study involved immigrants registered at a family health center. Data were collected using a sociodemographic questionnaire, the Perception of Health Scale, and the Health Literacy Scale.

Results: Statistically significant differences in THLS-32 scores were found based on participants’ occupation, marital status, and education level (p < 0.05). A moderately positive correlation was observed between health literacy and health perception scores (p < 0.05).

Conclusions: Research on the relationship between …

Inequities In The Rehabilitation Process Of Musculoskeletal Injuries In Maine, Devon A. Grant

Thinking Matters Symposium

Since 2016, Maine’s population has grown as a result of migration and a welcoming of refugees. Changes in state demographics influence the population’s and individuals’ social determinants of health (SDOH) (ie., “where people live, learn, work, and play”) and health literacy (ie., a person’s ability to find, understand, and use information to inform health-related decisions). This project aims to identify the health inequities or disparities throughout Southern Maine in the care of injuries to the lower extremity, such as the knee or ankle, as well as explore factors that influence the healthcare outcomes of athletes in surrounding communities. This study …

Primary Place To Go For Health Care And Its Association With Hpv Prevalence In Us Adults: Results From Nhanes 2013-2016, Amy L. Mcveety, Miyuki Sun

OHSU-PSU School of Public Health Annual Conference

Background: While access to health care is a known risk factor for many infectious diseases, including sexually transmitted infections, little research has investigated the relationship between access to primary care services and prevalent human papillomavirus (HPV) infection. Given HPV’s prevalence in the general population and lack of available treatments, it is necessary to understand possible risk factors to identify areas for intervention. This study uses primary place to go for health services as a proxy measure for access to care, in order to understand which sources of health care are serving patients with the highest prevalence of HPV infections and …

Advancing Pandemic Response: Integrated Strategies For Testing, Prediction, And Bias Mitigation, Tianshu Gu

Theses and Dissertations (ETD)

The COVID-19 pandemic, along with prior outbreaks such as SARS and Ebola, has revealed critical gaps in global pandemic preparedness, emphasizing the need for integrated approaches to infectious disease management. This dissertation addresses three key areas of pandemic response: developing scalable screening strategies, constructing reliable predictive models, and mitigating demographic biases in artificial intelligence (AI) models used for healthcare decision-making.

The first study introduces a global screening strategy designed to optimize resource use and increase testing capacity, particularly in low- and middle-income countries (LMICs) where resources are limited. This study leverages pooled testing methods, where multiple samples are combined into …

Evaluating Medical Usage And Injury Prevalence At The 2024 College World Series, Roarick Schollmeyer, Jd Gregerson, Benjamin Stevens, Katie Weaver, Joseph Lippert

EMET Projects

Large-scale events such as the College World Series (CWS) pose unique challenges for medical services due to high crowd density, prolonged event durations, and variable environmental conditions. This study aimed to assess the medical usage rate (MUR) and injury prevalence at the 2024 CWS to inform future event planning and emergency medical preparedness. A retrospective analysis was conducted using patient encounter data collected between June 14 and June 24, 2024. Data sources included Union Medical event services, which documented on-site treatments and dispositions, and Omaha Fire Department EMS records detailing prehospital care. The MUR was calculated as the number of …

Perspectives Of African American And Hispanic/Latino Individuals On Hiv Molecular Cluster Detection, Maxwell Richardson, Brendan H. Pulsifer, Jane Yoon Scott, David Holland, Eleanor W. Garlow, Pascale Wortley, Daniel Mauck, Jenna Gettings, Valeria Cantos, Masonia Traylor, Eric Rangel, David Folkes, Carlos Saldana

Journal of the Georgia Public Health Association

Background: Responding to HIV clusters detected using molecular data has been shown to reduce transmission and improve testing, treatment, and prevention. However, there are varied opinions about the use of cluster detection activities, and some advocates have raised concerns about patient consent, data security, and the potential for HIV criminalization. Incorporating the perspectives of marginalized populations that are disproportionately affected by HIV is essential to understanding the diversity of those perspectives, yet it is often overlooked in the literature. Thus, our study seeks to highlight the perspectives of Black/African American and Hispanic/Latino individuals in the Southern United States on HIV …

Resilience And Reality: Exploring The Lived Experiences Of People Living With Hiv In Texas During The Covid-19 Pandemic – A Qualitative Study., Ahmed F. Alanazi

Social Work Dissertations - Archive

This study investigated the lived experiences of individuals living with HIV (PLWH) in the Dallas-Fort Worth (DFW) area of Texas during the COVID-19 pandemic, using an Interpretative Phenomenological Analysis (IPA) framework. The research examined the intersection of health, social dynamics, and psychological resilience among PLWH, who faced compounded vulnerabilities due to systemic inequities and the dual public health crises of HIV and COVID-19. Through semi-structured interviews with ten participants from diverse backgrounds, the study captured the profound impacts of disrupted healthcare systems, heightened stigma, and social isolation on this marginalized population. The findings reveal that the pandemic exacerbated existing inequities …

Perceptions Of The Health Care System As Mediators In The Association Between Experiences Of Discrimination, Communication From Providers, And Gaps In Mammography, Hannah Cohen-Cline

Articles, Abstracts, and Reports

No abstract provided.