Health Services Research Commons^™

Challenges To Diabetes Self-Management For Adults With Type 2 Diabetes In Low-Resource Settings In Mexico City: A Qualitative Descriptive Study, Robin Whittemore, Mireya Vilar-Compte, Selene De La Cerda, Denise Marron, Rosabelle Conover, Roberta Delvy, Annel Lozano-Marrufo, Rafael Pérez-Escamilla

Department of Public Health Scholarship and Creative Works

Background: The prevalence of type 2 diabetes (T2D) in Mexico is one of the highest in the world, with high morbidity and mortality, and difficulty meeting glycemic targets. The purpose of this study was to identify the challenges for T2D self-management as perceived by both adults with T2D and health care providers in primary health clinics from Seguro Popular in Mexico City.

Methods: This was a qualitative descriptive study conducted in three Seguro Popular primary care clinics in Mexico City using convenience sampling. Semi-structured interviews were conducted with participants and data were analyzed using a content analysis approach.

Results: The …

Effectiveness Of Community Outreach Hiv Prevention Programs In Vietnam: A Mixed Methods Evaluation, Lora L. Sabin, Katherine Semrau, Mary Bachman Desilva, Le T T Loan, Jennifer J. Beard, Davidson H. Hamer, Jordan Tuchman, Ted Hammett, Nafisa Halim, Manisha Reuben, Aldina Mesic, Taryn Vian

Nursing and Health Professions Faculty Research and Publications

Background

In 2014, Vietnam was the first Southeast Asian country to commit to achieving the World Health Organization’s 90–90-90 global HIV targets (90% know their HIV status, 90% on sustained treatment, and 90% virally suppressed) by 2020. This pledge represented further confirmation of Vietnam’s efforts to respond to the HIV epidemic, one feature of which has been close collaboration with the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR). Starting in 2004, PEPFAR supported community outreach programs targeting high-risk populations (people who inject drugs, men who have sex with men, and sex workers). To provide early evidence on program impact, …

Heat Waves And Heat-Related Mortality In East Tennessee, Taiwo Adesoba

Electronic Theses and Dissertations

Heat waves represent a public health challenge that requires multiple responses and warnings to protect vulnerable populations. Although studies have reported an increasing trend of heat wave occurrence in many areas of the world, no clear trend exists in East Tennessee. Using data from Parameter-elevated Relationships on Independent Slope Models (PRISM), CDC WONDER and the United States Census Bureau, the relationship between mortality rates and year was estimated during heat wave events between 1999 and 2010. Five heat wave definitions were tested. Overall, 2007 and 2010 stand out as the years with the highest number of heat wave days in …

Short Relative Leg Length Is Associated With Overweight And Obesity In Mexican Immigrant Women, Mireya Vilar-Compte, James Macinko, Beth C. Weitzman, Carlos M. Avendaño-Villela

Department of Public Health Scholarship and Creative Works

Background: Prior research suggests that undernutrition and enteric infections predispose children to stunted growth. Undernutrition and infections have been associated with limited access to healthy diets, lack of sanitation, and access barriers to healthcare - all associated with human rights. Stunting has also been documented to be a major determinant of subsequent obesity and non-communicable diseases. Short leg length relative to stature during adulthood seems to be a good proxy indicator tracking such barriers, and has been reported to be associated with adverse health effects during adulthood. Our objective was to examine the association between relative leg length (as measured …

Building Financial Management Capacity For Community Ownership Of Development Initiatives In Rural Zambia, Viviane Sakanga, Parker S. Chastain, Kathleen L. Mcglasson, Jeanette L. Kaiser, Misheck Bwalya, Melvin Mwansa, Kaluba Mataka, David Kalaba, Nancy Scott, Taryn Vian

Nursing and Health Professions Faculty Research and Publications

Background: Building financial management capacity is increasingly important in low- and middle-income countries to help communities take ownership of development activities. Yet, many community members lack financial knowledge and skills.

Methods: As part of a larger health intervention, we designed and conducted financial management training for 83 members from 10 community groups in rural Zambia. Change scores between pre- and post-tests on financial knowledge were calculated and multivariate linear regression models run. Qualitative feedback was elicited.

Results: The training significantly improved knowledge of financial concepts. Participants with some or more than some secondary education had greater improvements …

Transition In Occupations Of Refugees During Resettlement, Jacqueline-Elizabeth Cantrell, Kimberley K. Banuelos, Adam Chan, Jennifer H. Daine

Occupational Therapy | MSOT Capstone Projects

Purpose: In 2016, there were 22.5 million refugees worldwide (UNHCR, 2017). California resettled just over 5,000 of those 85,000 (Igielnik & Krogstad, 2017). Limited research has been conducted in the United States (U.S.) focusing on the refugee experience; furthermore, there is a significant gap in research regarding the impact of the refugee experience on the occupations of refugees as they transition to living in the U.S. Smith (2012) explored the adaptation of cultural weaving among Karen refugees to maintain their previous occupations and the impact of daily weaving on their lives within Western culture; however, the study focused only …

Expanding International Health Curriculum For The Internal Medicine Residency At Mmc, Brian King, Hassan Mahmoud, Anthony Pastore

Thinking Matters Symposium Archive

While internal medicine residents at Maine Medical Center provide care for many refugees and immigrants, there is not a formal international health curriculum to equip residents to care for this vulnerable population. Since 2002, 3,793 refugees have arrived in Maine for resettlement. Our aim was to survey residents about their interest in added international health instruction and design an educational curriculum for these physicians.

Rethinking Health Services Measurement For Indigenous Populations, Angela Mashford-Pringle, Ian Ring, Fadwa Al-Yaman, John Waldon, Michelle Chino

School of Public Health Faculty Research

Indigenous people around the world experience shorter life expectancy, poorer health outcomes, and on average have less social capital, than non-Indigenous people in their respective countries. While national goals are to lower mortality and morbidity rates of Indigenous people, much evidence exists that indicates there is almost no Indigenous involvement in data collection, policy development, program implementation and development and measurement of services. A more holistic and culturally relevant framework is presented to improve services and outcomes for Indigenous populations.

Rethinking Health Services Measurement For Indigenous Populations, Michelle Chino Dr, Angela Mashford-Pringle, Ian Ring, Fadwa Al-Yaman, John Waldon

School of Public Health Faculty Research

Indigenous people around the world experience shorter life expectancy, poorer health outcomes, and on average have less social capital, than non-Indigenous people in their respective countries. While national goals are to lower mortality and morbidity rates of Indigenous people, much evidence exists that indicates there is almost no Indigenous involvement in data collection, policy development, program implementation and development and measurement of services. A more holistic and culturally relevant framework is presented to improve services and outcomes for Indigenous populations.

An Iterative Process For Training Design And Implementation Increased Health Workers' Knowledge For Taking Nutrition Behavior Change To Scale, Wendy Gonzalez, Anabelle Bonvecchio Arenas, Armando García-Guerra, Mireya Vilar-Compte, Alejandría Villa De La Vega, Laura Quezada, Cynthia Rosas, Ana Lilia Lozada-Tequeanes, Amira Hernández

Department of Public Health Scholarship and Creative Works

The shortage of skilled, motivated, and well-supported health workers is a major barrier to scaling up nutrition interventions and services. Objective: The objective of this study is to describe the process for developing and implementing a training of health personnel for the delivery of the Integrated Strategy for Attention to Nutrition (EsIAN), an evidence-based strategy for promoting infant and young child feeding through primary health care in Mexico. The specific objective is to provide a case study and highlight challenges, as well as elements to successfully mitigate these, and discuss potential applications of findings beyond the Mexican context. Methods: The …

Depression Among Epileptic Patients And Its Association With Drug Therapy In Sub-Saharan Africa: A Systematic Review And Meta-Analysis., Getenet Dessie, Henok Mulugeta, Cheru Tesema Leshargie, Fasil Wagnew, Sahai Burrowes

BACKGROUND: Despite the high prevalence of epilepsy in sub-Saharan Africa and the established relationship between depression and epilepsy, the extent of comorbid epilepsy and depression in the region is still poorly understood. The objective of this systematic review and meta-analysis is to address this gap in the literature by determining the pooled prevalence of depression among epileptic patients in sub-Saharan Africa.

METHODS: A systematic desk review and electronic web-based search of PubMed, Google Scholar, EMBASE, PsycINFO and the World Health Organization's Hinari portal (which includes the SCOPUS, African Index Medicus, and African Journals Online databases) conducted from December 2, 2017 …

Strengthening In-Service Training And Continuing Education (Ist/Ce) For Frontline Health Workers For Bauchi And Cross River States, Ekechi Okereke, Godwin Unumeri, Ibrahim Suleiman, Aisha Jibril

Reproductive Health

This brief details Council efforts to develop effective, and costed, in-service training and continuing education modules for frontline health workers in Bauchi and Cross River states in Nigeria. This project was funded by WHO to aid the training and development of Nigeria's public health worker sector.

Population Council's Support For Nigeria's Third National Human Resources For Health Conference And Efforts To Institutionalize Hrh Conferences In Nigeria, Ekechi Okereke, Godwin Unumeri, Ibrahim Suleiman, Aisha Jibril

Reproductive Health

This project brief describes the Population Council's partnership efforts with public health stakeholders in Nigeria to plan and host a third national conference for provision of necessary and relevant information on critical health issues to health staff and stakeholders throughout Nigeria.

An Oasis In The Hospital Desert – General Aviation Meets Medicine, Ariel Braverman

International Journal of Aviation, Aeronautics, and Aerospace

Use of General Aviation and to support medical services is not novel. However, this paper is an attempt to establish a concept of a framework of using aviation, especially relatively low-operational cost fixed-wing aircraft as a convenient high-speed transport to bring medical staff to the rural and remote areas. Operating flight network will also be more efficient from the financial point of view - better than attracting medical personnel with high salaries. Existing regional and local airport system can be a feasible basis for airport-based medical network. This article is just an initial one and additional work needs to evaluate …

Evaluation Of The Hiv Infant Tracking System (Hitsystem) To Optimise Quality And Efficiency Of Early Infant Diagnosis: A Cluster-Randomised Trial In Kenya., Sarah Finocchario-Kessler, Brad Gautney, Anlin Cheng, Catherine Wexler, May Maloba, Niaman Nazir, Samoel Khamadi, Raphael Lwembe, Melinda Brown, Thomas A. Odeny, Jacinda K. Dariotis, Matthew Sandbulte, Natabhona Mabachi, Kathy Goggin

Manuscripts, Articles, Book Chapters and Other Papers

BACKGROUND: The HIV Infant Tracking System (HITSystem) is a web-based intervention linking providers of early infant diagnosis, laboratory technicians, and mothers and infants to improve outcomes for HIV-exposed infants. We aimed to evaluate the efficacy of the HITSystem on key outcomes of early infant diagnosis.

METHODS: We did a cluster-randomised trial at six hospitals in Kenya, which were matched on geographic region, resource level, and volume of patients (high, medium, and low). We randomly allocated hospitals within a matched pair to either the HITSystem (intervention; n=3) or standard of care (control; n=3). A random number generator was used to assign …

Surgical And Medical Applications Of Drones: A Comprehensive Review, Brent Terwilliger, James C. Rosser Jr., Vudatha Vignesh, Brett C. Parker

Publications

Drones have the ability to gather real time data cost effectively, to deliver payloads and have initiated the rapid evolution of many industrial, commercial, and recreational applications. Unfortunately, there has been a slower expansion in the field of medicine. This article provides a comprehensive review of current and future drone applications in medicine, in hopes of empowering and inspiring more aggressive investigation.

Exploring Direct And Indirect Effects Of English Proficiency On Access, Utilization, And Health Status Among Californian Adults With Limited English Proficiency (Lep), Renee E. Pierre-Louis

Seton Hall University Dissertations and Theses (ETDs)

Background and Study Purpose: Findings from previous studies suggest that, in a health care delivery context, individuals with limited English proficiency (LEP) are adversely impacted by lack of patient-provider language concordance. Yet, the concept of LEP has been mostly studied in the context of cultural competence and language has been generally considered a demographic or cultural characteristic. There is a growing body of research concerning LEP and health status; however, it is limited. This study sought to evaluate the effects of LEP on access, utilization, and self-rated health status (SRHS) among LEP respondents to a large health interview survey …

Mobile Hiv Units In South Africa: A Systematic Review, Meaghan Doherty

Senior Honors Projects, 2010-2019

Abstract

Objective: To examine existing literature on mobile HIV testing units to determine if they have the potential to increase access to testing, treatment, and HIV education to decrease rates of HIV in South Africa.

Participants: Ten research articles evaluating the HIV intervention method of mobile HIV units in South Africa, including outcome measures.

Analysis: Systematic search of 87 articles from 2000 to 2018 and review of the 10 articles that met inclusion criteria.

Results: Several studies (n=5) showed that mobile testing units are effective at attracting hard to reach populations, such as men and young adults. Studies (n=3) also …

Research Support Infrastructure: Implementing A Clinical Research Coordinating Center, Julio A. Ramirez, Paula Peyrani, William A. Mattingly, Forest W. Arnold, Timothy L. Wiemken, Robert R. Kelley, Leslie A. Wolf, Ruth M. Carrico, Andrea Reyes-Vega

Faculty and Staff Scholarship

Insufficient infrastructure is one of the challenges facing investigators in the field of clinical research. At the University of Louisville (UofL) Division of Infectious Diseases, we developed a multidisciplinary coordinating center with the aim to support investigators in all aspects of the clinical research process. The objective of this article is to describe the composition and the role of the different units of the UofL Clinical Research Coordinating Center. The different components of the Center can serve as a template for institutions interested in developing a clinical research support infrastructure.

Challenges Of Refugee Health Care: Perspectives Of Medical Interpreters, Case Managers, And Pharmacists, Fabiana Kotovicz, Anne Getzin, Thy Vo

Journal of Patient-Centered Research and Reviews

Purpose: Our objective was to identify perceived challenges in the provision of health care for refugees from the perspective of medical interpreters, case managers, and pharmacists working with refugee patients in Milwaukee, Wisconsin.

Methods: Two 60-minute focus groups were performed exploring challenges in refugee health care using a literature-based semi-structured protocol. Focus groups were transcribed and de-identified prior to independent analysis by two of the investigators. Using a memoing-process qualitative approach, major concepts, cross-cutting themes, and subthemes were established and ultimately developed a narrative. The project protocol was approved as not human subject research by the local institutional review board. …

Leadership In Community Public-Private Partnership Health And Social Care Initiatives, Hawa Yatera Mshana, Magdeline Aagard, Cheryl Cullen, Patrick A. Tschida

Journal of Sustainable Social Impact

Although the public–private partnerships in health have been adopted as the best pathway to improving health outcomes in many developing nations, implementation lacks collaborative leadership. The purpose of this empirical qualitative case study was to determine key factors that promote leadership synergy (LS) between partners that enhance ownership and accountability of community health and social initiatives in Tanzania. The diffusion of innovation theory and public–private integrated partnership module were the theoretical framework guided this study. Diffusion of innovation theory is based on the importance of effective communication to spread new ideas and foster change in behavior in a social group …

Scaling Out Evidence-Based Interventions Outside The U.S. Mainland: Social Justice Or Trojan Horse?, Melanie M. Domenech-Rodriguez, Ana A. L. Baumann, Alejandro L. Vázquez, Nancy G. Amador-Buenabad, Natalie Franceschi Rivera, Nydia Ortiz-Pons, J. Rubén Parra-Cardona

Psychology Faculty Publications

Global health disparities continue to widen as professional standards for effectiveness of mental health services provision become more precise and difficult to achieve across varied economic and social contexts. Within the U.S., health disparities are evident in Latinx populations. Globally, the health disparities are also evident in Latin America as compared to the U.S. and other economically affluent nations. The diversification of psychology in content and persons has led to a unique opportunity to build bridges that can help reduce disparities in- and outside of the U.S. mainland. Collaborations can be of great use in addressing health disparities internationally but …

Three Essays On Maternal And Child Health, Mandar V. Bodas

Theses and Dissertations

This dissertation is a collection of three separate essays on the health of women and children. In the first essay, I along with my co-authors, analyzed the impact of two large, national-level health policies (the Janani Suraksha Yojana (JSY) and the National Rural Health Mission (NRHM)) on maternal health outcomes (proportion of institutional deliveries) in India. We used data from the India Human Development Survey (IHDS) and found that the JSY and the NRHM had a greater impact on institutional deliveries in high-focus states. We also found that the conditions of the public health facilities, did not change after the …

Family Planning And Hiv Interventions Among Women In Low-Income Settings, Steven P. Masiano

Theses and Dissertations

This dissertation examines the effectiveness of interventions related to family planning and the uptake of HIV-related preventive services among women in low-income settings. Women in low-income settings and living with HIV face many barriers to care, including limited access to services for family planning and HIV-related preventive care. At the same time, national, regional, and global efforts are looking for interventions to help control rapid population growth, create an HIV-free generation, and provide adequate preventive care for those living with HIV. This dissertation cuts across these issues and can help to inform debate and policies to address these issues.

This …

Sociocultural Interactions Of Cuban Doctors Participating In The More Doctors Program In Brazil, Joaquin Molina, Carlos Eduardo Siqueira, Leonardo Cavalcanti

Gastón Institute Publications

This book focuses on a different and underexplored attribute of the More Doctors Program by surveying doctors in the feld with the purpose of identifying important answers regarding the sociocultural interactions of Cuban doctors recruited by the program and of producing knowledge, while also making improvements in the participation, still limited, of foreign doctors in the primary care services offered by SUS. It proposes to induce perceptions, memories, and possible explanations to anyone who is somehow associated with the Program’s development, especially those committed to universal health care and primary assistance as the only paths to an effective health system. …

Gender Differences In Virologic Response After Antiretroviral Therapy In Treatment-Naïve Hiv-Infected Individuals: Results From The 550 Clinic Hiv Cohort Study., Andrea Reyes-Vega, Alejandra Loban, Kavitha Srinivasan, Stephen P. Furmanek, Conner English, Mary Bishop, Cathy Spencer, Daniel Truelove, Julio A. Ramirez, Anupama Raghuram, Paula Peyrani

Faculty and Staff Scholarship

Background

Controversy still exists regarding gender differences in virologic response between treatment-na•ve HIV-infected individuals. The objective of this study was to evaluate gender difference in virologic and immunologic response to antiretroviral therapy in treatment-na•ve HIV-infected individuals. Methods

This was a retrospective, observational study of treatment-na•ve HIV-infected individuals managed at the 550 clinic who started antiretroviral therapy (ART) between January 1st, 2010 and December 31, 2015. Patients with available viral load and CD4 counts before and one year after initiating ART were included in this study. Virologic suppression was defined as < 48 HIV-1 RNA copies/mL, and mmunologic recovery was defined as a CD4 count increase of at least 150 cells/mm3. Dichotomous variables were reported in number and percentages and analyzed using Chi-squared tests and Fisher’s exact (whichever was appropriate). Continuous variables were reported as median and interquartile range (IQR) and analyzed using Wilcox rank-sum tests. Multivariate analyses performed were logistic regressions with adjustment for other covariates. P value <0.05 was considered statistically significant. R version 3.3.2 was used for the statistical analysis. Results

A total of 70 women and 90 men were included …

Refugee-Centered Medical Home:A New Approach To Care At The University Of Louisville Global Health Center, Rahel Bosson, Ruth M. Carrico, Anupama Raghuram, Paula Peyrani, William A. Mattingly, Rebecca Ford, Stephen P. Furmanek, Julio A. Ramirez

Journal of Refugee & Global Health

Refugees arrive to the United States with a full spectrum of health conditions, many of which involve intense case management requiring significant financial investments and use of healthcare resources. Kentucky receives more than 3,000 new refugees each year and ranked 10th in the nation for numbers of new arrivals resettled during 2015. These refugees arrive from diverse countries representing different cultures and speaking different languages. In addition, they arrive with diverse health conditions and medical needs. The aims of this paper are to share experiences from the University of Louisville Global Health Center regarding conceptualization, implementation and evaluation of a …

Household Water Insecurity, Missed Schooling, And The Mediating Role Of Caregiver Depression In Rural Uganda, Christine E. Cooper-Vince, Bernard Kakuhikire, Dagmar Vořechovská, Amy Q. Mcdonough, Jessica M. Perkins, Atheendar S. Venkataramani, Rumbidzai Mushavi, Charles Baguma, Scholastic Ashaba, David Bangsberg, Alexander C. Tsai

OHSU-PSU School of Public Health Faculty Publications and Presentations

Background: School attendance rates in sub-Saharan Africa are among the lowest worldwide, placing children at heightened risk for poor educational and economic outcomes. One understudied risk factor for missed schooling is household water insecurity, which is linked to depression among women and may increase children’s water-fetching burden at the expense of educational activities, particularly among children of depressed caregivers. In this study conducted in rural Uganda, we assessed the association between household water insecurity and child school participation and the mediating pathways behind these associations.

Method: We conducted a population-based, cross-sectional study of female household heads (N = 257) and …

Utilizing Three Years Of Epidemiological Data From Medical Missions In Cambodia To Shape The Mobile Medical Clinic Formulary, Jeany Kim Jun, Junia S. Koo, Amy Y. Kang, Deborah B. Chien, Albert Shim, Dale Knutson, Eda M. Kim

Pharmacy Faculty Articles and Research

Objective: The purpose of this project was to gather epidemiological data on common diseases and medications dispensed during medical mission teams to Cambodia to shape the mobile medical clinic formulary.

Methods: Data for patients seen during week-long, mobile, medical clinics was collected in Cambodia during Septembers 2012 to 2014. Patient’s gender, age, weight, blood pressure, glucose, pertinent laboratory values, diagnoses, and medications dispensed were collected. Blood pressure and glucose were measured in patients 18 years and above. Data collected onto paper intake forms were transferred onto spreadsheets without patient identifying information and analyzed for aggregate means, common diseases, and most …

The Scoping Review Method: Mapping The Literature In “Structural Change” Public Health Interventions, Rosie Hanneke, Yuka Asada, Lisa D. Lieberman, Leah Christina Neubauer, Michael C. Fagan

Department of Public Health Scholarship and Creative Works

This case discusses how we used scoping review methodology to map the literature in an emergent area of research, “structural change” public health interventions. Scoping reviews are similar to systematic reviews in both scale and rigor; both of these literature review methodologies are comprehensive approaches to reviewing the literature on a topic. However, while a systematic review attempts to answer a specific, targeted research question, a scoping review is designed to map and categorize all of the literature on a broad topic. For this reason, it is an excellent method to employ in emergent research areas, in which researchers have …