Social and Behavioral Sciences Commons^™

Dark Shadow Of The Long White Cloud: Neighborhood Safety Is Associated With Self-Rated Health And Cortisol During Pregnancy In Auckland, Aotearoa/New Zealand, Zaneta M. Thayer

Dartmouth Scholarship

Auckland, Aotearoa/New Zealand is a culturally and ethnically diverse city. Despite popular global conceptions regarding its utopian nature, the lived experience for many individuals in Auckland attests to the substantial social, economic, and health inequalities that exist there. In particular, rapidly rising home prices constrain housing decisions and force individuals to live in less desirable neighborhoods, with potential impacts on individual health. One of the pathways through which adverse neighborhood conditions could impact health is through alterations in the functioning of the hypothalamic pituitary adrenal (HPA)-axis, which regulates the physiological stress response. This paper evaluates the relationship between perceived …

In The Information Age, Do Dementia Caregivers Get The Information They Need? Semi-Structured Interviews To Determine Informal Caregivers’ Education Needs, Barriers, And Preferences, Kendra Peterson, Howard Hahn, Amber J. Lee, Catherine A. Madison, Alireza Atri

Dartmouth Scholarship

Most patients with dementia or cognitive impairment receive care from family members, often untrained for this challenging role. Caregivers may not access publicly available caregiving information, and caregiver education programs are not widely implemented clinically. Prior large surveys yielded broad quantitative understanding of caregiver information needs, but do not illuminate the in-depth, rich, and nuanced caregiver perspectives that can be gleaned using qualitative methodology. We aimed to understand perspectives about information sources, barriers and preferences, through semi-structured interviews with 27 caregivers. Content analysis identified important themes

Pharmacy Use By Dual-Eligible Non-Elderly Veterans With Private Healthcare Insurance, Brian C. Lund, Mary E. Charlton, Alan N. West

Dartmouth Scholarship

The Veterans Health Administration (VHA) is the largest nationally integrated healthcare system in the United States, operating 168 medical centers and more than 1000 community based outpatient clinics. However, many veterans seek care outside the VHA system, particularly when they are also covered by state or federal programs such as Medicare or Medicaid, or have access to private health insurance, often through employment. Concerted efforts have been made to facilitate communication and coordinate care between VHA and private sector healthcare, but concurrent use of these systems adds to an already fragmented U.S health care system.

Patient‐Defined Goals For The Treatment Of Severe Aortic Stenosis: A Qualitative Analysis, Megan Coylewright, Roseanne Palmer, Elizabeth S. O'Neill, John F. Robb, Terri Fried

Dartmouth Scholarship

Patients with severe aortic stenosis (AS) at high risk for aortic valve replacement are a unique population with multiple treatment options, including medical therapy, surgical aortic valve replacement and transcatheter aortic valve replacement (TAVR). Traditionally, in elderly populations, goals of treatment may favour quality of life over survival. Professional guidelines recommend that clinicians engage patients in shared decision making, a process that may lead to decisions more aligned with patient-defined goals of care. Goals of care for high-risk patients with AS are not well defined in the literature, and patient-reported barriers to shared decision making highlight the need for explicit …

The Economic Burden Attributable To A Child’S Inpatient Admission For Diarrheal Disease In Rwanda, Fidele Ngabo, Mercy Mvundura, Lauren Gazley, Maurice Gatera, Celse Rugambwa, Eugene Kayonga, Yvette Tuyishme, Jeanne Niyibaho, Jason M. Mwenda, Philippe Donnen, Philippe Lepage, Agnes Binagwaho, Deborah Atherly

Dartmouth Scholarship

Backround:

Diarrhea is one of the leading causes of childhood morbidity and mortality. Hospitalization for diarrhea can pose a significant burden to health systems and households. The objective of this study was to estimate the economic burden attributable to hospitalization for diarrhea among children less than five years old in Rwanda. These data can be used by decision-makers to assess the impact of interventions that reduce diarrhea morbidity, including rotavirus vaccine introduction.

Methods:

This was a prospective costing study where medical records and hospital bills for children admitted with diarrhea at three hospitals were collected to estimate resource use and …

Is The Closest Facility The One Actually Used? An Assessment Of Travel Time Estimation Based On Mammography Facilities, Jennifer Alford-Teaster, Jane M. Lange, Rebecca A. Hubbard, Christoph I. Lee, Jennifer S. Haas, Xun Shi, Heather A. Carlos, Louise Henderson, Deirdre Hill, Anna N. A. Tosteson, Tracy Onega

Dartmouth Scholarship

Characterizing geographic access depends on a broad range of methods available to researchers and the healthcare context to which the method is applied. Globally, travel time is one frequently used measure of geographic access with known limitations associated with data availability. Specifically, due to lack of available utilization data, many travel time studies assume that patients use the closest facility. To examine this assumption, an example using mammography screening data, which is considered a geographically abundant health care service in the United States, is explored. This work makes an important methodological contribution to measuring access--which is a critical component of …

Measurement Challenges In Shared Decision Making: Putting The ‘Patient’ In Patient‐Reported Measures, Paul J. Barr, Glyn Elwyn

Dartmouth Scholarship

Measuring clinicians' shared decision-making (SDM) performance is a key requirement given the intensity of policy interest in many developed countries - yet it remains one of the most difficult methodological challenges, which is a concern for many stakeholders. In this Viewpoint Article, we investigate the development of existing patient-reported measures (PRMs) of SDM identified in a recent review. We find that patients were involved in the development of only four of the 13 measures. This lack of patient involvement in PRM development is associated with two major threats to content validity, common to all 13 PRMs of SDM: (i) an …