Medicine and Health Commons^™

So Many Hospitals, So Little Information: How Hospital Value Based Purchasing Is A Game Of Chance, Andrew I. Friedson, William C. Horrace, Allison F. Marier

Center for Policy Research

As part of the Patient Protection and Affordable Care Act, participating Medicare hospitals have part of their Medicare reimbursements withheld and then redistributed based on quality performance. The Hospital Value Based Purchasing reimbursement plan relies partly on ordinal rankings of hospitals to determine how money is distributed. We analyze the quality metric distributions used for payment and show that there is not enough information to reliably differentiate hospitals from one another near the payment cutoffs; and conclude that a large part of the payment formula is driven by sampling variability rather than true quality information. Alternative reimbursement plans are developed.

Using The Theory Of Fundamental Causes To Show The Potential Effects Of Socioeconomic Status On Surgical Outcomes, Mehwish Qasim, A.B.D.

Journal of Health Disparities Research and Practice

Surgical procedures are both costly and common. There are large differences in surgical outcomes both within and between hospitals based on patient characteristics such as measures of income. In both 2000 and 2009, patients residing in low-income communities had worse morbidity and mortality rates, across a wide range of quality indicators. In this review, the author will explicate the Theory of Fundamental Causes as it relates to surgical care, review key empirical findings and address potential limitations of the theory. This review will provide a platform for researchers to discuss current research in surgical disparities using the Theory of Fundamental …

“Great Job Cleaning Your Plate Today!” Determinants Of Child-Care Providers’ Use Of Controlling Feeding Practices: An Exploratory Examination, Dipti A. Dev, Brent A. Mcbride, Katherine E. Speirs, Kimberly A. Blitch, Natalie A. Williams

Department of Child, Youth, and Family Studies: Faculty Publications

Background National early childhood obesity prevention policies recommend that child-care providers avoid controlling feeding practices (CFP) (e.g., pressure-to-eat, food as reward, and praising children for cleaning their plates) with children to prevent unhealthy child eating behaviors and childhood obesity. However, evidence suggests that providers frequently use CFP during mealtimes.

Objective Using the Academy of Nutrition and Dietetics (2011) benchmarks for nutrition in child care as a framework, researchers assessed child-care providers’ perspectives regarding their use of mealtime CFP with young children (aged 2 to 5 years).

Design Using a qualitative design, individual, face-to-face, semi-structured interviews were conducted with providers until …

The Relation Between Discrimination, Sense Of Coherence And Health Varies According To Ethnicity; A Study Among Three Distinct Population Groups Living In Israel, Orna Baron-Epel, Vincent Berardi, John Belletierre, Waleed Shalata

Psychology Faculty Articles and Research

Self-reported experiences of discrimination and sense of coherence (SOC) have been found to be associated with health. A face-to-face survey of Long Term Jewish Residents (LTJR), Arabs and former Soviet Union (fSU) immigrants in Israel was performed. Respondents reported their physical and mental health, self-reported experiences of discrimination, SOC and socioeconomic status. Multivariable logistic regressions and bootstrapping path analyses were performed. Discrimination was associated with health after adjusting for all other variables. SOC was also associated with health. SOC did not mediate the strong association between discrimination and health among Israeli LTJR, but was a significant mediator among Arabs and …

Facing Our Demons: Psychiatric Perspectives On Exorcism Rituals, Joel R. Sanford

The Hilltop Review

Belief in possession by malevolent spirits exists in many cultures and religions throughout the world, and such beliefs often serve as explanations for a variety of psychological and emotional afflictions. Traditional remedies in these cases often involve exorcism rituals, which are believed to expel spirits from a person's mind and/or body. Some of the cases commonly attributed to involuntary spirit possession are diagnosed within the psychiatric community as schizophrenia or some sort of dissociative disorder and treated with psychotherapy and/or medicine. For some in the psychiatric community, exorcisms and their use by patients are viewed as problematic due to their …

Ramadan & Pregnancy, Omar Rizvi

Celebration of Learning

Fasting during Ramadan, the ninth month of the Muslim calendar, is one of the five pillars of Islam and is fard (obligatory) for all Muslims physically and mentally capable of doing so. In the Qur’an, it is made abundantly clear that religion and its acts of worship are not meant to pose undue difficulty or hardship (Qur’an 22:78, 5:6, 2:185). My paper explores the Islamic definitions for “unnecessary difficulty” and “physically capable” specifically in regards to pregnant women. At what point does fasting incur significant, if any, damage to the fetus that it should prevent the mother from participating in …

Obesity Over The Life Course: Perspectives In Health And Mortality, Noura E. Insolera

Dissertations, Theses, and Capstone Projects

This dissertation seeks to examine obesity in different contexts throughout the life course. Through empirical analyses, separate stages of the life course are considered: namely childhood through adolescence, young adulthood, and adulthood. By using a life course perspective, it is possible to consider longitudinal and intergenerational approaches to these questions, which will update and inform the current debates surrounding obesity.

Beginning with children, the intergenerational transmission of diet disease knowledge, socioeconomic status, and child health behaviors are considered in their associations with the outcomes of child diet in 2002, and in turn their associations with child obesity in 2007. Information …

Ethnicity Matters: Implications For Understanding And Acting Upon Disparities In Health Affecting Black Men In The United States, Helen V. S. Cole

Dissertations, Theses, and Capstone Projects

Compared to non-Hispanic whites, non-Hispanic blacks have higher rates of mortality from heart disease, cancer, cardiovascular disease, and HIV/AIDS. Black men have a life expectancy approximately 4.7 years than the life expectancy of non-Hispanic white men, due in part to higher prevalence of chronic disease among black men. Many factors are hypothesized to contribute to disparities in health between races, including differences in socioeconomic status; culturally-linked behaviors such as diet, substance use, and physical activity; access to quality healthcare and other resources; and experiences of racism, both institutional and interpersonal. However, in public health research, race is usually treated as …

Prevalence Of Chronic Health Conditions Among Latinos In The United States Between 1999 And 2011, Amanda Mía Marín-Chollom

Center for Latin American, Caribbean, and Latino Studies

Introduction: This study examines the prevalence of five major chronic health conditions – heart disease, stroke, cancer, arthritis, and diabetes – among adults 18 years of age and older in the United States between 1999 and 2011.

Methods: The data used in this report come from the Center for Disease Control and Prevention’s (CDC) National Center for Health Statistics, Health Data Interactive tables. Patterns were examined by age structure among the four largest race/ethnic groups in the U.S., and among the two largest Latino subgroups in the U.S. (Mexicans and Puerto Ricans)

Results: Latinos had higher rates of diabetes than …

The Relationship Between Food Insecurity And Weight In The United States, 2011 – 2014, Sebastián Villamizar-Santamaría

Center for Latin American, Caribbean, and Latino Studies

Introduction: This report examines the relation between weight and food insecurity in the United States between 2011 and 2014.

Methods: The data used in this report come from the Integrated Health Interview Services (IHIS) and its food security index. Weight is assessed by body mass index, and the population is divided into four weight groups based on body mass index ranges.

Results: First, food insecurity rates declined among the general population of Latinos between 2011 and 2014, however, food insecurity rates rose dramatically among underweight Latinos over that time period. Second, food insecurity rates were greatest among the obese and …

Multiple Dimensions Of Stigma And Health Related Factors Among Young Black Men Who Have Sex With Men, Dexter R. Voisin

Faculty Scholarship

This study is among the first to examine the association between multiple domains of HIV-related stigma and health-related correlates including viral load and medication adherence among young Black men who have sex with men (N = 92). Individual logistic regressions were done to examine the hypothesized relationships between HIV-related stigma and various health and psychosocial outcomes. In addition to examining total stigma, we also examined four domains of HIV stigma. Findings revealed the various domains of stigma had differential effects on health-related outcomes. Individuals who reported higher levels of total stigma and personalized stigma were less likely to be virally …

Science, Symptoms, And Support Groups:Adhd In The American Cultural Context, Kealy D. Fallon

Theses and Dissertations

This thesis is a cultural analysis of the behaviorally- and psychiatrically-defined disorder ADHD, socio-historically contextualizing it in the United States and exploring ethnographically how people affected by it talk about and organize their experience of its symptoms.

The Social Implications Of Wellness, Mary G. Fisher

BU Well

This paper presents the existing health disparities between populations of varying socio-economic statuses in the US as part of a broader discussion of the modern wellness industry. The discussion highlights the threat modern wellness poses to the individual and society and the implications these threats have on the health and future of the US if the wellness industry is left unchecked.

Sickness Of The Soul: Language Mediated Understandings Of Depression Across Cultures, Elyssa M. Fogleman

Senior Honors Projects, 2010-2019

Through the use of word association tasks and semi-structured interviews, the present study gathered information on the current dominant understandings of “depression” in America and “yuutsu” and “utsubyou” in Japan. The results were compared to the findings of a similar study that was conducted in the mid 1970s that aimed to find connections between language and the subjective experience of depression. In comparing the responses from the 1970s and the present, it was found that the dominant understanding of depression has been subject to change. These changes can be attributed to larger shifts in the sociopolitical climate, the proliferation of …

The Effect Of Sleep Quality And High Intensity Physical Activity On Inflammation And Cardiovascular Disease Risk Factors In College Students, Catherine Abraham

Honors Scholar Theses

Background: Inflammation is the common denominator in chronic conditions such as obesity, diabetes, and depression. While adequate physical activity and optimal sleep quality may help maintain normal inflammation levels, evidence is somewhat conflicting. Aim: This cross-sectional observational study aimed to assess how sleep quality and high intensity physical activity associated with cardiovascular disease (CVD) risk factors and inflammatory biomarkers in a sample of young adults (n=106, ages 18-25 years). Methods: Laboratory-based assessments included lifestyle behaviors (sleep quality, Pittsburgh Sleep Quality Index; self-reported frequency/intensity of physical activity; Healthy Behavior Index derived from reported preference for diet and physical activity), CVD risk …

Women And Healthcare In Appalachia: Impeding Circumstance And The Role Of Technology, Ashley Cano

Electronic Theses and Dissertations

For decades, healthcare access and quality in central and southern Appalachia have trailed the rest of the country. Entrenched poverty and low educational attainment compound healthcare problems. This study examines the healthcare obstacles women encounter in southern and central Appalachia and analyzes how technology use, such as Internet searching and social media affect women’s healthcare decisions. Data were analyzed from four focus groups conducted with women from the region. Results indicate that seeing a physician or not did not influence women’s propensity to search the Internet for health-related information or to seek support through social media sites. Additionally, women reported …

Factors Associated With African American Women’S Sexual Health And Risk Behavior: A Mixed Methods Study, Melody N. Waller

Theses and Dissertations (ETD)

Introduction: When looking at the health status of our nation, an examination of sexual and reproductive health reveals that there are multiple conditions related to sexual behavior posing a burden on the health of African American women (AAW). Disproportionate rates of sexually transmitted infections, unintended/teen pregnancy, and sexual violence in this group reveal the need to integrate a broader construct to address the multiple factors known to contribute to disparities in sexual and reproductive health affecting AAW. Current health promotion efforts including the encouragement of abstinence and condom use fail to address the multiple components involved in sexual health and/or …

Predictors Of Quality Of Life For African American Women Who Assist Persons Who Receive Dialysis, Shaquita A. Starks

Theses and Dissertations (ETD)

The purpose of this predictive correlational study was to describe predictors of quality of life (QoL) for African American women who were caregivers of persons with end stage renal disease (ESRD). Five purposes, derived from a review of literature and conceptual model, guided this study. First, the study described the association between demographic factors (i.e., education, employment, age, marital status), and QoL. Second, the study explored the relationship between stress and QoL. Third, the study described the association between depressive symptoms and QoL. Fourth, the study described the association between family health/happiness and QoL. Fifth, the study described the extent …

Relationship-Centred Care In Health: A 20-Year Scoping Review, Sophie Soklaridis Phd, Paula Ravitz Md Frcpc, Gili Adler Nevo Md Frcpc, Susan Lieff Md Prcpc

Patient Experience Journal

Relationship-centred care (RCC) is a framework for conceptualizing health care which recognizes that the nature and quality of relationships in health care influence the process and outcomes of health care. Our goal was to undertake a scoping review of the peer-reviewed and grey literature on RCC in health. Using Arksey and O’Malley’s scoping review methodology we identified literature about RCC in teaching, learning and clinical practice. Electronic databases were searched, and targeted searches were also conducted for grey literature to capture unpublished material. Subsequently, data abstraction tools were used with eligible studies for analysis. Sixty-nine publications originated mainly from the …

Understanding Transgender Community: Locating Support And Resiliency Using The Minority Stress Model, Rosalind D. Kichler

Department of Sociology: Dissertations, Theses, and Student Research

The minority stress model (Meyer 2003) predicts stigmatized minorities, like transgender persons, suffer worse mental health due to exposure to discrimination. However support from similarly stigmatized others can ameliorate the effect of discrimination stress. Although gender and sexual minorities are often assumed to have access to and support from “the” LGBTQ community or “the” transgender community, many may not understand themselves as members of this community nor feel supported by it. Therefore it is essential to interrogate what community means to LGBTQ persons, particularly to transgender people for whom a paucity of literature exists. Based on in-depth interviews with 10 …

The Components Of Attentiveness In Oncology Care, Klaartje Klaver, Andries Baart

The Qualitative Report

This article presents the first findings of a qualitative empirical study of caregivers' attentiveness in hospital oncology care. It takes a care ethical perspective, in which attentiveness is considered an indispensable element of good care. The data are derived from participant observation at the oncology department of a general hospital in the Netherlands. The analysis shows a descriptive exploratory model of attentiveness, which comprises a coherent set of the clusters perception (A), object finding (B), and space for attentiveness (C). The methodological output of this article is an important one: the presented descriptive model of attentiveness promotes further research into …

Dossier De Politique No. 25 - Les Immigrants Sont-Ils En Meilleure Santé Que Les Natifs Du Canada?, Zoua M. Vang, Jennifer Sigouin, Astrid Flenon, Alain Gagnon

Population Change and Lifecourse Strategic Knowledge Cluster Research/Policy Brief

Plusieurs études montrent que les immigrants sont en meilleure santé que leurs concitoyens du pays d’accueil, du moins dans les premiers temps suivant leur arrivée. Le présent travail de synthèse (prenant en considération 77 travaux empiriques sur la question) démontre que si l’effet de « l’immigrant en bonne santé » est souvent avéré chez les immigrants adultes, il en va tout autrement chez les enfants ou les personnes âgées. L’ampleur de l’effet de sélection est aussi nettement plus significative pour les indicateurs de mortalité que de morbidité. Notre analyse suggère que les politiques en matière de santé des immigrants ne …

Dossier De Recherche No. 22 - De Nouvelles Pistes Sur Le Vieillissement Démographique Et Les Coûts Des Soins De Santé Au Québec, Michaël Boissonneault, Jacques Légaré, Yann Décarie

Population Change and Lifecourse Strategic Knowledge Cluster Research/Policy Brief

Cette recherche s'intéresse aux déterminants individuels associés à la variation des coûts publics des soins de santé, chez les Québécois de 65 ans et plus, vivant en ménage privé, avec incapacités. À l'aide de données administratives, la variation des coûts pour la consultation de professionnels de la santé et la consommation de produits pharmaceutiques a été analysée en fonction du nombre d’incapacités ainsi que de la nature de celles-ci. Les résultats montrent que des coûts plus élevés sont associés à un nombre plus élevé d'incapacités ainsi qu'à certains types particuliers d'incapacité, soient celles liées à l’agilité, la mobilité et, plus …

Research Brief No. 13 - The Social And Health Service Needs Of Aboriginal Peoples In Urban Southern Ontario, Martin Cooke, Julia Woodhall, Jennifer Mcwhirter

Population Change and Lifecourse Strategic Knowledge Cluster Research/Policy Brief

The disproportionate needs of urban Aboriginal people make it important for urban social and health service providers to understand the conditions faced by this population. This synthesis paper reviews recent literature on urban Aboriginal populations in order to identify their characteristics and main areas of need. It is meant to inform those who work in health and social service planning and delivery in smaller urban centers, particularly non-Aboriginal service agencies in Southern Ontario. The existing research shows that urbanized First Nations, Métis and Inuit have greater needs for specific health, cultural, justice, financial, and educational services. Further-more, the literature indicates …

Policy Brief No. 10 - The Town With No Poverty: Health Effects Of Guaranteed Annual Income, Evelyn L. Forget

Population Change and Lifecourse Strategic Knowledge Cluster Research/Policy Brief

Guaranteed Annual Income (GAI) has been advocated and opposed in both the United States and Canada as a means to fight poverty since the 1960s, but how does GAI influence specific health and social outcomes? In examining data from a town involved in a Canadian GAI field experiment, we primarily found that a relatively modest GAI can improve population health at the community level. Considering the increasing burden of health care costs in Canada, it is possible that implementing GAI could amount to considerable savings.

Policy Brief No. 5 - The Social And Health Consequences Of Family/Friend Caregiving, Stephanie Fletcher, Janet Fast, Jacquie Eales

Population Change and Lifecourse Strategic Knowledge Cluster Research/Policy Brief

The retrenchment of health care and other public support services coupled with economic and demographic changes have increased demands on family/friend caregivers. Family/friend caregivers are expected to do more with less. Yet the social and health consequences of providing family/friend care can undermine caregivers’ own wellbeing. A better understanding of these non-economic costs is important to preserving this vital resource. Using Statistics Canada’s 2007 General Social Survey (GSS), we describe the impact caregiving has on the health and social well-being of family/friend caregivers aged 45 and older in Canada.

Exploration Of The State Of Mental Healthcare Services For Youth In Nairobi, Rashiidah Richardson

Independent Study Project (ISP) Collection

This paper is formative research concerning the state of mental health care for youth in Nairobi, Kenya. Using a mixed methods design, the objectives of this study were to identify the most prevalent mental health concerns among youth in Kenya, to explore the availability and acceptability of youth friendly mental health care services, and to explore the quality of and challenges to providing youth friendly mental health care services. Results indicate that substance abuse, conduct disorder, and family conflict may be among the most pressing mental health concerns for young people. Furthermore, while young people may be willing to seek …

Population Neuroscience Approaches To Minority Discrimination And Health, Alleah Bouley, Alexander Johnson, Bethany Stoutamire, Elizabeth Straley, Jacob Cheadle

UCARE: Research Products

Alleah Bouley, Alex Johnson, Bethany Stoutamire, Elizabeth Straley

UCARE Abstract: Academic Year 2015-2016

Advisor: Dr. Jacob Cheadle

Population Neuroscience Approaches to Minority Discrimination and Health

STATEMENT OF PURPOSE

The primary purpose of our research is to explore the effects of social exclusion and discrimination on the mental and physical health and wellbeing of sexual minorities (gay, lesbian, and bisexual individuals). Addressing this complicated issue is a team effort, so participation in this project will provide a novel set of research experiences for participating undergraduates.

RESEARCH QUESTIONS

Our UCARE research will address two important questions. The first question we will address …

An Analysis Of Women’S Access To Acute Opioid Detoxification Services In Maine: Identifying The Barriers To Treatment, Karen E. Conley

Muskie School Capstones and Dissertations

The lack of treatment facilities and services for opioid use disorder in Maine, combined with an increased prevalence of addiction, creates a potential for health inequity between men and women that may be intensified by barriers in access to care. This capstone study utilized detoxification screening inquiry forms and data obtained from the Milestone Foundation’s acute opioid detoxification program to assess and categorize barriers to access by gender. A barriers model was developed based on existing literature and was to identify potential associations among and between the known barriers to accessing treatment. Barriers were described as internally or externally based, …

Marital Quality Buffers The Association Between Socioeconomic Status And Ambulatory Blood Pressure, Wendy C. Birmingham, Jenny M. Cundiff, Bert N. Uchino, Timothy W. Smith

Faculty Publications

Background Socioeconomic status is robustly associated with rates of death and disease. Psychophysiological stress processes are thought to account for a portion of this association. Purpose Although positive and supportive relationships can buffer psychophysiological stress responses, no studies have examined whether the quality of a primary adult relation�ship—marriage—may buffer the negative association be�tween socioeconomic status and stress-related disease processes. Methods The current study examines the interaction between income and marital quality (supportive vs. ambivalent) on individuals’ daily ambulatory blood pressure, a valid and re�liable indicator of cardiovascular risk. Results Results revealed that supportive marital relationships buffered the otherwise higher ambulatory …