The document summarizes how geographic information systems (GIS) can be used to analyze the relationship between cardiovascular disease morbidity and socioeconomic status in Georgia. It finds that areas with lower socioeconomic status, as measured by several indicators, tend to have higher rates of cardiovascular disease hospitalizations after adjusting for age. Using GIS allows targeting prevention programs to areas of highest need by visualizing disease burden and identifying populations at higher risk.
This presentation summarizes research on the determinants of access to quality health care for children in Georgia. The study used a merged dataset containing information on over 1,300 Georgia children ages 4-17. Access was defined based on utilization of preventive care and quality of received care. Results from descriptive analyses and multivariable logistic regressions found that over 30% of children had access to higher quality care. Factors like having insurance, higher income levels, and being in better health were associated with higher odds of access, while being a racial/ethnic minority was associated with lower odds. The findings can help inform efforts to improve insurance coverage and reduce disparities in access to quality care for children in Georgia.
AHRQ Quality and Disparities Report, May 2015Joe Soler
The document is a presentation from the National Healthcare Quality and Disparities Report Chartbook on Care Coordination from May 2015. It discusses trends in care coordination measures from the report and provides data on various measures of care coordination, including rates of patients receiving discharge instructions, hospital readmission rates, and preventable emergency department visits. The goal is to assess quality of care coordination and identify areas for improvement, particularly in reducing disparities. Several charts display care coordination measure results over time and differences between demographic groups to examine health equity.
This systematic review examined the effectiveness of disease management and case management for people with diabetes. The review found:
1) Disease management was effective in improving glycemic control, screening for diabetic complications, and monitoring of lipid levels.
2) Case management was effective in improving both glycemic control and provider monitoring of glycemic control, particularly in managed care settings in the U.S. for adults with type 2 diabetes.
3) Case management delivered with disease management or additional interventions was also effective.
This document discusses non-adherence to medication. It begins by defining non-adherence and reviewing studies showing patients only adhere to their medications 35-50% of the time. There are two types of non-adherence: passive (barriers outside patient control) and active (intentional non-adherence). Non-adherence increases morbidity, mortality, and costs the healthcare system. Studies show inconsistent gender differences in adherence, with most showing lower adherence in women, and the highest non-adherence rate in adults aged 65-75. The document proposes targeting female patients aged 65-75 in the UK prescribed antihypertensive medication, using a remote intervention informed by the Health Belief Model.
Medication non-adherence is a growing concern, as it is increasingly associated with negative health outcomes and higher cost of care. Tackling the burden of non-adherence requires a collaborative, patient-centric approach that considers individual patient needs and results in intelligent interventions that combine high-tech with high-touch.
Levels of Utilization and Socio - Economic Factors Influencing Adherence to U...inventionjournals
This document analyzes levels of utilization and socio-economic factors influencing adherence to antiretroviral therapy (ART) among people living with HIV/AIDS in Dodoma Municipality and Kongwa District, Tanzania. The study found that ART usage rates ranged from 100% at some facilities to 40% at others. Common reasons for dropping out of ART programs included side effects like vomiting (25.1%) and frequent sickness (19.9%), as well as lack of employment support (66.7%) and lack of confidentiality (50%). The document concludes that improving adherence requires addressing side effects, providing income assistance, and ensuring confidentiality in HIV services.
Ethnic and racial minorities experience higher mortality rates than white individuals for several health conditions, according to research presented at public health conferences. For example, one study found that non-Hispanic black individuals with chronic hepatitis B had higher 10-year mortality than white individuals. Another study showed that non-Hispanic black adults faced higher cardiovascular mortality over 10 years than other races. Several frameworks were discussed for analyzing health disparities using a social determinants of health approach, including examining the intersection of multiple social identities. Presenters advocated applying research findings to policy through frameworks like Health in All Policies.
The document discusses the issue of inadequate and unaffordable healthcare in the US, highlighting that 49.9 million Americans lack health insurance. It identifies groups most affected like minorities and those with lower incomes. A lack of preventative care leads to increased costs. Potential solutions discussed include expanding Medicaid eligibility and the models of the Veterans Health Administration and systems in France and Italy. New approaches like eReferral aim to improve access to specialty care.
This presentation summarizes research on the determinants of access to quality health care for children in Georgia. The study used a merged dataset containing information on over 1,300 Georgia children ages 4-17. Access was defined based on utilization of preventive care and quality of received care. Results from descriptive analyses and multivariable logistic regressions found that over 30% of children had access to higher quality care. Factors like having insurance, higher income levels, and being in better health were associated with higher odds of access, while being a racial/ethnic minority was associated with lower odds. The findings can help inform efforts to improve insurance coverage and reduce disparities in access to quality care for children in Georgia.
AHRQ Quality and Disparities Report, May 2015Joe Soler
The document is a presentation from the National Healthcare Quality and Disparities Report Chartbook on Care Coordination from May 2015. It discusses trends in care coordination measures from the report and provides data on various measures of care coordination, including rates of patients receiving discharge instructions, hospital readmission rates, and preventable emergency department visits. The goal is to assess quality of care coordination and identify areas for improvement, particularly in reducing disparities. Several charts display care coordination measure results over time and differences between demographic groups to examine health equity.
This systematic review examined the effectiveness of disease management and case management for people with diabetes. The review found:
1) Disease management was effective in improving glycemic control, screening for diabetic complications, and monitoring of lipid levels.
2) Case management was effective in improving both glycemic control and provider monitoring of glycemic control, particularly in managed care settings in the U.S. for adults with type 2 diabetes.
3) Case management delivered with disease management or additional interventions was also effective.
This document discusses non-adherence to medication. It begins by defining non-adherence and reviewing studies showing patients only adhere to their medications 35-50% of the time. There are two types of non-adherence: passive (barriers outside patient control) and active (intentional non-adherence). Non-adherence increases morbidity, mortality, and costs the healthcare system. Studies show inconsistent gender differences in adherence, with most showing lower adherence in women, and the highest non-adherence rate in adults aged 65-75. The document proposes targeting female patients aged 65-75 in the UK prescribed antihypertensive medication, using a remote intervention informed by the Health Belief Model.
Medication non-adherence is a growing concern, as it is increasingly associated with negative health outcomes and higher cost of care. Tackling the burden of non-adherence requires a collaborative, patient-centric approach that considers individual patient needs and results in intelligent interventions that combine high-tech with high-touch.
Levels of Utilization and Socio - Economic Factors Influencing Adherence to U...inventionjournals
This document analyzes levels of utilization and socio-economic factors influencing adherence to antiretroviral therapy (ART) among people living with HIV/AIDS in Dodoma Municipality and Kongwa District, Tanzania. The study found that ART usage rates ranged from 100% at some facilities to 40% at others. Common reasons for dropping out of ART programs included side effects like vomiting (25.1%) and frequent sickness (19.9%), as well as lack of employment support (66.7%) and lack of confidentiality (50%). The document concludes that improving adherence requires addressing side effects, providing income assistance, and ensuring confidentiality in HIV services.
Ethnic and racial minorities experience higher mortality rates than white individuals for several health conditions, according to research presented at public health conferences. For example, one study found that non-Hispanic black individuals with chronic hepatitis B had higher 10-year mortality than white individuals. Another study showed that non-Hispanic black adults faced higher cardiovascular mortality over 10 years than other races. Several frameworks were discussed for analyzing health disparities using a social determinants of health approach, including examining the intersection of multiple social identities. Presenters advocated applying research findings to policy through frameworks like Health in All Policies.
The document discusses the issue of inadequate and unaffordable healthcare in the US, highlighting that 49.9 million Americans lack health insurance. It identifies groups most affected like minorities and those with lower incomes. A lack of preventative care leads to increased costs. Potential solutions discussed include expanding Medicaid eligibility and the models of the Veterans Health Administration and systems in France and Italy. New approaches like eReferral aim to improve access to specialty care.
Contrasting Measures of Health Insurance Literacy and their Relationship to H...soder145
This document summarizes research contrasting two measures of health insurance literacy and their relationship to health care access. The researchers analyzed data from a 2015 Minnesota health survey. They found that:
1) Understanding insurance terminology was associated with higher confidence in getting needed care and lower odds of forgone care, while proactive insurance use correlated with lower odds of forgone care.
2) Correlates of health insurance literacy, such as education, varied between the two measures.
3) Both measures captured distinct concepts and translated to improved access, though proactive use only predicted forgone care and not confidence in care.
4) The researchers concluded both measures have value but more work is needed to better operationalize
Overview of the MNHA survey, methodology, and evidence of the impact of the a...soder145
The document summarizes findings from the Minnesota Health Access Survey (MNHA) on health insurance coverage in Minnesota from 2001-2015. Key findings include:
- The uninsured rate in Minnesota dropped significantly from 8.2% in 2013 to 4.3% in 2015, mirroring national declines under the Affordable Care Act.
- Gains in coverage occurred across age, income, race/ethnicity groups but inequities remain, with those with lower incomes or non-white races still facing higher uninsurance rates.
- The most common reason for being uninsured in 2015 was that coverage was too expensive.
The changing demographics of the uninsured in MN and the nationsoder145
The document analyzes changes in the demographics of the uninsured in Minnesota and nationally between 2013 and 2014 following coverage expansions under the Affordable Care Act. It finds that uninsured rates declined significantly in both Minnesota and all 50 states. While the characteristics of the uninsured remained largely the same, the uninsured population is now more likely to be Hispanic, non-citizens, and Spanish speakers in both Minnesota and nationally. The uninsured are also less likely to be children in Minnesota and very low income or Asian nationally. Continued outreach efforts are needed to enroll groups with historically high uninsurance rates.
Post reform changes in health care access and affordability in MN soder145
This document summarizes a presentation on changes in health care access and affordability in Minnesota following health care reforms. It analyzes data from Minnesota health surveys from 2007-2015. Key findings include: most Minnesotans have a usual source of care, though the uninsured report less access; while access has improved for many, some face issues getting appointments or with provider acceptance; forgone care due to costs has decreased for routine and mental care but remains an issue for low-income residents; and the percentage of people with medical bill or basic needs payment problems has declined since 2013 reforms.
This systematic review and meta-analysis examined the association between depressive symptoms and adherence to antiretroviral therapy (ART) among people living with HIV. It analyzed data from 111 studies with 42,366 participants across low, middle, and high income countries. The analysis found that the rate of depressive symptoms among people living with HIV ranged from 12.8% to 78% across studies, while the rate of good ART adherence (≥80%) ranged from 20% to 98%. There was no significant difference in depressive symptom rates by country income, but good adherence was significantly higher in lower income countries (86%) than higher income countries (67.5%). The meta-analysis showed that people living with HIV with depressive symptoms had a
Barriers to Access Quality Healthcare Services among Physically Challenged Pe...Premier Publishers
This study examined barriers to accessing quality healthcare among physically challenged persons in Gem Sub County, Siaya County, Kenya. The researchers conducted a cross-sectional study using questionnaires with 108 physically challenged individuals. The results showed that environmental accessibility of hospitals, their locations, and infrastructure leading to the hospitals greatly influenced the ability of physically challenged persons to access healthcare. All healthcare facilities were not adequately equipped to handle people with disabilities. Healthcare system-related factors like distance to facilities, awareness of services, and staff attitudes negatively influenced access to quality care for physically challenged persons in Gem Sub County. The combination of these barriers created significant obstacles for physically challenged persons to overcome in accessing needed healthcare services.
Opportunities for Expanding HIV Testing through Health ReformCDC NPIN
The document discusses opportunities to expand HIV testing through recent US health reform efforts. It notes that Medicaid expansion, Medicare improvements, and private health insurance reforms will require coverage of preventive services rated A or B by the US Preventive Services Task Force. This includes HIV testing for those at increased risk. While routine HIV testing is not currently covered, many people could now receive testing through these revised policies. Advocates may still need to work on regulations and state-level decisions to maximize expanded HIV testing opportunities through health reform implementation.
This document provides an overview of issues facing children with special health care needs (CSHCN) in California. It discusses key focus areas like care coordination and family engagement. It notes that California ranks poorly nationally in areas like preventative care, care coordination, and family-centered care for CSHCN. The document also discusses the medical and social complexity of CSHCN, the importance of care coordination systems, and the need to better support families providing care.
D. Stephen Goggans, MD, MPH
District Health Director - East Central District
Georgia Department of Public Health
Presentation to the Georgia Senate Women's Adequate Healthcare Study Committee
www.gacommissiononwomen.org
This survey of 948 oncologists from 82 countries investigated which cancer medicines they deemed most essential for public health in their countries. The most commonly selected medicines were doxorubicin, cisplatin, paclitaxel, pembrolizumab, trastuzumab, carboplatin, and 5-fluorouracil - 19 of the top 20 medicines are currently on the WHO Essential Medicines List. Availability of these medicines was lowest in low-income countries, ranging from 9-54% availability, compared to 68-94% availability in high-income countries. Risk of catastrophic health expenditures for cancer treatment was also higher in low-income countries. The findings challenge the feasibility of adding more expensive
Advancing a Sexual Health FrameworkFor Gay, Bisexual and Other MSMIn the Unit...CDC NPIN
Richard J. Wolitski presented on advancing a sexual health framework for gay, bisexual, and other men who have sex with men (MSM) in the United States. He noted that over 30,000 new HIV infections occurred among MSM in 2009, showing that current efforts are not effective. A sexual health approach considers broader health issues, relationships, discrimination and stigma. It emphasizes wellness, prevention, and respectful relationships. Structural changes are needed to address homophobia and improve health care and education to reduce HIV transmission and promote sexual health for all.
This document summarizes information about Emory University's graduate medical education programs for the 2014-2015 year. It provides details such as: the total number of residents/fellows being trained, major training facilities, debt levels of incoming residents, accreditation status of programs, and 2015 residency match results. It also discusses regulations from the Accreditation Council for Graduate Medical Education and how Medicare funding supports direct and indirect costs of medical education.
This study evaluated a brief intervention program aimed at reducing frequent visits to emergency departments in Christchurch, New Zealand. 53 participants who frequently visited the emergency department received a 12-week program including assessments of psychological distress and quality of life. The results found that participants significantly reduced their emergency department visits while maintaining their general practice attendance. They also reported decreased psychological distress and increased quality of life. Although the small sample size limits conclusions about the program's efficacy, the results indicate further development of brief intervention models for emergency departments is warranted.
Open classroom health policy - session 10.16 - iselin and youngBrian Young
This document summarizes a presentation about paying physicians and hospitals based on performance and value rather than volume of services. It discusses how the Affordable Care Act is implementing various pay-for-performance and value-based purchasing models in Medicare, including programs that pay hospitals and physicians based on meeting quality metrics and accountable care organizations that share in savings if reducing healthcare spending. It also notes concerns about whether these programs reliably improve quality and whether improvements are sustained, as evidence on their effectiveness is limited. Unintended consequences like patient selection and focusing only on measured aspects of care are also discussed.
Adherencia al tarv en am latina y caribeRosa Alcayaga
This systematic review and meta-analysis examined adherence to antiretroviral therapy (ART) among people living with HIV in Latin America and the Caribbean. The analysis included 53 studies published between 2005-2016 involving over 22,000 individuals across 25 countries. The overall adherence rate was estimated to be 70%, similar to rates in high-income regions. Adherence was higher with shorter recall periods and in lower income countries. Common barriers to adherence included substance abuse, depression, unemployment and pill burden. The review suggests adherence in the region may be below the level needed for long-term viral suppression.
Nicole S. Carlson, PhD, CNM
President, Georgia Affiliate of American College of Nurse-Midwives
Assistant Professor, Emory University School of Nursing
Presentation to the Georgia Senate Women's Adequate Healthcare Study Committee
November 9, 2015
Program Collaboration & Service Integration Michigan NhpcCDC NPIN
The document summarizes the organizational structure of disease prevention and control efforts within the Michigan Department of Community Health. It describes the Division of Health, Wellness and Disease Control which oversees HIV/AIDS, sexually transmitted diseases, and minority health. It provides details on collaboration between units to integrate information on related issues into training. Challenges and opportunities for further integration across the department are also discussed.
In Spring 2013, we are on the precipice of dramatic, disruptive change in the health field that offers an unprecedented opportunity and challenge to transform health care and population health.
We know that traditional public health approaches along with more and better health care are not enough to improve health outcomes, equity, and cost. We must also:
- implement sustainable, fundamental "upstream" changes that address the root causes of disease and disability; and
- transform the way we deliver health care to ensure access to quality, affordable health care for all.
Enjoy this Bright Spot presentation with David Law of Joy-Southfield Community Development Corporation, which was presented at the 2013 Annual Leadership Conference, co-sponsored by the Center for Health Leadership (CHL) and the California Pacific Public Health Training Center (CALPACT) at UC Berkeley's School of Public Health.
To learn more about this event, please visit:
http://calpact.org/index.php/en/events/leadership-conference
Learn more about CALPACT:
http://calpact.org/
Learn more about the CHL:
http://chl.berkeley.edu/
Affordable Care Act Briefing, Joanne Grossi, LWVMCVAcalindstrom
Presentation made to LWV of Montgomery County, VA and friends on Aug. 7, 2012. Speaker, Joanne Grossi, Director Region U.S. Dept. of Health and Human Services. (Shared with her permission)
The document outlines a health systems development framework with the goal of improving survival rates. It discusses interventions across several components: enhancing service delivery and utilization through expanded community healthcare; strengthening health workforce training and management; improving logistics and supply systems for essential drugs; and building leadership and planning capabilities through tools like District Health Profiling. The overall aim is to develop more integrated and sustainable healthcare systems.
Delivered by Prof Frances Ruane, Chairperson of the Expert Group on Resource Allocation in the Health Sector, Executive Director of the ESRI at the IPHA Annual Meeting 2010.
Contrasting Measures of Health Insurance Literacy and their Relationship to H...soder145
This document summarizes research contrasting two measures of health insurance literacy and their relationship to health care access. The researchers analyzed data from a 2015 Minnesota health survey. They found that:
1) Understanding insurance terminology was associated with higher confidence in getting needed care and lower odds of forgone care, while proactive insurance use correlated with lower odds of forgone care.
2) Correlates of health insurance literacy, such as education, varied between the two measures.
3) Both measures captured distinct concepts and translated to improved access, though proactive use only predicted forgone care and not confidence in care.
4) The researchers concluded both measures have value but more work is needed to better operationalize
Overview of the MNHA survey, methodology, and evidence of the impact of the a...soder145
The document summarizes findings from the Minnesota Health Access Survey (MNHA) on health insurance coverage in Minnesota from 2001-2015. Key findings include:
- The uninsured rate in Minnesota dropped significantly from 8.2% in 2013 to 4.3% in 2015, mirroring national declines under the Affordable Care Act.
- Gains in coverage occurred across age, income, race/ethnicity groups but inequities remain, with those with lower incomes or non-white races still facing higher uninsurance rates.
- The most common reason for being uninsured in 2015 was that coverage was too expensive.
The changing demographics of the uninsured in MN and the nationsoder145
The document analyzes changes in the demographics of the uninsured in Minnesota and nationally between 2013 and 2014 following coverage expansions under the Affordable Care Act. It finds that uninsured rates declined significantly in both Minnesota and all 50 states. While the characteristics of the uninsured remained largely the same, the uninsured population is now more likely to be Hispanic, non-citizens, and Spanish speakers in both Minnesota and nationally. The uninsured are also less likely to be children in Minnesota and very low income or Asian nationally. Continued outreach efforts are needed to enroll groups with historically high uninsurance rates.
Post reform changes in health care access and affordability in MN soder145
This document summarizes a presentation on changes in health care access and affordability in Minnesota following health care reforms. It analyzes data from Minnesota health surveys from 2007-2015. Key findings include: most Minnesotans have a usual source of care, though the uninsured report less access; while access has improved for many, some face issues getting appointments or with provider acceptance; forgone care due to costs has decreased for routine and mental care but remains an issue for low-income residents; and the percentage of people with medical bill or basic needs payment problems has declined since 2013 reforms.
This systematic review and meta-analysis examined the association between depressive symptoms and adherence to antiretroviral therapy (ART) among people living with HIV. It analyzed data from 111 studies with 42,366 participants across low, middle, and high income countries. The analysis found that the rate of depressive symptoms among people living with HIV ranged from 12.8% to 78% across studies, while the rate of good ART adherence (≥80%) ranged from 20% to 98%. There was no significant difference in depressive symptom rates by country income, but good adherence was significantly higher in lower income countries (86%) than higher income countries (67.5%). The meta-analysis showed that people living with HIV with depressive symptoms had a
Barriers to Access Quality Healthcare Services among Physically Challenged Pe...Premier Publishers
This study examined barriers to accessing quality healthcare among physically challenged persons in Gem Sub County, Siaya County, Kenya. The researchers conducted a cross-sectional study using questionnaires with 108 physically challenged individuals. The results showed that environmental accessibility of hospitals, their locations, and infrastructure leading to the hospitals greatly influenced the ability of physically challenged persons to access healthcare. All healthcare facilities were not adequately equipped to handle people with disabilities. Healthcare system-related factors like distance to facilities, awareness of services, and staff attitudes negatively influenced access to quality care for physically challenged persons in Gem Sub County. The combination of these barriers created significant obstacles for physically challenged persons to overcome in accessing needed healthcare services.
Opportunities for Expanding HIV Testing through Health ReformCDC NPIN
The document discusses opportunities to expand HIV testing through recent US health reform efforts. It notes that Medicaid expansion, Medicare improvements, and private health insurance reforms will require coverage of preventive services rated A or B by the US Preventive Services Task Force. This includes HIV testing for those at increased risk. While routine HIV testing is not currently covered, many people could now receive testing through these revised policies. Advocates may still need to work on regulations and state-level decisions to maximize expanded HIV testing opportunities through health reform implementation.
This document provides an overview of issues facing children with special health care needs (CSHCN) in California. It discusses key focus areas like care coordination and family engagement. It notes that California ranks poorly nationally in areas like preventative care, care coordination, and family-centered care for CSHCN. The document also discusses the medical and social complexity of CSHCN, the importance of care coordination systems, and the need to better support families providing care.
D. Stephen Goggans, MD, MPH
District Health Director - East Central District
Georgia Department of Public Health
Presentation to the Georgia Senate Women's Adequate Healthcare Study Committee
www.gacommissiononwomen.org
This survey of 948 oncologists from 82 countries investigated which cancer medicines they deemed most essential for public health in their countries. The most commonly selected medicines were doxorubicin, cisplatin, paclitaxel, pembrolizumab, trastuzumab, carboplatin, and 5-fluorouracil - 19 of the top 20 medicines are currently on the WHO Essential Medicines List. Availability of these medicines was lowest in low-income countries, ranging from 9-54% availability, compared to 68-94% availability in high-income countries. Risk of catastrophic health expenditures for cancer treatment was also higher in low-income countries. The findings challenge the feasibility of adding more expensive
Advancing a Sexual Health FrameworkFor Gay, Bisexual and Other MSMIn the Unit...CDC NPIN
Richard J. Wolitski presented on advancing a sexual health framework for gay, bisexual, and other men who have sex with men (MSM) in the United States. He noted that over 30,000 new HIV infections occurred among MSM in 2009, showing that current efforts are not effective. A sexual health approach considers broader health issues, relationships, discrimination and stigma. It emphasizes wellness, prevention, and respectful relationships. Structural changes are needed to address homophobia and improve health care and education to reduce HIV transmission and promote sexual health for all.
This document summarizes information about Emory University's graduate medical education programs for the 2014-2015 year. It provides details such as: the total number of residents/fellows being trained, major training facilities, debt levels of incoming residents, accreditation status of programs, and 2015 residency match results. It also discusses regulations from the Accreditation Council for Graduate Medical Education and how Medicare funding supports direct and indirect costs of medical education.
This study evaluated a brief intervention program aimed at reducing frequent visits to emergency departments in Christchurch, New Zealand. 53 participants who frequently visited the emergency department received a 12-week program including assessments of psychological distress and quality of life. The results found that participants significantly reduced their emergency department visits while maintaining their general practice attendance. They also reported decreased psychological distress and increased quality of life. Although the small sample size limits conclusions about the program's efficacy, the results indicate further development of brief intervention models for emergency departments is warranted.
Open classroom health policy - session 10.16 - iselin and youngBrian Young
This document summarizes a presentation about paying physicians and hospitals based on performance and value rather than volume of services. It discusses how the Affordable Care Act is implementing various pay-for-performance and value-based purchasing models in Medicare, including programs that pay hospitals and physicians based on meeting quality metrics and accountable care organizations that share in savings if reducing healthcare spending. It also notes concerns about whether these programs reliably improve quality and whether improvements are sustained, as evidence on their effectiveness is limited. Unintended consequences like patient selection and focusing only on measured aspects of care are also discussed.
Adherencia al tarv en am latina y caribeRosa Alcayaga
This systematic review and meta-analysis examined adherence to antiretroviral therapy (ART) among people living with HIV in Latin America and the Caribbean. The analysis included 53 studies published between 2005-2016 involving over 22,000 individuals across 25 countries. The overall adherence rate was estimated to be 70%, similar to rates in high-income regions. Adherence was higher with shorter recall periods and in lower income countries. Common barriers to adherence included substance abuse, depression, unemployment and pill burden. The review suggests adherence in the region may be below the level needed for long-term viral suppression.
Nicole S. Carlson, PhD, CNM
President, Georgia Affiliate of American College of Nurse-Midwives
Assistant Professor, Emory University School of Nursing
Presentation to the Georgia Senate Women's Adequate Healthcare Study Committee
November 9, 2015
Program Collaboration & Service Integration Michigan NhpcCDC NPIN
The document summarizes the organizational structure of disease prevention and control efforts within the Michigan Department of Community Health. It describes the Division of Health, Wellness and Disease Control which oversees HIV/AIDS, sexually transmitted diseases, and minority health. It provides details on collaboration between units to integrate information on related issues into training. Challenges and opportunities for further integration across the department are also discussed.
In Spring 2013, we are on the precipice of dramatic, disruptive change in the health field that offers an unprecedented opportunity and challenge to transform health care and population health.
We know that traditional public health approaches along with more and better health care are not enough to improve health outcomes, equity, and cost. We must also:
- implement sustainable, fundamental "upstream" changes that address the root causes of disease and disability; and
- transform the way we deliver health care to ensure access to quality, affordable health care for all.
Enjoy this Bright Spot presentation with David Law of Joy-Southfield Community Development Corporation, which was presented at the 2013 Annual Leadership Conference, co-sponsored by the Center for Health Leadership (CHL) and the California Pacific Public Health Training Center (CALPACT) at UC Berkeley's School of Public Health.
To learn more about this event, please visit:
http://calpact.org/index.php/en/events/leadership-conference
Learn more about CALPACT:
http://calpact.org/
Learn more about the CHL:
http://chl.berkeley.edu/
Affordable Care Act Briefing, Joanne Grossi, LWVMCVAcalindstrom
Presentation made to LWV of Montgomery County, VA and friends on Aug. 7, 2012. Speaker, Joanne Grossi, Director Region U.S. Dept. of Health and Human Services. (Shared with her permission)
The document outlines a health systems development framework with the goal of improving survival rates. It discusses interventions across several components: enhancing service delivery and utilization through expanded community healthcare; strengthening health workforce training and management; improving logistics and supply systems for essential drugs; and building leadership and planning capabilities through tools like District Health Profiling. The overall aim is to develop more integrated and sustainable healthcare systems.
Delivered by Prof Frances Ruane, Chairperson of the Expert Group on Resource Allocation in the Health Sector, Executive Director of the ESRI at the IPHA Annual Meeting 2010.
There are several ethical issues related to allocating scarce health care resources. Different ethical frameworks provide approaches for prioritizing patients, such as maximizing health benefits for the greatest number, or allocating based on principles of fairness and medical need. While it is difficult to satisfy all expectations, transparent use of ethical tools and frameworks can help clinicians and committees make reasoned and justifiable decisions about resource allocation.
Resource estimation and allocation happens to be one of the most crucial make/break points for most projects. However, this detail usually gets underestimated by project managers which consequently become evident in their lack of efficiency and effectiveness in the tasks they oversee. This lecture brings out a few techniques (scientific) as to how PMs can easily navigate their way through this difficulty.
This document discusses several project scheduling techniques including PERT, CPM, and GERT. It provides background on the development of PERT for the Polaris missile program and CPM for chemical plant construction. Key aspects of each technique are summarized, such as how PERT uses three time estimates to model uncertainty and calculate activity mean and variance. The document also covers topics like crashing, resource constraints, and limitations of PERT/CPM that GERT addresses.
Planning, scheduling and resource allocationJatin Mandhyan
The document summarizes a project to construct a new four-lane cable-stayed bridge over the Yamuna River in Allahabad, India. The project involved replacing an existing two-lane bridge that was over 100 years old and unable to handle increasing traffic volumes. Key aspects summarized are:
- The loan agreement between Japan and India to fund the project totaling 10 billion yen.
- Construction of the 1,640m long Naini Bridge with four traffic lanes and additional features like toll booths and structural monitoring systems.
- Several years of delay in completion from 1994 to 2004 due to issues with consultant selection, design reviews, and contractor tendering.
- The bridge helped alleviate traffic
Resource planning and resource allocationVenu Yemul
This document discusses resource planning and allocation for construction projects. It addresses the importance of managing resources like manpower, equipment, and materials. The key resources are labor, materials, and equipment. The document outlines different approaches to allocating resources based on whether resources are limited or unlimited, and how to level resource usage over time to improve efficiency and productivity.
K TO 12 GRADE 7 LEARNING MODULE IN HEALTH (Q1-Q2)LiGhT ArOhL
This document provides an overview of a health module for grade 7 learners. It discusses the concept of holistic health and the five dimensions of health - physical, mental, emotional, social, and moral-spiritual. It emphasizes that attaining balance across all dimensions is important for overall well-being. The document also addresses the changes that occur during puberty, noting that while patterns are similar for all adolescents, the pace of individual growth and development varies. Learners are provided various assessment activities to evaluate their understanding of health topics and reflect on their own health habits.
Human Resource Management involves attracting, managing, motivating and developing employees. The key HRM functions are staffing, training and development, motivation, and maintenance. Staffing includes job design, analysis, recruitment, and selection. Training and development helps employees improve skills and prepares the organization for future needs. Motivation keeps employees enthusiastic about their work. Maintenance retains productive employees through welfare programs, health and safety initiatives, and internal communication. External factors like government regulations, labor unions, and management theories also influence HRM.
Human Resource Management involves four main processes: planning, attracting, developing, and retaining human resources or employees. Planning involves strategic HR planning and job design. Attracting involves recruiting and selecting candidates from internal and external pools. Developing involves orientation, training, performance appraisal, and development. Retaining involves compensation, labor relations, maintenance through career counseling and health programs, and separation procedures.
Introduction to human resource managementTanuj Poddar
The document provides an introduction to human resource management. It discusses key points such as the definition of HRM, the history and evolution of HRM approaches, functions of HRM including strategic and operational functions, emerging roles of HRM, and challenges faced by HR professionals. Organizational structure and its relationship to HRM is also examined, including differences between formal and informal organizations as well as line and staff functions. The roles of HR executives are outlined.
Human Resource Management involves hiring, motivating, and maintaining employees in an organization. It focuses on managing people to accomplish individual, organizational, and social goals. HRM aims to make integrated decisions regarding recruiting, developing, compensating, and separating employees in a way that is consistent with the organization's effectiveness and ability to serve customers with high quality products and services.
Human resource management involves recruiting, selecting, training, developing and managing employees to achieve organizational goals. It includes human resource planning to ensure the organization has the right people with the right skills. The key components of an HRM system are recruitment, training, compensation, performance management and career development.
Human resource management involves recruitment, management, and development of employees. It focuses on five key functional areas: staffing, rewards, employee development, employee maintenance, and employee relations. Staffing deals with hiring qualified candidates. Rewards involve compensation and benefits systems. Employee development analyzes training needs. Employee maintenance ensures workplace health and safety. Employee relations includes schemes for employee involvement and union negotiations. The document outlines the various activities of HRM such as recruitment, training, performance management, compensation, and employee surveys. It emphasizes that properly executing HRM functions is crucial to achieving organizational goals.
This document provides a summary of key health indicators and socioeconomic determinants of health for Gloucester-Mathews, Virginia based on the most recent publicly available data. Some of the key findings include:
- The population of Gloucester-Mathews decreased slightly from 2010 to 2015, while the populations of Gloucester County and Mathews County varied, with Gloucester County growing and Mathews County declining.
- The Gloucester-Mathews population has a higher percentage of older residents compared to Virginia overall.
- Rates of chronic conditions like obesity, diabetes and high blood pressure are similar to or higher than state averages.
- Preventative health screening rates vary within Gloucester-Mathews, with some groups having
The goal of this webinar was to help healthcare professionals improve care coordination for patients with advanced illness and to reduce hospital readmissions and length of stay.
No sólo de especialistas médicos vive el hombretrujillo40
- The study examined the relationship between specialist physician supply and mortality rates using county-level data from 1996-2000 in the United States.
- They found that higher ratios of primary care physicians were associated with lower mortality rates for total, heart disease, and cancer mortality. However, higher ratios of specialist physicians showed no improvement or even higher mortality rates.
- These findings suggest that simply increasing the supply of specialists will not necessarily improve population health outcomes and could worsen health disparities.
The document discusses rural health professional workforce shortages in the United States. It defines different levels of rurality and provides data on physician and primary care provider distribution across rural and urban areas. There are shortages of primary care physicians and other providers in many rural areas. While policies aim to address shortages, ongoing payment challenges and scope of practice issues pose barriers to improving rural health workforce capacity.
The document discusses rural health professional workforce issues in the United States. It defines different levels of rurality and provides data on physician and other provider distribution across rural and urban areas. There are shortages of primary care providers in many rural areas. While policies aim to address shortages, ongoing payment challenges and scope of practice issues pose barriers to improving rural health workforce capacity.
1) The study examines how individual and neighborhood level poverty impact medication adherence among individuals with high cholesterol in New York City. It uses data from the 2014 New York City Community Health Survey.
2) Preliminary results show that individuals with incomes below 200% of the federal poverty level and those living in high poverty neighborhoods are less likely to adhere to cholesterol medications.
3) Additional factors associated with non-adherence include being uninsured, using the emergency department as a usual source of care, depression, younger age, and being black. The study aims to further explore these relationships through statistical analysis.
ALE Presentation: A Multiple Cause Analysis of Massachusetts Trends in HIV an...David Meyers
This document summarizes a study examining infectious disease mortality in Massachusetts from 2002-2011 using multiple cause of death data. The study analyzed deaths related to sepsis, influenza/pneumonia, hepatitis C, and HIV/AIDS. It found over 90,000 deaths were associated with these infectious diseases. Mortality rates and trends varied significantly by race, age, gender, and location. Spatial and temporal clustering methods identified populations and locations with higher mortality that should be public health priorities.
This is part 2 of a two part session deliver for a Common Awards (Theology, Ministry and Mission, University of Durham) course on health and the Church. The first part focuses on a theological perspective and the second part focuses on public health perspectives
This document analyzes cancer mortality rates between rural and urban counties in Wisconsin from 2003-2007. It finds that the smallest and most rural county (Menominee) had the highest cancer mortality rate and no local hospital, while more populous counties with multiple hospitals like Milwaukee, Brown, Dane and Waukesha had lower rates. Ensuring access to healthcare, especially in rural areas, through initiatives like comprehensive cancer control coalitions, could help reduce cancer deaths in Wisconsin.
This document summarizes Donald Hayes' presentation on the use of geographic information systems (GIS) technology and community level data visualization to inform planning efforts in Hawaii. Some key points:
- The Hawaii Department of Health uses a variety of health and socioeconomic datasets to identify needs, support grant applications, research, legislation and program evaluation.
- Data is compiled into a Primary Care Data Book which provides indicators by community on health outcomes, risk factors and socioeconomics using data sources like the census and vital records.
- The Data Book is used to assess primary care needs, highlight differences between communities, and facilitate data-driven decision making. It has supported funding and policy decisions and is utilized by various organizations.
The document discusses health information utilization in Namibia and associated challenges. It notes Namibia's population of 1.83 million people spread unevenly across a large area. The health information system collects routine data from all health facilities to analyze trends, guide policies, and monitor performance. Key challenges include staff turnover, timeliness of data collection, and a lack of designated information staff at district levels. Strengthening coordination, training, and computer systems are opportunities that could help address challenges and improve health information utilization in Namibia.
This document summarizes a study that utilized the Behavioral Risk Factor Surveillance System (BRFSS) to identify health disparities among manufacturing workers in South Texas compared to state and county populations. The study found disparities among the manufacturing workers in health care coverage, utilization of preventive health services, rates of chronic diseases, health behaviors, obesity rates, and self-reported health status. The results indicate a need for interventions to promote healthy behaviors for these workers and suggest that low health care coverage contributes to lower use of screening and prevention services.
Open DataFest III - 3.14.16 - Day One Afternoon SessionsMichael Kerr
Slide presentations delivered during the afternoon sessions of Day One of the California Statewide Health and Human Services Open DataFest - March 14 - 15, 2016, Sacramento, CA
This document discusses racial disparities in the treatment of cardiovascular disease. It provides an overview of health care disparities, noting they are differences in quality of care that are not due to access, clinical needs, or patient preferences. The document reviews literature finding racial minorities receive fewer cardiovascular procedures than whites. It also outlines federal programs and recommendations from the Institute of Medicine to address disparities through increased data collection, provider training, and health system changes. The role of perfusionists in efforts to eliminate disparities through education and data collection is discussed.
The report analyzes progress on 50 health-related SDG targets and indicators in the Eastern Mediterranean Region between 2015 and 2019. It finds that over half of the indicators showed some progress, including reductions in child malnutrition and increases in vaccination rates and healthcare workers. However, targets for reducing maternal, child, and neonatal mortality are still not being met. It also identifies five key challenges: weak governance, fragmented healthcare systems, limited data availability, emergencies like COVID-19, and issues of gender equality and health disparities. The way forward involves strengthening leadership, investing in health systems, expanding access to care, collaborating across sectors, and ensuring equity.
Used for Medical Grand Rounds at several hospitals, this is data based comprehensive review of the shortcomings of the American Medical System and dysfunctional political attempts at reform. Single payer, Medicare for all, with elimination of for profit insurance companies is the best answer.
Informatics and healthcare disparities 2014dcarla904
The document discusses health disparities and barriers to healthcare access in the United States. It notes that factors like financial concerns, geography, literacy, race, culture and others can contribute to population-specific differences in disease burden and access to care. Some populations experience disproportionately higher rates of chronic illnesses and mortality from certain causes. Efforts are needed to improve access, reduce disparities, and accelerate quality improvement, especially around preventive care and patient safety, in order to ensure all patients receive high-quality care.
Healthcare challenges & solutions in indiakripak93
This document discusses the key challenges facing India's healthcare system and potential solutions. The main challenges are the large burden of infectious and chronic diseases, high maternal and child mortality rates, lack of universal access to healthcare, shortage of resources, and inadequate healthcare financing. Proposed solutions include strengthening public health programs, improving access to healthcare in rural areas, providing incentives for medical professionals to work in underserved areas, leveraging public-private partnerships, and increasing public financing of healthcare.
DIABETES MELLITUS WITH Applied Research in Healthcare Administration.docxstirlingvwriters
The document discusses diabetes mellitus with complications as the principal diagnosis for analysis using secondary data from Texas hospitalizations between 2009-2014. It provides statistics on the total number of discharges, payer type, and patient race/ethnicity for diabetes mellitus with complications during these years. The assignment is to develop a research question, analyze the provided data to answer it, and discuss implications for healthcare administrators.
The document summarizes the DaTA study, which assessed using technology as an intervention to increase physical activity and improve cardiovascular health in subjects with metabolic syndrome or risk factors for type 2 diabetes or cardiovascular disease. It notes challenges with rural health like shortages of professionals and insufficient infrastructure for research. It proposes an integrated academic rural health center model to increase teaching capacity, provide more time for professional development, research, and community service, and serve as a recruitment tool for rural medicine.
Similar to Geographic Information Systems for Resource Allocation (20)
This document summarizes Georgia's trauma system and the need to improve it. It notes that Georgia currently has 18 trauma centers but should have 30 to adequately cover the state. The trauma death rate in Georgia is higher than the national average. In 2010, voters rejected an amendment that would have imposed a $10 fee to generate $80 million annually for trauma centers. The document outlines the different levels of trauma centers and the components and goals of Georgia's trauma system and five-year plan to improve emergency care access statewide.
The Determinants of Timely Access to Quality Health CareGPHA
This presentation summarizes research on the determinants of access to quality health care for children in Georgia. The study used a merged dataset containing information on over 1,300 Georgia children ages 4-17. Access was defined based on utilization of preventive care and quality of received care. Results from descriptive analyses and multivariable logistic regressions found that over 30% of children had access to higher quality care. Factors like having insurance, higher income levels, and being in better health were associated with higher odds of access, while being a racial/ethnic minority was associated with lower odds. The findings can help inform efforts to improve insurance coverage and reduce disparities in access to quality care for children in Georgia.
This document discusses cultural competence and diversity. It provides definitions of culture, cultural determinism, ethnocentrism, and cultural relativity. It describes how culture manifests itself through symbols, heroes, rituals, and values. The document also discusses developing culturally competent health promotion programs by understanding an individual's worldview, assessing one's own organization, and utilizing the National CLAS Standards. The overall purpose is to facilitate understanding of cultural diversity.
Incorporation Population Health into Medical EducationGPHA
The document outlines plans to incorporate population health into the medical education curriculum at the Medical College of Georgia at Georgia Health Sciences University. It discusses assessing internal resources and community needs. A framework is proposed to introduce population health concepts into the 3rd and 4th year of medical school through lectures, seminars, clinical experiences, and service learning opportunities. The goal is to better prepare physicians for a healthcare system focused on prevention and community health as recommended by organizations like the Institute of Medicine and licensing exams. Contact information is provided for those wanting more details on the population health initiative.
The document summarizes a community gardening program started in Clayton County, Georgia. It discusses the health, economic, and social benefits of community gardens. It also provides an overview of the program's goals, partnerships, lessons learned, and next steps to expand access to fresh produce through community gardens in the county. Six community gardens were established in the first year of the program across various locations.
This document discusses how to help employees confront and embrace change. It outlines several key points about managing change, including the three phases of change (current state, transition state, future state), the three main concerns about change, and best practices for reinforcing change through repeated communication. It also introduces the ADKAR model, which maps five key stages or elements for individual change: awareness, desire, knowledge, ability, and reinforcement. The document emphasizes that effective change management requires facilitating employees through these stages using tools like communication, buy-in roadmaps, training, coaching and addressing resistance. The overall message is that embracing uncertainty is key for public health leaders in the 21st century.
This document summarizes the "MOMS" program in Clayton County, Georgia which aims to improve birth outcomes for at-risk mothers. The program was created through a state grant to address high infant mortality rates. It provides home visitation and support services to pregnant women up to 18 months after birth. The program aims to educate the community and engage various partners to support mothers and promote healthy pregnancies and births. It highlights some success stories of mothers and infants who benefited from the program.
The document summarizes the Youth Risk Behavior Surveillance System (YRBS), which collects data on risky health behaviors among youth. Some key points:
- The YRBS is conducted nationally and in Georgia to monitor priority health risk behaviors like substance use, violence, sexual behaviors, diet, and physical activity.
- In Georgia, the YRBS surveys approximately 2,000 high school students and 2,000 middle school students every other year. It finds high rates of behaviors like insufficient physical activity, obesity, alcohol and drug use, and violence.
- The data is used to inform health policies and programs, describe trends over time, support funding requests, and create awareness among stakeholders like legislators and school
Michelle Carvalho and colleagues presented on using mini-grants and technical assistance to disseminate evidence-based programs in rural Georgia communities. They provided mini-grants of up to $4000 and technical assistance to 12 community organizations to implement nutrition or physical activity programs. Process evaluation found that while some core program elements were adapted, overall fidelity was high. Contextual factors like scheduling and recruitment challenges influenced implementation. Ongoing training and technical assistance shows promise for supporting communities to adopt evidence-based programs.
ABDOMINAL TRAUMA in pediatrics part one.drhasanrajab
Abdominal trauma in pediatrics refers to injuries or damage to the abdominal organs in children. It can occur due to various causes such as falls, motor vehicle accidents, sports-related injuries, and physical abuse. Children are more vulnerable to abdominal trauma due to their unique anatomical and physiological characteristics. Signs and symptoms include abdominal pain, tenderness, distension, vomiting, and signs of shock. Diagnosis involves physical examination, imaging studies, and laboratory tests. Management depends on the severity and may involve conservative treatment or surgical intervention. Prevention is crucial in reducing the incidence of abdominal trauma in children.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Integrating Ayurveda into Parkinson’s Management: A Holistic ApproachAyurveda ForAll
Explore the benefits of combining Ayurveda with conventional Parkinson's treatments. Learn how a holistic approach can manage symptoms, enhance well-being, and balance body energies. Discover the steps to safely integrate Ayurvedic practices into your Parkinson’s care plan, including expert guidance on diet, herbal remedies, and lifestyle modifications.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
Here is the updated list of Top Best Ayurvedic medicine for Gas and Indigestion and those are Gas-O-Go Syp for Dyspepsia | Lavizyme Syrup for Acidity | Yumzyme Hepatoprotective Capsules etc
Adhd Medication Shortage Uk - trinexpharmacy.comreignlana06
The UK is currently facing a Adhd Medication Shortage Uk, which has left many patients and their families grappling with uncertainty and frustration. ADHD, or Attention Deficit Hyperactivity Disorder, is a chronic condition that requires consistent medication to manage effectively. This shortage has highlighted the critical role these medications play in the daily lives of those affected by ADHD. Contact : +1 (747) 209 – 3649 E-mail : sales@trinexpharmacy.com
REGULATION FOR COMBINATION PRODUCTS AND MEDICAL DEVICES.pptx
Geographic Information Systems for Resource Allocation
1. Geographic Information Systems for Resource Allocation Presentation to Georgia Public Health Association April 12, 2011 Michael Bryan, Chronic Disease Epidemiologist
2. DCH Mission ACCESS Access to affordable, quality health care in our communities RESPONSIBLE Responsible health planning and use of health care resources HEALTHY Healthy behaviors and improved health outcomes
3. DCH Initiatives FY 2011 FY 2011 Continuity of Operations Preparedness Customer Service Emergency Preparedness Financial & Program Integrity Health Care Consumerism Health Improvement Health Care Transformation Public Health Workforce Development
4.
5.
6. Number of Farms by County, Georgia 1997 Without GIS Visualization Capabilities County No. Farms County No. Farms County No. Farms County No. Farms County No. Farms County No. Farms Rabun 122 Gwinnett 303 Hancock 103 Muscogee 39 Appling 494 Decatur 335 Towns 121 Barrow 361 Butts 148 Effingham 203 Randolph 119 Grady 462 Fannin 151 Polk 344 Heard 160 Bleckley 221 Chatham 42 Thomas 421 Murray 238 Paulding 218 Spalding 193 Marion 147 Turner 230 Seminole 183 Whitfield 325 Cobb 128 Glascock 76 Candler 264 Ben Hill 159 Charlton 75 Catoosa 215 Oglethorpe 319 Jefferson 356 Chattahoochee 13 Worth 406 Lowndes 373 Union 256 Clarke 80 Burke 346 Macon 282 Wayne 276 Echols 67 Walker 478 Wilkes 298 Washington 327 Treutlen 157 Coffee 656 Camden 46 Dade 175 Lincoln 163 Meriwether 257 Dodge 491 Clay 56 Brooks 430 Gilmer 267 DeKalb 46 Troup 221 Schley 91 Irwin 288 Habersham 407 Oconee 305 Pike 252 Pulaski 161 Bacon 324 White 284 Walton 493 Lamar 188 Taylor 196 Lee 157 Lumpkin 198 Haralson 260 Monroe 179 Toombs 401 Dougherty 139 Stephens 188 Morgan 390 Baldwin 137 Montgomery 252 Calhoun 122 Gordon 535 Carroll 702 Jones 157 Tattnall 589 Tift 359 Dawson 160 Douglas 107 Screven 325 Wheeler 176 Pierce 379 Chattooga 278 Rockdale 102 Wilkinson 88 Dooly 259 Early 279 Floyd 437 Greene 198 Upson 185 Evans 183 Berrien 399 Pickens 194 Newton 260 Jenkins 248 Bryan 61 Ware 274 Franklin 699 Taliaferro 55 Bibb 149 Webster 76 Baker 131 Hall 666 Columbia 169 Twiggs 98 Stewart 77 Mitchell 464 Hart 460 McDuffie 217 Talbot 111 Sumter 314 Atkinson 196 Banks 446 Clayton 54 Harris 207 Telfair 271 Brantley 207 Bartow 400 Henry 327 Crawford 123 Wilcox 273 McIntosh 24 Cherokee 493 Warren 134 Emanuel 441 Liberty 43 Cook 226 Forsyth 434 Fayette 184 Johnson 288 Crisp 213 Colquitt 634 Jackson 719 Richmond 106 Laurens 688 Long 64 Miller 251 Elbert 320 Jasper 185 Peach 157 Quitman 17 Clinch 93 Madison 622 Coweta 316 Houston 249 Jeff Davis 220 Lanier 92 Fulton 257 Putnam 152 Bulloch 524 Terrell 174 Glynn 36
7. Number of Farms by County, Georgia 1997 With GIS Visualization Capabilities
53. Socioeconomic Indicators Indicator Range Median Mean( σ ) High Education 7.6% - 46.1% 15.6% 18.2% (8.1%) White Collar 29.9% - 72.3% 45.2% 47.2% (8.5%) Median Family Income $27,232 - $78,853 $38,463 $40,411 ($9,485) Unemployment Rate 3.0% - 9.5% 4.9% 5.1% (1.2%) Poverty 5.2% - 36.2% 18.3% 18.6% (6.4%)
54.
55. The Health Message Conundrum CVD Morbidity Economic Resources Low Low High High
56. The Health Message Conundrum CVD Morbidity Economic Resources Low Low High High
57. Examples of CVD Morbidity by Local Economic Resource (LER) Index *Age-Adjusted Deduplicated Hospital Discharges per 100,000 population County LER Quintile CVD Morbidity* Clay 0 417 Quitman 0 253 Catoosa 4 316 Dade 3 210 Jones 4 1800 Houston 4 1758 Marion 0 1799 Twiggs 1 1749
58. Examples of CVD Morbidity by Local Economic Resource (LER) Index *Age-Adjusted Deduplicated Hospital Discharges per 100,000 population County LER Quintile CVD Morbidity* Clay 0 417 Quitman 0 253 Catoosa 4 316 Dade 3 210 Jones 4 1800 Houston 4 1758 Marion 0 1799 Twiggs 1 1749
Editor's Notes
This presentation will address the rather broad categories of “Health Improvement” and “Public Health”
Objectives: In our objectives section we will identify the primary thrust of the presentation. Background: In the background we will address the two distinct topics pertinent to this presentation. The first being to establish what GIS is and its unique capabilities. The second being to speak towards research demonstrating the association between socioeconomic status and CVD disparity. Cardiovascular Disease and Socioeconomic Status Example: Next, we will walk through an example that demonstrates the utility of GIS in program development by looking at cardiovascular disease morbidity and socioeconomic status in Georgia. Conclusion: In our final section we will summarize the functionality of GIS in the example and the functionality of GIS in a broader sense to public health practitioners
My goal for you is not to teach you the technical side of GIS so that you can leave here knowing how to operate arcGIS. Rather, it is to demonstrate for how GIS might be incorporated in your own work and to get you thinking about the possibilities that are inherent in the process of easily and simply visualizing a disease, an area, risk factors, co-morbidities, et cetera ad infinitum and how this can be engaged in the decision-making process.
The database system in GIS consists of a database, where the data is stored in a logical manner, a database management system in the form of a computer software that provides the interface between an individual user and the database, and a relational database model. Spatially indexed data refers to data that is related to objects in space, such as objects (like a building, a car crash, a crime), lines (like roads, gas pipelines), or polygons (like states, counties, or census tracts). Procedures that might be operated upon a GIS include counting the number of cancer cases within a given county, constructing a 10 mile buffer around all trauma care hospitals to determine access, clipping only crashes within the state of Georgia from a national database of all crashes to create a new database, determine the rate of asthma cases by census tract.
We will be focusing on the first of these bullets. We will leave the functionality of GIS as a means of cluster detection, as demonstrated in the map to the right, and as a means of making regression analyses more specific as they incorporate spillover effects into the model itself for a later conversation.
This quotation was attained in response to a questionnaire in the United Kingdom regarding the uptake of GIS in the National Health Service. We, meaning those who utilize GIS on a daily basis, can’t just assume others will want to use GIS. We should be humble in the usage and promotion of GIS and in identifying what it is, especially with regards to program development and implementation. Yet at the same time we must acknowledge that the role of GIS in public health is constantly changing and that there is a need for more research to establish the context the GIS is most applicable.
GIS can be used to make program adjustments based not only on risk of the disease itself but also risk factors of the disease and other exposures such as socioeconomic position like we will be focusing on in our example. A program may incorporate these in their prioritization of potential targets or
Our interest in looking at the CVD-Socioeconomic status relationship is based on the growing body of evidence that links the two together. The line on top is the quintile with the lowest economic status, while the line on bottom at “1” is the quintile with the highest economic status. As the graph to the right demonstrates, areas of lower socioeconomic status are at greater risk of mortality for men – the same is true for women. This graph demonstrates how the disparity between the highest and lowest economic groups has actually widened a good deal over time, especially for those of the lowest economic group – the top line. In 1969, those in the most deprived quintile were only 30% more likely to die due to CVD, whereas in 1997, they were at nearly 80% higher risk of mortality due to CVD – for women, this figure is closer to 95% Moving forward, GIS could be used to address this ever-widening disparity in disease burden to mitigate the divide between those areas of the highest economic standing and those of the lower economic standing
Not only is it the disease itself which is associated with areal socioeconomic disparity, but so too are risk factors for the disease. The diagram to the right demonstrates the findings in that in a given city, with decreased economic deprivation, here illustrated with increasing house values, there is a concurrent decrease in current smoking amongst women – the same is true for men. Diez-Roux’s 1997 article, “Neighborhood Environments and Coronary Heart Disease: A multilevel analysis”
So, lets say that our objective is to increase the control of high blood pressure and cholesterol. We want to demonstrate how using GIS makes deciding which counties are in greatest need of controlling their high blood pressure and cholesterol easier and how GIS may impact the program by overlaying socioeconomic status data on the CVD data. Socioeconomic status is just one of a number of other factors that may be taken into account when designing a CVD intervention for a county – one may also be interested in co-morbid conditions like obesity and diabetes and several risk factors like smoking, nutrition, physical inactivity, or health access as means of decision-making. As the number of criterion increases so too does the decisionmakingGIS can help ease the process of not only understanding these dynamics both within an individual county and throughout the state but also communicating these dynamics.
(Read slide first) Area-based socioeconomic measures permit the routine monitoring of inequalities in health The Local Economic Resource Index and Poverty Prevalence have been shown to be sensitive to socioeconomic gradients in health White Collar Occupations: Management Occupations, except farm managers Business and financial operations occupations Professional and related occupations Sales and office occupations
(Go through slide first) Deduplication indicates that we counted an individual only once even if re-admitted in the same calendar year Though we had access to all diagnoses we utilize the principle diagnosis as that is intended to communicate the primary reason an individual visited the hospital in the first place.
(Read slide first) With these sort of background numbers it is easy to understand why there are programs already attempting to mitigate this issue and why there are others being developed to approach CVD reduction throughout the state.
(Read slide first) This single variable measure has been shown to perform as well as more complex measures of economic deprivation such as the Townsend Index while still maintaining the same qualities listed above
Point out which county is Dade (lowest/top left) and which is Heard (highest/7 th one down). This begins the prioritization of counties. Heard is a likely candidate for the CVD program intended to promote hypertension and cholesterol screenings as are the other counties in dark red.
Notice that this is based on “unemployment” so being a darker blue color is not a good thing.
After having taken into account the preceding indicators of socioeconomic status, the Local Economic Resource Index provides a meaningful way of understanding which counties have the most economic resources to pull from at a given time. As expected, Economic Resources are centralized around urban areas like Atlanta and Savannah while Rural Georgia counties are consistently among the most deprived counties.
In this map, being a darker shade of blue is not a good thing. One may notice that this map is essentially the reciprocal of the previous map depicting Local Economic Resources.
When comparing the difference in the hospital discharge rate for quintile 0, the least economically advantaged quintile, with quintile 4, the most economically advantaged quintile, we found that unemployment, education, and economic resources all had significant differences in the means of the two groups.
CVD morbidity and socioeconomic position are inversely related. CVD morbidity amongst counties in the lowest Local Economic Resource quintile is 20% higher as compared to counties in the highest Local Economic Resource quintile – the same is true for unemployment and education One has a couple of options with these results: First, one could extrapolate that a county with low socioeconomic status should have high CVD morbidity. How does this insensitive extrapolation get a program any closer to identifying target counties? Second, one could go back to the source dataset and identify the counties with the highest CVD morbidity and then find counties of the lowest socioeconomic status. But what about if a program wants to take other criteria into account, such as access to healthcare facilities, health insurance coverage, a co-morbid factor such as obesity? Then going back to a table seems tedious and out of touch with technological options that GIS can offer. This would traditionally be the endpoint of an Epidemiological analysis – charts, graphs, relative risks that establish a risk factor-disease association, but no maps and no spatially referenced findings being communicated.
Without the incorporation of spatially referenced data into the results what can an audience member say about a given county’s CVD burden or its socioeconomic status? What would happen if we went past these findings to help program planners and other stakeholders identify SPECIFIC areas in need of a program or those capable of having a program? By using spatially referenced data one is communicated to in a very straightforward and visual manner the value of the variables of interest and how they inter-relate. At this point we have seen the distribution of CVD morbidity and the distribution of socioeconomic position in each county. It is somewhat satisfying to have seen this, but we then need to ask ourselves how to integrate the two thoughts together in an effective way that expedites the decision-making process by not only demonstrating high priority counties but also unique traits of these counties pertinent to program design – in this case socioeconomic position.
The goal of utilizing 3-Dimensional graphics is to demonstrate where there is a confluence of both disease burden, risk factors, or other criterion like obesity, high cholesterol, current smoking, asthma, et cetera – any criteria that are important and able to be assessed from a programmatic decision-making perspective. This is where I view one of the strengths of GIS – presenting vast amounts of intelligible data in a concise format in place of presenting tables or portions of tables which are not effective communication devices in large scale or complex formats. (Begin arcScene after reading slide) (Focus on Poverty-CVD Morbidity 3-D map): In the West Central, or Columbus, Health District, we see one county in the least economically advantaged quartile and appears to have one of the highest CVD morbidity rates. This is Randolph County and it had a CVD morbidity rate of 1,882 age-adjusted deduplicated hospital discharges in 2008. It had a poverty rate of 24.3% and a Local Economic Resource Index score of ZERO, meaning that it was in the lowest quintile for unemployment (6%), education (11% have at least an Associate’s Degree), income (with a family median income of $30,000) and white collar employment (where 19% of the population was employed in a white collar occupation). The county was named after John Randolph, a Republican from Virginia who was also a descendant of Pocahontas. It has a population of almost 8,000 and covers 429.3 square miles and is home to one of the first pecan trees brought into GA. Up the GA line a bit you will reach another peak portraying an unusually high CVD morbidity rate. This is Troup County. However, this time it is one of the more advantaged counties. Troup has a CVD morbidity of 1,740 age-adjusted deduplicated hospital discharges in 2008. Its poverty rate was 16.4%. It has an LER score of 10. Breaking this down, it was in the 4 th highest quintile in white collar occupation at 31%. It was in the 2 nd quintile of unemployment at 5.8% (ahh, for the good ole days when 5.8% was considered among the worst counties). Troup was in the 4 th highest quintile for median income at $42,000 and also in the 4 th highest percent of population that has attained at least an Associates degree at 22%. Troup county is currently home to 68,000 residents. It was created out of a settlement with Creek Indians in 1827. Troup county is currently home to several industries, including textiles, product packaging, and batteries and is highly anticipating the construction of a KIA’s first American automobile manufacturing facility. If both of these counties could be chosen to receive the hypertension and cholesterol screening program, Randolph, the least economically advantaged county in GA may require more resources to achieve the goal of increasing the number of screenings. For example, as compared to Troup county, Randolph may benefit more from the addition of a comprehensive wellness center where individuals may go not just for free or reduced price hypertension and cholesterol screenings but also for exercise classes, healthy eating and cooking classes, smoking cessation counseling, and other health education opportunities. Whereas in Troup County, individuals may benefit more from simple media campaigns or other informational sessions, relying on their actual doctors to perform the screenings. Troup county residents may already have access to the healthcare and health facilities that residents of Randolph lack due to their greater economic resources to pull from. They may even have greater access to places like gyms and parks where they can safely exercise thus decreasing their physical inactivity rate. GIS allows us to easily find the target counties via the elevation. From here we can overlay any number of risk factors or other criterion that are important in program implementation. This allows us to communicate the data in a format intelligible to most audiences to guide the decision-making process. Ours is only one simple example for portraying the traits of a county’s disease burden and a single risk factor. One can repeat this process with any and all criterion by which one would want to make decisions on counties to target and which type of program to implement.
Given completion of the selection process we may have ended up with Houston and Irwin counties being ones receiving the intervention, one an economically advantaged county, the other a more disadvantaged county. Irrespective of whether programmatic personnel have chosen the more economically advantaged or disadvantaged county, a given program may then want to decide to prioritize target areas for the hypertension and cholesterol screening intervention based on CVD morbidity at a smaller subsection of the county – in our case, we chose to use a census block group. Knowing where burden is the highest in a chosen county may be useful in deciding where to further target resources. GIS allows us to swiftly and effectively move from the county level to this rather fine scale of block group. First, Houston county is one of the most economically advantaged counties in Georgia. However, as previously mentioned, it also has one of the highest CVD morbidities in Georgia. If the program doesn’t have much in the way of resources or is looking to somehow implement a program in one of the more advantaged areas, they may then narrow down the populations that they need to target to the block group level. A block group is smaller than a census tract and usually contains between 600 and 3000 persons – optimally about 1500. They are the smallest area for which sample information is available from the Census Bureau and are intended to reflect generally homogenous populations. Second, Irwin County is one of the most deprived counties in Georgia as it has an Local Economic Resource Index score of zero. Understanding that this is already a disadvantaged area without much in the way of economic resources, a program may want to focus on the block groups with the highest CVD morbidity to more directly address the disease. Houston County’s highest CVD morbidity rates occur seemingly randomly throughout the county whereas Irwin County’s seem concentrated in the Northeast side. Understanding these two aspects further enable program planners to more effectively target those populations suffering from the highest burden of CVD. In Irwin County, given the concentrated nature of the CVD morbidity, a program planner may come to the conclusion that if a comprehensive wellness center is to be built it may be most fruitful to place it so that these populations have greater access to it than those that may not have such a high burden. Houston county on the other hand, may benefit more from a more broad spectrum media campaign to increase awareness of hypertension and cholesterol screening and its benefits.
(Read through slide first) In the example we have used, GIS provided a means of understanding the relationship between a disease, CVD, and a risk factor thereof, socioeconomic status. It allowed us to quickly and simply identify where there was a confluence of high CVD morbidity and low socioeconomic status – presumably this would be the county or counties in need of the most help. Though the same conclusions could have been drawn using traditional database systems without the use of GIS, the data integration and visualization capabilities combined with the ability to spatially reference data allows for a more intuitive, less cumbersome means of comprehending and communicating which counties should be the targets of programs and which programs and health messages would be best suited to a particular county.
It is GIS’s ability to effectively portray the confluence of a given disease and its risk factors or co-morbidities that makes it useful to public health practitioners who are looking for a given area to target. The example provided is from the state government’s perspective on the distribution of funds for public health programs in a given county. This same approach could be useful at most any scale as in the maps portraying the block groups for Houston and Irwin counties. Sure, the same data can be understood in table format without GIS as the individual from UK likely does very well. But how does one then communicate this data to their audience? As my hypothetical program design consortium, would you have preferred me to present 159 observations for each of the 7 variables we have used in a table? Would that have been an effective means of internalizing and comprehending where there is a confluence of high CVD-low SES at the same time as noticing where there is also high CVD-high SES? This ability to take data from disparate sources and at multiple levels and then to communicate it in a way that allows others to quickly and easily determine the burden of disease on an area and other spatially referenced variables of importance is a tool that public health practitioners may find incredibly useful as they utilize data-based decision-making.
Life expectancy for those
What is the purpose of those two adjectives? Final comments Do you think you have answered sufficiently the question you raised initially: “ We haven’t got GIS. It isn’t a problem for us. Why is it a problem for you?” I think we can get the information you presented without drawing any map at all. See slides 34 & 35. The question, rather, is what does GIS add to that information? If you used CVD as an example, then you have to give clear examples of how GIS helps to make the right decision in priority setting and choice of intervention. What activities are included in the CVD prevention or health promotion programs? And which ones should be directed to which population group? How should a component of a program be delivered for one community differently? What are the common parameters used for program development or priority setting or resource allocation, etc and which ones are influenced by GIS or what additional dimension does GIS bring in?
One way of conceptualizing how to apply what we know of both CVD morbidity and Economic Resources is with the following. Have a very simplistic conceptualization of the CVD Morbidity-Local Economic Resources relationship: Green: Low Economic Resources, low CVD Morbidity Blue: High Economic Resources, low CVD Morbidity Yellow: High Economic Resources, high CVD Morbidity Red: Low Economic Resources, High CVD morbidity (Click to next slide)
One way of conceptualizing how to apply what we know of both CVD morbidity and Economic Resources is with the following. Have a very simplistic breakdown of the CVD Morbidity-Economic Resources relationship: Green: Low Economic Resources, low CVD Morbidity Blue: High Economic Resources, low CVD Morbidity Yellow: High Economic Resources, high CVD Morbidity Red: Low Economic Resources, High CVD morbidity We had previously started our research under the premise that CVD morbidity would be inversely related to areas of fewer economic resources. We had previously started our research under the premise that CVD morbidity would be inversely related to areas of fewer economic resources. Our findings also indicate that one would expect the most deprived counties to have 20% higher CVD morbidity as compared to the least deprived counties. Though this may be true in general, it is not an absolute. So, there are likely to be exceptions to this trend.
Green: low economic resource, low CVD – These are some of the lowest CVD morbidities in the dataset from Clay and Quitman counties, both also having some of the lowest economic resources Blue: high economic resource, low CVD – this is what one would extrapolate from research findings where Catoosa and Dade, of higher local economic resources, having low CVD morbidity (click to next slide)
Yellow: high economic resource, high CVD – in this conceptual box one may want to take notice as Jones and Houston counties are of the highest Local Economic Resources, but they also have some of the highest CVD morbidities Red: low economic resources, high CVD – again, this is what one would expect from the research as Marion and Twiggs have very little local economic resources and they have two of the higher CVD morbidities. Jones, Houston, Marion, and Twiggs are all worthy of interventions for hypertension and cholesterol screening as they have a CVD morbidity nearing 2% of the population. Given that one had to pick only one county, I am guessing most of us would pick the county with the least amount of economic resources of these four – Marion. But, what if one could choose several counties for the intervention? One would then have to answer questions regarding program design as the program itself, though having the same objective, is likely to differ in a county of exceptionally high Local Economic Resources as compared to a county of exceptionally low Local Economic Resources