Дисертації з теми "Public health support roles"

In this study, autism parent-led support groups and the contribution these groups had in creating parental advocacy were studied. The primary purpose of the study was to determine if autism parent-led support groups promoted advocacy skills of parents of children with autism. The secondary purpose of the study was to evaluate the level and extent of support provided by parent-led support groups. The qualitative data collection was done through individual interviews of parents of children with autism whose children were of any age. Through data analysis 6 major themes were identified: advocacy, emotional support, difficulty with funding, informational support, instrumental support, and appraisal support. Parents indicated that parent-led support groups assisted them in acquiring advocacy skills and provided good emotional support, informational support, and appraisal support. This research was important because parents of children with autism have greater problems with treatments than parents of children with other chronic developmental disorders, and many parents felt they needed to obtain advocacy skills in order to find the best interventions for their child. The social change implication of this study is that people can better understand the impact that parent-led support groups can have in facilitating advocacy among parents who participate in the groups. This study also brings to light the support these groups provide, and how this support impacts their lives.

Recently, the Centers for Medicare and Medicaid Services (CMS) ranked all hospitals based on Medicare readmission rates for heart attacks, heart failure, and pneumonia. CMS offered subsidies to hospitals ranked in the 4th quartile to develop community support services to reduce the problem of potentially preventable readmissions (PPRs). CMS cited 4 of the 5 hospitals in Prince George's County in the 4th quartile. The purpose of this quantitative research study was to investigate the relationship between community support services and the reduction of PPRs in Prince George's County. The Evans and Stoddart field model of health and well-being guided this study with support from Bertalannffy's general systems theory. This study sought to relate community support services to PPRs in Prince George's County in contrast to other Maryland counties. To evaluate relationships between community support services and the reduction of PPAs, secondary data were provided by CMS in conjunction with the Robert Wood Johnson Foundation and the University of Wisconsin. The data included 26 behavioral community support factors from 53,229 Medicare paid claims in Maryland residents from July 1, 2008 to June 30, 2011. Lack of diabetes screening is a community support factor within quality of care. Using multiple regressions, there was a statistically significant relationship found between diabetic screenings and pneumonia readmission rate. The implication for social change is that reimbursement of key screening recommendations to CMS, local government, and hospitals in Prince George's County may reduce readmission rates, thereby positively affecting patients, improving community health, and decreasing health care costs in Prince George's County.

This study investigated the presence and roles of Child Life Specialists (CLSs) in camps for children coping with chronic illnesses and conditions. The current research project surveyed 118 camp coordinators and directors regarding their awareness of CLSs as well as the presence and roles of these professionals at their camps. Additionally, 61 Certified Child Life Specialists (CCLSs) were surveyed about their main responsibilities at camp and subjective beliefs regarding the effects of camp on children's health related quality of life (HRQoL). Further areas explored in this research included the applicability of Child Life education and training in the camp environment, Child Life motivations for joining the camp community, and CCLSs' previous experiences in this setting both as campers and counselors. Results indicated that the majority of camp coordinators and directors were aware of CLSs prior to this study as well as indicated that CLSs had worked at their camp. This subset of participants was also significantly more likely to be interested in bringing a CLS or additional specialists to their camp. Further results indicated that CLSs hold a wide range of roles and responsibilities in the camp setting, both paid and volunteer-based. All CCLSs indicated that they felt attending camp had positive effects upon children's HRQoL, particularly in the areas of psychosocial development and coping, as further illustrated by first-hand anecdotes from their time at camp.

VL is considered as a major public health problem in the Indian subcontinent and the annual case load of VL in this focus is represents around 80% of the global burden. In Nepal, a quarter of the country’s population is estimated to be at risk of this disease. The disease in the ISC is caused by L. donovani, which is transmitted from man to man by the bite of the sandfly Phlebotomus argentipes. VL occurs predominantly among the poorest of the poor. Since 2005, the governments of Bangladesh, India and Nepal have been engaged in a collaborative effort to eliminate VL from the region. The strategies to control the disease include early diagnosis and treatment, along with vector control measures, effective disease surveillance, social mobilization and partnership building, and clinical and operational research. In recent years, considerable efforts were made within the elimination initiative. Still, important gaps remain in the understanding of the VL epidemiology, and impact as well as on the best approach to case management or vector control. These knowledge gaps may affect the success of the ongoing VL elimination initiative and make it difficult to meet the set target of bringing the incidence down to less than 1 case per 10,000 by 2015. With this background we focused on some of the knowledge gaps; we wanted to generate evidence and offer sound recommendations for policy makers to underpin the ongoing VL elimination initiative in the Indian subcontinent in general and in Nepal in particular.

We have - for the first time- described the epidemiology of L. donovani infection in high transmission areas in Nepal. The sero-prevalence of L. donovani infection was 9% in these communities, but there was wide variation between endemic villages (5-15%). The seroprevalence rates remain however substantially lower than those observed in a parallel study in the neighbouring districts in Bihar, India. In our study 39% of individuals who live together in a house with at least one recent VL case were serologically (DAT) positive compared to 9% in the overall study population in the same endemic region. This pattern suggests that untreated VL cases are the main source of transmission and sharing the same household is an important risk factor for L. donovani infection. Therefore, the VL elimination campaign recently initiated an active case detection strategy including the search of active cases of VL and post-kala-azar dermal leishmaniasis (PKDL).

Generally the risk factors for VL are linked to precarious housing conditions and an environment that provides excellent breeding sites for the sandfly vector.VL has thus been largely considered as a disease of the rural poor. However, with occasional cases being reported also from town e.g. Dharan in south-eastern Nepal, questions were raised about possible extension of transmission to urban areas.

We conducted an outbreak investigation including a case-control study among the residents of Dharan town. We documented several clusters of VL cases in the more peripheral wards of the town. These are wards with new settlements where the poorest migrants install themselves. They are typically a rural-urban interface with most residents dependent on daily wages as agricultural labourers. However, several factors pointed to urban transmission: firstly, we found a strong association between VL and certain housing factors. Secondly, the clustering of VL cases in space and the intra-household clustering makes urban transmission more likely than infection due to migration. Finally, the entomological data also provide further evidence in support of local transmission of VL inside the town. The vector P. argentipes was captured repeatedly inside the town, and some of them were infested with L. donovani.

We studied the health seeking behavior and documented the households cost of VL care in a miltefosine-based programme after the intensified implementation of VL control efforts in Nepal. We enrolled 168 patients that had been treated for VL within twelve months prior to the survey in five districts in south-eastern Nepal. We observed a median delay of 25 days to present to the appropriate level of the primary healthcare system. Most patients first visited unqualified local practitioners or traditional faith healers for VL care. With a median total cost of US$ 165 per episode of VL treatment, the economic burden of VL across all households was 11% of annual household income or 57% of median annual per capita income. About half of the households exceeded the catastrophic expenditure threshold of 10% of annual household income. Our findings seem to suggest that, compared to previous studies, the economic burden of VL (as a % of household income) has indeed decreased. However, despite the provision of free diagnostics and drugs by the government, households still incurred substantial medical out-of-pocket expenditure, especially at private providers. The government should consider specific policies to reduce VL care costs such as a conditional cash programme for travel and food, and a better health insurance scheme.

We monitored clinical outcomes of VL treatment with miltefosine up to 12 months after the completion of therapy and explored the potential role of patient compliance, drug resistance, and reinfection. The initial cure rate was 95.8% and cure rate at 6 months after treatment was 82.5%, which further dropped to 73.3% at 12 months after miltefosine treatment. The relapse rate at 6 months was 10.8% and 20.0% at 12 months i.e. relapse is observed in one-fifth of miltefosine treated VL patients in Nepal. The decreased effectiveness of miltefosine observed in our study is an alarming signal for the ongoing VL elimination initiative and implicates the need for reviewing the drug policy in the Indian subcontinent. Relapse was most common among children (<12 years of age) and continued to occur beyond the commonly used 6-month follow-up period. No significant clinical risk factors or predictors of relapse apart from age <12 years were found. Parasite fingerprints of pre-treatment and relapse bone marrow isolates were similar within 8 tested patients, suggesting that clinical relapses were not due to re-infection with a new strain, but due to true recrudescences. MIL blood levels at the end of treatment were similar for cured and relapsed patients.The MIL-susceptibility of 131 VL isolates was also analysed in vitro with a promastigote assay and the mean promastigote MIL-susceptibility (IC50) of isolates from definite cures was similar to that of relapses.

We also assessed patient adherence to miltefosine treatment for VL given on an unsupervised ambulatory basis, prescribed under routine conditions (i.e. little or no time for treatment counselling) in government primary healthcare facilities. Our findings showed that adherence is a problem and the target of 90% of capsules taken is not reached in 15% of the enrolled patients. The gastrointestinal related side-effects and treatment-negligence after the resolution of clinical symptoms of VL were the main reasons for poor adherence. Effective counselling during the treatment, a short take-home message on the action and side effects of miltefosine, and on the importance of adherence are the best way to prevent poor adherence.

Post-kala-azar dermal leishmaniasis is more commonly seen in inadequately treated cases which is considered as a reservoir of infection maintaining disease transmission. The occurrence of PKDL in Nepal is relatively low compared to neighbouring countries involved in the elimination initiative. Supervised and adequate treatment of VL seems essential to reduce the risk of PKDL development. Policy makers should include surveillance and case management of PKDL in the VL elimination programme.

Doctorat en Santé Publique
info:eu-repo/semantics/nonPublished

This study explored the perceived effects of microaggressions on Peer Support Specialists (PSS). Although some research exists on the perceived effects of microaggression on individuals with lived experience of mental illness, known culturally as a marginalized group (Sue, 2010); none exists on PSS. The mental health movement began in the early 1900’s, which later evolved into mental health recovery and psychiatric rehabilitation. This movement brought forth the development of psychopharmacology, supportive services, and mental health programs. During the early phases of mental health recovery and treatment, individuals with lived experience of mental illness were utilized as peers and eventually as peer support specialists, or liaisons. Peer support specialists (PSS) provide an invaluable resource to individuals struggling with mental illness, as the literature supports. Despite strides towards societal acceptance, individuals with mental illness, continue to experience discrimination, stigma and microaggressions. Research on historical trauma, although beyond the scope of this research will be reviewed to provide an understanding of how microaggressions are passed on and additionally a narrative review of Adverse Childhood Experiences (ACEs) and the Connor-Davidson Resilience Scale (CD-RISC-25), aimed to contribute to the understanding of the history of trauma, engagement, and recovery. This research qualitatively explored the experience of sixteen participants who are PSS and in active recovery of mental illness. Semi structured focus group interviews revealed five major themes: Category 1–Microinvalidation: (1.1) Invalidation; (1.2) Second Class Citizen; Category 2–Resilience: (2.1) Advocacy; (2.2) Belonginess; (2.3) Perseverance.

Effective recognition and proper treatment of cardiovascular diseases (CVDs) in Hispanic woman is a public health problem that needs further investigation. Guided by the stress and coping social support theory, the purpose of this cross-sectional survey study was to examine the relationship between attitudes, emotional support, and the perception of success in managing cardiovascular diseases (CVDs) in 335 Hispanic women living in Atlanta, Georgia. Correlations, independent-sample t tests, simple linear regression, and multiple linear regressions showed ethnicity as a moderating variable between the perception of success in handling CVD and emotional support, while emotional support was shown to be a significant predictor of perceived success for all participants. The relationship between the 2 variables was positive for Hispanic women and negative for non-Hispanics women. Diet and exercise also emerged as a significant direct predictor of perceived success in handling CVD when the variable of emotional support was controlled. Key findings also showed that, while Hispanic women had higher scores for perceived success in handling CVD, non-Hispanic women had higher emotional support scores. This study supports positive social change by highlighting the unique needs of Hispanic women to healthcare providers, relative to effective recognition and positive treatment regimens, if cardiovascular disease is suspected. Positive social change will be demonstrated with the recognition of better health outcomes for Hispanic women.