scholarly journals A General Pathway Model for Improving Health Disparities: Lessons from Community and Cultural Involvement in Improving Cervical Cancer Screening in Vietnamese Women

2019 ◽  
Vol 8 (2) ◽  
pp. 154
Author(s):  
Richard Kones ◽  
Umme Rumana ◽  
Fauzia Arain
Keyword(s):  
Health Disparities ◽  
High Risk ◽  
Risk Model ◽  
Clinical Manifestations ◽  
Pap Test ◽  
High Risk Population ◽  
Pathway Model ◽  
Community Based ◽  
Community Based Research ◽  
Pathways Model

Objective: Chronic diseases have become dominant in the global health landscape. Despite remarkable advances in basic science, pharmacology, surgery, and technology, progress in lifestyle improvements, now considered essential, has been disappointing. Patient adherence to medications and other instructions play the greatest role in individual outcome shortfalls. Classically medicine has approached management using a high-risk model, targeting clinical manifestations of disease with progressively intensive therapies, in contrast with population-based models. In an effort to identify effectiveness among the many models available, the “pathways model” is reevaluated. Methods: Relying upon secondary data from prior studies in which Papanicolaou (Pap) test utilization was successfully improved, a “pathway model” is qualitatively reexamined in which characteristics of patients, providers, and the health system—as impacted by culture, beliefs, values, and habits—are acknowledged and incorporated by community resources into treatment plans. In so doing, health disparities are also addressed. Observations: The culturally inclusive pathways model using immersion community-based participation was successful in modifying behaviors when applied to a high-risk population in great need of improving Pap test adherence. Conclusions: In populations characterized by recognized cultural barriers contributing to low adherence, the pathways model may improve chronic disease outcomes. This model emphasizes a high degree of immersion within a culture and community as vehicles to improve patient behavior and address inequities. Central features are concordant with current concepts in guidelines, scientific statements, manuals, and advisories concerning the conduct of community-based research and social determinants of health. The pathways model deserves consideration for use in other chronic illnesses, such as cardiometabolic disease.

scholarly journals Antiviral treatment for outpatient use during an influenza pandemic: a decision tree model of outcomes averted and cost-effectiveness

2018 ◽  
Vol 41 (2) ◽  
pp. 379-390
Author(s):  
Sudhir Venkatesan ◽  
Cristina Carias ◽  
Matthew Biggerstaff ◽  
Angela P Campbell ◽  
Jonathan S Nguyen-Van-Tam ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
High Risk ◽  
Cost Saving ◽  
Decision Tree ◽  
Antiviral Treatment ◽  
Decision Tree Model ◽  
High Risk Population ◽  
Tree Model ◽  
Community Based ◽  
Population Groups

Abstract Background Many countries have acquired antiviral stockpiles for pandemic influenza mitigation and a significant part of the stockpile may be focussed towards community-based treatment. Methods We developed a spreadsheet-based, decision tree model to assess outcomes averted and cost-effectiveness of antiviral treatment for outpatient use from the perspective of the healthcare payer in the UK. We defined five pandemic scenarios—one based on the 2009 A(H1N1) pandemic and four hypothetical scenarios varying in measures of transmissibility and severity. Results Community-based antiviral treatment was estimated to avert 14–23% of hospitalizations in an overall population of 62.28 million. Higher proportions of averted outcomes were seen in patients with high-risk conditions, when compared to non-high-risk patients. We found that antiviral treatment was cost-saving across pandemic scenarios for high-risk population groups, and cost-saving for the overall population in higher severity influenza pandemics. Antiviral effectiveness had the greatest influence on both the number of hospitalizations averted and on cost-effectiveness. Conclusions This analysis shows that across pandemic scenarios, antiviral treatment can be cost-saving for population groups at high risk of influenza-related complications.

scholarly journals Pengaruh Kesehatan Lingkungan terhadap Perubahan Epidemiologi Demam Berdarah di Indonesia

e-CliniC ◽  
2017 ◽  
Vol 5 (2) ◽  
Author(s):  
Ribka Wowor
Keyword(s):  
High Risk ◽  
Environmental Factors ◽  
Dengue Hemorrhagic Fever ◽  
Health Problem ◽  
Human Population ◽  
Dengue Infection ◽  
Clinical Manifestations ◽  
Hemorrhagic Fever ◽  
Effective Control ◽  
High Risk Population

Abstract: In Indonesia, dengue hemorrhagic fever (DHF) is a serious health problem. Infection of dengue has occurred in Indonesia for the last two decades. It is a self limiting disease, however, its clinical manifestations has become worsened since several years ago. Epidemiologic pattern of dengue infection changes every year, and there is a peak of new cases every 10 years. Nowadays, adolescence and adult individuals belong to the high risk population of this infection. This epidemiologic changing of DHF is influenced by several environmental factors, inter alia: 1) increasing of human population; 2) uncontrolled urbanization; 3) no effective control of mosquitoes in endemic areas; and 4) modernized public transportation.Keywords: environmental sanitation, epidemiology, dengue hemorrhagic fever Abstrak: Di Indonesia, demam berdarah dengue (DBD) masih merupakan masalah kesehatan masyarakat yang penting. Infeksi dengue terjadi secara endemis di Indonesia selama dua abad terakhir. Penyakit ini bersifat self limiting namun dalam beberapa tahun terakhir memperlihatkan manifestasi klinis yang semakin berat sebagai DBD dan frekuensi kejadian luar biasanya semakin meningkat. Pola epidemiologi infeksi dengue mengalami perubahan dari tahun ke tahun, jumlah kasus memuncak setiap siklus 10 tahunan. Kelompok usia yang terserang dengue berubah menjadi kelompok remaja dan dewasa. Perubahan epidemiologi DBD ini turut dipengaruhi oleh faktor kesehatan lingkungan. Faktor-faktor yang memengaruhi peningkatan dan penyebaran kasus DBD sangat kompleks yaitu, antara lain: 1) pertumbuhan penduduk yang tinggi dan cepat; 2) urbanisasi yang tidak terencana dan tidak terkendali; 3) tidak adanya kontrol vektor nyamuk yang efektif di daerah endemis; serta 4) peningkatan sarana transportasi.Kata kunci: kesehatan lingkungan, epidemiologi, demam berdarah dengue

scholarly journals Developing Effective Interuniversity Partnerships and Community-Based Research to Address Health Disparities

2006 ◽  
Vol 81 ◽  
pp. 47-53 ◽  
Author(s):  
Timothy S. Carey ◽  
Daniel L. Howard ◽  
Moses Goldmon ◽  
James T. Roberson ◽  
Paul A. Godley ◽  
...  
Keyword(s):  
Health Disparities ◽  
Community Based ◽  
Community Based Research

scholarly journals MP33: Predictors of delirium in older patient at the emergency department: a prospective multicentre derivation study

CJEM ◽  
2019 ◽  
Vol 21 (S1) ◽  
pp. S54
Author(s):  
E. Béland ◽  
A. Nadeau ◽  
V. Boucher ◽  
P. Carmichael ◽  
P. Voyer ◽  
...  
Keyword(s):  
Emergency Department ◽  
High Risk ◽  
Length Of Stay ◽  
Risk Model ◽  
Classification Tree ◽  
Cognitive Status ◽  
Hospital Length Of Stay ◽  
Classification Error ◽  
High Risk Population ◽  
Modifiable Factors

Introduction: Delirium is a frequent pathology in the elderly presenting to the emergency department (ED) and is seldom recognised. This condition is associated with many medical complications and has been shown to increase the hospital length-of-stay. The objective of this study was to identify the predictor factors of developing delirium in this high-risk population. Methods: Design: This study was part of the multicenter prospective cohort INDEED study. Participants: Patients aged 65 and older, initially free of delirium and with an ED stay of 8h or longer, were followed up to 24h after ward admission. Measures: Clinical and demographic variables were collected by interview and chart review. A research professional assessed their delirium status twice daily using the Confusion Assessment Method (CAM). Analyses: A classification tree was used to select predictors and cut-points that minimized classification error of patients with incident delirium. After literature review, nineteen predictors were considered for inclusion in the model (eight non-modifiable and eleven modifiable factors). Results: Among the 605 patients included in this study, incident delirium was detected by the CAM in 69 patients (11.4%). In total, fourteen variables were included in a preliminary model, of which six were intrinsic to the patient and eight were modifiable in the ED. Variables with the greatest impact in the prediction of delirium includes age, cognitive status, ED length of stay, autonomy in daily activities, fragility and mobility during their hospital stay. The diagnostic performance of the model applied to the study sample gave a sensitivity of 78.3% (95% CI: 66.7 to 87.3), a specificity of 100.0% (95% CI: 99.3 to 100.0), a PPV of 100.0% (95% CI: 93.4 to 100.0) and a NPV of 97.3% (95% CI: 95.6 to 98.5). Conclusion: The delirium risk model developed in this study shows promising results with elevated sensitivity and specificity values. Considering the limited ability to predict and detect delirium among physicians, the potential increase in sensitivity provided by this tool could be beneficial to patients. This model will ultimately serve to identify high-risk patients with the goal of developing strategies to alter modifiable risk factors and subsequently decrease the incidence of delirium in this population.

scholarly journals Reducing health disparities through community-based research

2001 ◽  
Vol 116 (6) ◽  
pp. 517-519 ◽  
Author(s):  
Edward L Baker ◽  
LuAnn E White ◽  
Maureen Y Lichtveld
Keyword(s):  
Health Disparities ◽  
Community Based ◽  
Community Based Research
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