Summary of Current Problem and Study Relevance. A review of the literature reveals that there is limited training for medical professionals on the topic of child sexual abuse in the U.S. and in Canadian graduate medical education models, including the post M.D. educational environment. Therefore, effective strategies for preventing child maltreatment are needed. Few primary care-based programs have been developed, and most have not been well evaluated (Dubowitz, Feigelman, Lane, & Xxx, 2009). The Physician’s Power to Protect program has been designed for medical professionals to address this gap in specialized and standardized training pertaining to the prevention and detection of child sexual abuse. Given the existing data, there is a need for such a program to be implemented in the existing graduate medical education landscape. However prior to implementation, the Physician’s Power to Protect program should be fully evaluated. This thesis develops a public health grant proposal to evaluate the effectiveness of the curriculum, methods and teaching resources of the Physician’s Power to Protect program in preparedness for its integration and adoption by medical schools throughout Georgia and across the U.S. and Canada. According to the Facilitator Guide for the Physician’s Power to Protect program, there are two types of evaluation plans for this program, that were devised at its inception, and will be implemented in this proposal as well: a performance evaluation that assesses behavior change as a result of the program, and a learning evaluation that assesses outcomes for each session or module. Assessment for this educational program consists of informal and formal assessments that are completed during and after each didactic session. By definition, “informal assessment is a technique that can be incorporated into classroom activities which do not provide a comparison to a broader group, and formal assessment is a preplanned assessment which provides a larger picture of learning outcomes and comparison to a broader group or predetermined standards” (Duan, Green, Mehrotra, Odani, & Xxxxxx, Physician's Power to Protect: Facilitator's Guide, 2014). At the inception of the Physician’s Power to Protect program, an evaluation of the curriculum was proposed which will be discussed in greater detail later on in this chapter of the grant proposal. Currently, pre- and post-training surveys are used as evaluation tools for the Physician’s Power to Protect program (Appendix 3 and Appendix 4). The Physician’s Power...
Summary of Current Problem and Study Relevance. A wealth of prior research has demonstrated that marital status is associated with health, and that the event of widowhood is associated with subsequently increased risk on the part of the surviving spouse for a number of adverse health outcomes, most notably death. Results of combined meta analyses suggest that bereavement increases mortality by about 25% on average for males, but less so for females. Results of numerous studies also suggest that the bereavement effects are greatest during the first six months of widowhood, but may persist for up to 20 years. Research to date has not revealed clear mechanistic pathways to explain how mortality risk is increased. Prior research suggests that the context of the predeceased spouse’s death – such as whether the death was expected – generally appears to have a bearing on how well the surviving spouse does. However, the number of studies that have examined variability in mortality as a function of specified characteristics of the predeceased spouse’s death – especially using multivariate analysis – is limited. Furthermore, no known published studies to date have combined the use of group-based trajectory modeling to empirically evaluate end-of-life patterns of health decline in predeceased spouses with formal analysis of the subsequent survival of the bereaved spouses. The present research therefore seeks to make a contribution to the body of knowledge by combining these two concepts, in order to explore how the predeceased spouse’s trajectory of morbidity during the last part of their life affects the subsequent survival of the bereaved spouse.
Summary of Current Problem and Study Relevance. Adolescence is a period of significant physical, social and emotional growth, as well a period of increased vulnerability to sexual health risks. The public discourse on sexuality has historically turned a blind eye to the realities faced by young people. Many studies conducted in Senegal use epidemiological monitoring of high-risk groups and repeated behavioral surveys to track sexual behavior and attitudes. Surveys of Senegalese youth‟s knowledge, attitudes and practices are limited in providing a contextualized understanding of the HIV epidemic (Winskell and Xxxxx 2005), and are vulnerable to social desirability bias. Data exploring adolescent sexuality in Senegal are limited to a few qualitative studies that explore this topic through IDIs and FGDs in select settings. Relatively little is known about young people‟s social constructions of HIV & AIDS. Through analysis of fictional narratives written by young Senegalese people, this study uses a non-directive approach to explore the symbolic and social aspects that shape how Senegalese youth make sense of HIV & AIDS. Moreover, findings will highlight existing communication needs. This is the first analysis of stories submitted to the 2008 Scenarios from Africa contest. Findings will contribute to a longitudinal, multi-country research process examining stories about HIV & AIDS written by young Africans.
Summary of Current Problem and Study Relevance. After reviewing the literature, a comprehensive list of ignition sources, fuel sources, and oxidizers was developed. The ignition and fuel sources corresponding to medical devices will be used as search criteria to identify reports of surgical fires in FDA’s XXXXX database. Knowing that Xxxxx & Xxx (2011) found that 91% of fires were started by either ESU or laser, and ECRI Institute note that 80% of all fires are started using these ignition sources, it is with good confidence that as long as these devices are included in the search criteria of the thesis, a majority of the surgical fire adverse event reports should be captured. The review of the literature noted that fuels in the operating room are ubiquitous. None the less, including the fuels identified in the literature as search criteria for the thesis study will also help target the search. Finally, the estimates in the literature for the frequency of occurrence or incidence of surgical fires will be used to compare the results obtained in the thesis study.
Summary of Current Problem and Study Relevance. Multiple imputation methods can reduce bias and overestimation of uncertainty by the complete- case analysis when assuming MAR missing data mechanism. In addition, multiple imputation has influence over the selection of variables in the final regression models. As demonstrated by xxx xxx Xxxxxxx, et al.,51 missing data analysis methods yielded different final regression models due to the differences in the variable selection outcomes. Therefore, it is critical that any study constructing multivariate regression models perform missing data analysis to strengthen the study’s conclusions or identify the effect that missing data can have. The studies by Xxxxxxxx, et al.17 and Xxxxxxxxxxx, et al.18 used complete-case analysis to determine the parameter estimates of their regression models. There were no discussions of the potential effect of missing data on the outcomes. This lack of reporting reflects the common practice in current epidemiologic studies. Xxxxxxxx, et al.58 reported that among 61 randomly selected quality of life studies from the New England Journal of Medicine, Journal of the American Medical Association, BMJ, and Lancet from 2005 to 2006, 36 (59%) had some form of missing data but did not perform any imputation analysis. Current statistical software have the ability to perform multiple imputation methods. Although assumptions about the missing data mechanism are still required, software such as SAS and SPSS provide investigators with user-friendly interfaces to perform complicated missing data analysis. Therefore, investigators should be able to assess for the effects of missing data on their study conclusions. The key strength of multiple imputation methods is its robustness in generating parameter estimates that are close to the “true” value while addressing the variance. Unlike single imputation methods where parameter estimates have artificially inflated precisions, multiple imputations maintain the variance expected in parameter estimates while reducing bias. Several studies that engineered missing data in order to compare the results of multiple imputation to the “true” data have reported moderate to high correlations and similar confidence levels.21,41–43,49 These studies provide confidence in the method and support its application in situations where missing data mechanisms are MAR and the unobserved values are unavailable for validation. The current thesis builds upon the literature by providing further support for using multiple imp...
Summary of Current Problem and Study Relevance. The review of the literature provided an overview of sex trafficking including risk factors. Following this foundational review, the literature demonstrates the challenging health needs for survivors of sex trafficking and suggests healthcare providers play an important part of the public health response to address trafficking. The literature points to the crucial role providers can play in addressing trafficking while highlighting challenges they may face. However, much of the literature is not specifically focused on the experience of primary care providers. The literature places an emphasis on trauma-informed care, an understanding of risk factors and red flags, and healthcare provider partnerships with social services as critical aspects to address trafficking within healthcare settings. Although the literature conveys the need and significance of the provider in addressing trafficking in healthcare, it is only suggestive of the impact such an approach plays on trafficking prevalence and population-level health outcomes. Most research reviewed as a part of this study, defined aspects of the utility of specific tools, such as protocols or trainings, which may engender support for providers across healthcare settings. However, the literature suggests there is ample opportunity to assess the short and long-term impact these tools have on health outcomes. Even though literature positions primary care as a key setting from which to address trafficking, the research on how primary care providers should approach addressing trafficking is
Summary of Current Problem and Study Relevance. The reviewed literature contains several studies that have examined cervical cancer screening among HIV infected women. It is recognized that only one of the presented studies (Xxxxx et al.) used a nationally representative cohort of persons receiving care for HIV in the U.S. All others were carried out in specific geographic areas, so it must be acknowledged that results may not generalize to all HIV clinics. It must also be noted that the possibility of bias may exist within some of the works due to the use of volunteers (Xxxxxxxx et al., Solomon et al.) and the data collection method used (interview – Oster et al., Xxxxx et al.; questionnaire – Xxxxxx et al.). In addition, it is possible that underreporting of true screening rates may have occurred due to incomplete documentation in patient medical records (Logan et al., Xxxxxxxx et al., Xxxxxx et al., Xxxxx et al.). However, overall, these works do appear to adequately demonstrate the less than optimal adherence to Pap screening in this population. Research has suggested that HIV positive women are underutilizing gynecologic healthcare, cervical cancer screening in particular. Limited published literature is available that provides an examination of perceived patient barriers to care within this group or interventions to reduce/eliminate this disparity in care. The proposed clinical quality improvement project for the WCHD RWP will build upon the literature by examining the impact of an intervention (a telephone care management system) on patient completion of annual cervical cancer screening and assessing for barriers that prevent patients from maintaining up-to-date Pap smears.
Summary of Current Problem and Study Relevance. With Georgia being the worst state for maternal mortality overall and Black mothers being 234% more likely to die from pregnancy and birth-related complications, an intervention is needed to save the lives of many women. A mobile unit that is accessible to many in rural areas of Georgia could make a difference in health outcomes that are experienced due to pregnancy and birth. New mothers would not have to drive long distances for care, decreasing the likeliness that they will experience negative health outcomes due to inaccessible care, and increase the likelihood of them seeking care during and after their pregnancy. Having the unit staffed by Black providers is a factor that could increase the number of patients that seek care from the mobile unit and continue to get their services there due to being more likely to trust their provider. Our target population for this intervention is Black women, ages 18-45. This age range was chosen because it is roughly the range of reproductive age for women, with 18 being the minimum age for eligibility so mothers can participate without having to gain parental/guardian consent. Women should also be between their first and second trimester, regardless of how many pregnancies they have had. This eligibility criteria are important as women further along in pregnancy have already established care with a provider and should continue to see that provider for the duration of their pregnancy and postpartum. Flyers for recruitment to use the mobile unit will be posted in community center bulletin areas, local health clinics, churches, grocery stores and the closest hospitals to the town/city. We will utilize a mixed-methods approach to gain a better understanding of past experiences, current experiences and thoughts on what our target audience is looking for when it comes to a mobile clinic. These measures will be taken after the needs assessment is conducted. In addition, we will utilize focus groups and surveys to collect data on our target population. By utilizing Community-Based Participatory Research framework (National Institute on Minority Health and Health Disparities, 2018), our target audience/community can have a say in the development of the intervention. This will improve the efficacy of our research because we are working with those we intend to serve and collaborating on finding the best ways to provide the intervention.
Summary of Current Problem and Study Relevance. With Georgia being the worst state for maternal mortality overall and Black mothers being 243% more likely to die from pregnancy and birth-related complications, an intervention is needed to save the lives of many women. A mobile unit that is accessible to many in rural areas of Georgia could make a difference in health outcomes that are experienced due to pregnancy and birth. New mothers would not have to drive long distances for care, decreasing the likeliness that they will experience negative health outcomes due to inaccessible care, and increase the likelihood of them seeking care during and after their pregnancy. Having the unit staffed by Black providers is a factor that could increase the number of patients that seek care from the mobile unit and continue to get their services there due to being more likely to trust their provider. Chapter 3: Methodology Agencies that Fund Mobile Clinics There are many mobile clinics both in the United States and worldwide that provide various services. As discussed in the literature review, there is a maternal mobile clinic operating in Haiti that is funded by foreign donors and foundation grants (Xxxxxx, Xxxxxx & Xxxxxx, 2018). The World Health Organization is a large funder of mobile clinics globally that provide services to displaced population (WHO, 2021). Endowments foundations such as The Duke Endowment (2020) fund mobile clinics to reach areas, with the goal of improving access to quality health care. Research shows that there are many different funding agencies that are interested in expanding healthcare access through mobile units. Global organizations such as the World Health Organization utilize mobile clinics on a greater scale and provide more general services to their target populations. Donors and foundation grants, such as the ones used to fund the maternal mobile unit in Haiti are used for a more specific population, such as pregnant women in rural Haiti. Large state-side foundations such as The Duke Endowment have a more general purpose and includes improving access to healthcare via mobile units ran by hospital staff in needed areas in North Carolina and South Carolina. March of Dimes was chosen for this grant due to their mission on improving health for mothers and babies. March of Dimes (original name National Foundation for Infantile Paralysis) was founded in 1938 by Xxxxxxxx X. Xxxxxxxxx with the goal of uncovering the mysteries of polio. After the polio vaccine was successfully created, t...
