<p> The capstone project reports the risk factors causing unplanned hospital readmission of vascular patients as well as the effects on healthcare cost. The methods for determining the risk factors include clinical indicators for risk prediction process, and the STAAR (State Action on Avoidable Rehospitalization) initiatives, which can be used as healthcare improvement projects to facilitate the cross-continuum team. The findings indicate a relationship between the patient&rsquo;s engagement in the lower extremity vascular procedure, and effectiveness of follow-up after surgery in the reduction of hospital readmission and healthcare cost. Potential strategies to prevent the risk factors for readmission of vascular patients and to reduce the healthcare cost are discussed. Presenting unplanned readmission for vascular patients and reducing the cost associated with readmission is important for senior leaders and policy makers to improve health care outcome.</p>

The United States is home to approximately 44.5 million immigrants and refugees, and these numbers continue to grow. To ensure a healthy immigrant and refugee population, it is important to address the unique health needs of these communities. Migrant women face many obstacles in obtaining women’s health services, including language and cultural barriers, difficulty finding childcare to attend medical appointments, and transportation difficulties. These factors are compounded by systemic difficulties in receiving health insurance coverage. Published literature describes women’s health in immigrant and refugee women living in the United States, but much of this literature either focuses on specific cultural or religious groups rather than looking at overall trends in women’s health care or does not differentiate between women’s and men’s health services in immigrant and refugee populations. Through reviewing published studies, the aim of this paper is to analyze general trends about the accessibility of women’s health services to immigrant and refugee women living in the United States. This paper will also look at specific examples of cultural and religious groups in the United States to examine the variation in women’s health preferences and issues among immigrant women of different backgrounds. Finally, this paper will explore potential ways to improve women’s health services available to immigrant and refugee women living in the United States.

MSc., Faculty of Science, University of the Witwatersrand, 2011 / There is an increasing adoption of outdoor visits in high schools in Lesotho and this study was done to find out what students learn about community health as they visit Lesotho Water and Sewage Authority (WASA). Eighty Form D (equivalent to grade 11 in South Africa) learners were the participants in this study. In order to capture students‘ learning a qualitative study was designed. The study used observations, questionnaire (n=80) and semi-structured interviews (n=8) with learners. The data was analyzed inductively and deductively in order to answer questions about knowledge changes as a result of a visit to WASA, and about the aspects of the visit that influence learners‘ knowledge about community health. Analysis of the questionnaire and the interviews revealed that learners greatly gained knowledge as a result of the visit to WASA while others developed misconception and others did not change their conceptions at all. The forms of conceptual change identified from learners responses were enrichment and conceptual capture. Learners realized that water purification is not a minute-made activity since there are several steps involved in water purification and that taps are not the main water sources. Learners also became aware that boiling water is not the only effective way of treating water instead other purifying stations like WASA can purify water suitable for domestic use. However, some learners believed that water that has been treated by the sewage plant is not suitable to be purified and used for domestic purpose. The observation analysis indicated that the physical facilities, displays, prior knowledge and participation during the visit are some of the aspects that influence learners‘ knowledge about community health. The realism of concepts communicated during the visit enhanced learners‘ ability to acquire knowledge about community health. The physical facilities such as the machinery at WASA provided the concrete evidence that water is drawn from the rivers therefore rivers are the main water sources. Visual displays contributed much in learners‘ ability to gain knowledge during the visit to WASA. It has also been found that although manipulation of objects was minimal, learners still gained information communicated during the visit. With the stated findings above, a visit to WASA enhance learner‘s ability to acquire information about community health.

Prenatal health programs and public health promotion provide strategies to mitigate modifiable risks to pregnancy. Women marginalized by race/ethnicity, disability, sexual identity, socioeconomic status, immigration, Francophone and Indigenous status experience barriers to prenatal service access. Multijurisdictional program evaluations were conducted to review prenatal health promotion, design, implementation and evaluation strategies for Canadian government-hosted websites, prenatal e-classes and international prenatal guidance documents. Gaps were noted in prenatal content targeted to non-Anglophone, immigrant, Indigenous and disabled women and LGBTQ communities. I recommend that prenatal program best practices consist of evidence-based, theoretical foundations which recognize the diverse interacting determinants of health across the lifespan. Intersectoral collaborations and integration of public health into primary care facilitates delivery of accessible, inclusive, woman-centred services. These best practices are anticipated to help harmonize prenatal programs across communities, which optimize maternal-child health and children’s long-term health outcomes.

<p> In response to the growing need for early disease detection and diagnosis, Mastergene aims to provide genetic testing services ranging from new born screening to diagnostic screening for individuals up to 65 years of age to gain insight into their genetic information &amp; understand their own health &amp; personal information. This information will assist individuals in making treatment decisions for healthy living. Through Indian healthcare market analysis, it is evident that there exists a huge gap between hospitals and patients when it comes to understanding genetic testing and its benefits. Mastergene, with its innovative in-house laboratory, will arise awareness amongst the general population and will facilitate early detection of highly prevalent diseases in the Indian community. As a stand-alone diagnostic laboratory, Mastergene will outsource genetic testing kits from a supplier, send it to its patients on order and obtain patient&rsquo;s sample in that genetic test kit for testing purposes. In conclusion, Mastergene will bring this enormous breakthrough to diagnose the disease from its root cause rather than symptoms alone.</p><p>

Introduction: Despite the method existing for centuries, uses of crowdsourcing have been rising rapidly since the term was coined a decade ago. Crowdsourcing refers to ‘outsourcing’ a problem or task to a large group of people (i.e., a crowd) rapidly and cheaply. Researchers debate over definitions of crowdsourcing, and it is often conflated with mHealth, web 2.0, or data mining. Due to the inexpensive and rapid nature of crowdsourcing, it may be particularly amenable to health research and practice, especially in a global health context, where health systems, human resources, and finances are often scarce. Indeed, one of the dominant methods of health research prioritization uses crowdsourcing, and in particular, wisdom of the crowds. This method, called the Child Health and Nutrition Research Initiative (CHNRI) method, employs researchers to generate and rank research options which are scored against pre-set criteria. Their scores are combined with weights for each criterion, set by a larger, diverse group of stakeholders, to create a ranked list of research options. Unfortunately, due to difficulties in defining and assembling a group of stakeholders that would be appropriate to each exercise, 75% of CHNRI exercises to-date did not involve stakeholders, and therefore presented unweighted ranks. Methods: First, a crowdsourcing was defined through a literature review. Benefits and challenges of crowdsourcing were explored, in addition to ethical issues with crowdsourcing. A second literature review was conducted to explore ways in which crowdsourcing has been already used in health and global health. As crowdsourcing could be a potential solution to data scarcity or act as a platform for intervention in global health settings, but its potential has never been systematically assessed, a CHNRI exercise was conducted to explore potential uses of crowdsourcing in global health and conflict. Experts from both global health and crowdsourcing participated in generation and scoring ideas. This CHNRI exercise was conducted in-line with previously described steps of the CHNRI method for setting health research priorities. As three quarters of CHNRI exercises have not utilized a larger reference group (LRG) of stakeholders, and the public was cited as the most difficult stakeholder group to involve, we conducted a survey using Amazon Mechanical Turk, an online crowdsourcing platform, that involved an international group of predominantly laypersons who, in essence, formed a public stakeholder group, scoring the most common CHNRI criteria using a 5-point Likert scale. The resulting means were converted to weights that can be used in upcoming exercises. Differences in geographic location, and whether the respondents were health stakeholders were assessed through the Fisher exact test and Wilcoxon rank-sum test, respectively. The influence of other demographic characteristics was explored through random-intercept modelling and logistic regression. Finally, an example of a national-level CHNRI exercise, which is the largest CHNRI conducted to-date, exploring research priorities in child health in India is described. Results: A comprehensive definition of crowdsourcing is given, along with its benefits, challenges, and ethical considerations for using crowdsourcing, based on a literature review. An overview of uses of crowdsourcing in health are discussed, and potential challenges and techniques for improving accuracy, such as introducing thresholds, qualifiers, introducing modular tasks and gamification. Crowdsourcing was frequently used as a diagnostics or surveillance tool. The CHNRI method was not identified in the second literature review. In re-weighting the CHNRI criteria using a public stakeholder group, we identified differences in relative importance of the criteria driven by geographic location and health status. When using random-intercept modelling to control for geographic location, we found differences due to health status in many criteria (n = 11), followed by gender (n = 10), ethnicity (n = 9), and religion (n = 8). We used the CHNRI method to explore potential uses of crowdsourcing in global health, and found that the majority of ideas were problem solving or data generation in nature. The top-ranked idea was to use crowdsourcing to generate more timely reports of future epidemics (such as in the case of Ebola), and other ideas relating to using crowdsourcing for the surveillance or control of communicable disease scored highly. Many ideas were related to the United Nations’ Sustainable Development Goals (SDGs). Finally, a national-level exercise to set research priorities in child health in India identified differential priorities for three regions (Empowered Action Group and North Eastern States, Northern States and Union Territories, and the Southern and Western States). The results will be very useful in developing targeted programmes for each region, enabling India to make progress towards SDG 3.2. Conclusion: Crowdsourcing has grown exponentially in the past decade. Integrating gamification, machine learning, simplifying tasks and introducing thresholds or trustworthiness scores increases accuracy of results. This research provides recommendations for improvements in the CHNRI method itself, and for crowdsourcing, generally. Crowdsourcing is a rapid, inexpensive tool for research, and thus, is a promising data collection method or intervention for health and global health.

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