In 1993, the last health reform “Law 100” was introduced in Colombia. It has been over 30 years since its implementation, and there have been many changes to the healthcare system in Colombia ever since. The policy increased health insurance coverage to almost 95% of the population, providing better and more affordable patient care. However, increasing the availability of resources does not necessarily make them accessible to all of Colombia’s residents. This study aims to analyze the outcomes of “Law 100” to the system and studies critical obstacles that halt healthcare equity in Colombia, particularly for those in rural and low-income populations. Disparities in access to quality healthcare, a shortage of healthcare professionals, and insufficient preventative measures are persisting problems that have challenged the Colombian healthcare system. In addition, this study explores models from Brazil, Thailand, and Finland, which have healthcare systems similar to Colombia's and have faced and overcome comparable concerns. Based on these successful models, policy recommendations adapted to fit the Colombian healthcare system include implementing community-based healthcare teams, creating educational incentives for healthcare workers in underserved areas, and launching public health prevention campaigns. This study offers actionable improvements for Colombian policymakers to reduce healthcare disparities and develop a fairer system for all citizens.

Objective: Evaluate how a social marketing approach compares to traditional nutrition education curriculum for promoting behavioral changes related to eating and food. Design: Nonequivalent comparison group, entry-exit design. Participants from 12 Kentucky counties assigned either comparison or pilot group. Comparison group received traditional nutrition education curriculum and pilot group received the social marketing program, Cook Together, Eat Together (CTET) curriculum. EFNEP’s Behavior Checklist and 24-Hour Dietary Recall were administered at entry and exit of the 8-week programs. Participants: Females (18-72 years of age) from families eligible to receive SNAP benefits (n=64 comparison group participants, n=60 pilot group participants). Intervention: Comparison group completed an 8-week standard lesson and pilot group completed CTET program in varying time frames (1-8 weeks). Main Outcome Measures: Eating behavior changes between entry and exit for comparison versus pilot. Analysis: Quantitative data were analyzed using independent and paired t-tests with significance of P≤ 0.05 and 0.10. Results: Groups were demographically similar. Both had significant differences in entry and exit scores for Behavior Checklist and 24-Hour Recall (P≤ 0.05). Conclusion and Implications: Positive behavior change was observed in both comparison and pilot groups. A social marketing program proves to be a promising approach to nutrition education.

Cervical cancer rates among Vietnamese American women are the highest when compared to other women of color and white women. In an article by Taylor, Nguyen, and McPhee, a majority of Vietnamese Americans immigrated to the United States over the last three decades; and the President's Advisory Commission on Asian Americans identified cervical cancer among Vietnamese women as one of the most important health disparities experienced by the Asian American population. HPV vaccination, according to the CDC, helps prevent cervical cancer and it is recommended that female and male preteens, ages 11 or 12, receive the vaccination. My research aims to better understand what second generation Vietnamese American women know about the HPV vaccination, their relationship to healthcare, and their overall health. By interviewing second generation Vietnamese American women, I hope they become more empowered to ask their doctors about health disparities that affect their communities. In looking at preventative measures to cervical cancer and trying to better understand a vulnerable population's relationship to healthcare, I hope that the rates of cervical cancer will go down in Vietnamese American women. Furthermore, I hope to push for greater disaggregation of data collection among Asian American populations to better understand the health disparities that affect the various ethnicities that fall under the umbrella term, Asian American.

The Johnson City Community Health Center is one of over 1200 community health centers serving over 22 million patients across the United States. Community health centers primarily serve patients with low income or without health insurance, but most serve all the members of their communities. These centers provide many services and treat health problems in a holistic manner in order to improve the health of their communities and also allow the members of those communities to progress. The Johnson City Community Health Center is compared to successful CHCs from across the nation to determine if it has characteristics to be successful in this community. A SWOT Analysis is conducted by evaluating the Marketing Mix, or the Product, Price, Placement, and Promotion, of the center and also by examining the Political, Economic, Social, and Technological environments it operates in. This research determines the internal Strengths and Weaknesses and external Opportunities and Threats of the Johnson City Community Health Center and concludes that it does have the characteristics needed to be successful in the community. This research can be used by center management to improve services, but it can also be used by other researchers to continue evaluations of community health centers across the nation.

Nurses are frequently seen in public in their “scrubs,” which could mean that contaminated clothing is being brought into the community, thereby posing an infection risk. The purpose of this study is to investigate if and which contaminants are present on the fabrics and the actions nurses are taking to eliminate contamination risks. Eleven scrub tops were worn on hospital units over one twelve-hour shift. The contaminated scrubs and three control tops were then swabbed and used to inoculate agar plates. After incubation, colonies were counted, streaked onto nutrient and Mannitol-salt agar for isolation, and incubated. Using API Staph strips and Gram staining, the bacteria were identified. The nurses also completed a short survey on laundering and scrub care. All scrub tops, except the controls, were contaminated with multiple species of bacteria including Staphylococcus species. Responses to the survey showed that no two nurses washed their scrubs in the same manner and many wear them in public. The results determined that bacteria can survive on clothing and pose the possibility of transmission throughout the hospital and public venues. The survey results indicate a need for employer laundering policies, public awareness of the risk for transmission of disease from contaminated clothing, and stricter regulations about employees wearing scrubs outside of health care facilities.

Decades of research have shown that there are significant advantages to maintaining close communicative and collaborative relationships between primary care and behavioral health providers. Fiscal, structural, and systemic barriers, however, often restrict the degree to which such interprofessional collaboration can occur. In the present study the authors examined relationships between primary care clinics in the Appalachian region’s characteristics (i.e., clinic type, rurality, and clinic size), barriers (i.e., fiscal, structural, and systemic) reported to using increased collaboration, and the level of collaboration used at a particular clinic. For the present study 136 surveys were completed by providers working in primary care practices across the Appalachian region of Tennessee. The results showed that only about one fifth of the primary care clinics in Appalachian Tennessee reported engaging in moderate to high levels of primary care behavioral health (PCBH) collaboration (e.g., colocated or integrated models of care). Among community health clinics, however, nearly half reported moderate or high levels of collaboration. The findings of this study underscore the importance policy change (e.g., changes in reimbursement patterns, increases in incentives, introduction of PCBH models in training programs) in facilitating the uptake of high levels of PCBH collaboration in Appalachian Tennessee (especially in regards to nonpublicly funded clinics). Further, the methodology used in this study could provide policymakers and researchers in other regions of the U.S. with a means for obtaining baseline data regarding local trends in PCBH collaboration and could serve as first step in developing a standardized methodology for comparing the overall uptake of PCBH collaboration models across regions.

For decades, healthcare access and quality in central and southern Appalachia have trailed the rest of the country. Entrenched poverty and low educational attainment compound healthcare problems. This study examines the healthcare obstacles women encounter in southern and central Appalachia and analyzes how technology use, such as Internet searching and social media affect women’s healthcare decisions. Data were analyzed from four focus groups conducted with women from the region. Results indicate that seeing a physician or not did not influence women’s propensity to search the Internet for health-related information or to seek support through social media sites. Additionally, women reported facing many barriers including trust in local physicians, access, availability, cost, and quality of healthcare. These issues often impede women’s access to preventative care and place burdens on their health and an already strained healthcare system.

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Background: Rates of accidental overdose mortality from substance use disorder (SUD) have risen dramatically in the United States since 1990. Between 1999 and 2004 alone rates increased 62% nationwide, with rural overdose mortality increasing at a rate 3 times that seen in urban populations. Cultural differences between rural and urban populations (e.g., educational attainment, unemployment rates, social characteristics, etc.) affect the nature of SUD, leading to disparate risk of overdose across these communities. Methods: Multiple-groups latent class analysis with covariates was applied to data from the 2011 and 2012 National Survey on Drug Use and Health (n=12.140) to examine potential differences in latent classifications of SUD between rural and urban adult (aged 18 years and older) populations. Nine drug categories were used to identify latent classes of SUD defined by probability of diagnosis within these categories. Once the class structures were established for rural and urban samples, posterior membership probabilities were entered into a multinomial regression analysis of socio-demographic predictors' association with the likelihood of SUD latent class membership. Results: Latent class structures differed across the sub-groups, with the rural sample fitting a 3-class structure (Bootstrap Likelihood Ratio Test P value=0.03) and the urban fitting a 6-class model (Bootstrap Likelihood Ratio Test P valueThis result supports the hypothesis that different underlying elements exist in the two populations that affect SUD patterns, and thus can inform the development of surveillance instruments, clinical services, and prevention programming tailored to specific communities.

The IDSA Community-Acquired Pneumonia (CAP) Guideline recommends ceftriaxone in combination with doxycycline as an alternative to combination therapy with ceftriaxone and azithromycin for non-intensive care unit (ICU) patients hospitalized with CAP. This is an attractive alternative regimen due to recent concerns of increased cardiovascular risk associated with azithromycin. The objective of this study was to compare the clinical outcomes of azithromycin and doxycycline each in combination with ceftriaxone for non-ICU Veterans hospitalized with CAP.