Objective: To explore and describe how healthcare non-governmental organizations provide and evaluate programs and services that result in positive and sustainable health outcomes in children and adolescents living in low-and middle-income countries and to better understand the role of nursing within these organizations. Scoping Review: A scoping review informed by the Arksey & O’Malley framework was completed to explore the research on the delivery of pediatric health services by non-governmental organizations in low-and middle-income countries. Qualitative Study: Semi-structured interviews were conducted to share the voices and experiences of stakeholders working in the field of NGO practice to provide clarity, further insight and depth to the results from the scoping review and broaden the understanding of the role of nursing on this topic. Conclusions: Despite variability in practice and a multitude of competing priorities, outcome evaluation is growing within the field of pediatric NGO practice, and progress is being made towards evaluation of broader health outcomes besides unidimensional health indicators or outputs. Nurses can play a significant role in improving pediatric NGO program development and evaluation practices and are well positioned to be global health leaders who can influence policy and practice for the achievement of positive and sustainable health outcomes in children and adolescents in low-and middle-income countries.

Class of 2007 Abstract / Objectives: To evaluate the impact of a training program in health outcomes and pharmacoeconomics (PE) to determine how it has impacted PE application in the workplace and what topics and teaching methods are most useful to participants. Methods: This study is a descriptive study of data obtained through a questionnaire that surveyed course participants from the 2005 and 2006 University of Arizona Health Outcomes and PharmacoEconomic Center training programs. Results: There were a total of 20 respondents from the two programs, 70% had a pharmacy background and 55% practice in a pharmaceutical industry setting. The respondents felt that lecture based workshops were the most helpful and 90% responded that the program enhanced their communication with colleagues regarding PE and outcomes research. Conclusions: The program participants benefited from participation in the training program and have integrated material from the training program into the workplace. Lecture and case-based workshops were the most useful teaching methods used in the training program.

Stroke is the second most common cause of death worldwide. However stroke is not invariably fatal and survivors may experience major physical, social and psychological problems. The United Kingdom government identified the improvement of the quality of life of stroke survivors as a key objective in the recent "Health of the Nation" consultative document. The concept of health related quality of life has developed over the past few years. Although there is no one universally agreed definition, there are several instruments which claim to measure at least some aspects of health related quality of life. These instruments have not been extensively tested in stroke patients, so the hypothesis which I shall test in this thesis is as follows: that a simple instrument can prove a feasible, valid, reliable, and clinically useful measure of health related quality of life in stroke survivors. I selected a simple measure of health related quality of life (the EuroQol questionnaire) and evaluated its validity in a sample of patients with stroke. A small, but important proportion of patients were unable to complete EuroQol questionnaires either by themselves or by interview, so I investigated whether a proxy (e. g. a spouse or carer) could assess the patient's health status after stroke accurately and without bias. Previous studies comparing one or more different health status instruments did not involve strictly random allocation, so could not provide reliable information on the "best" measure of quality of life to use in stroke patients. I therefore performed a study in a sample of survivors of stroke which directly compared the EuroQol and SF- 36 by using a strict random allocation of questionnaires. It was not possible to compare quantitatively the reliability and validity of the EuroQol and SF-36; however, a qualitative comparison suggested their reliability was similar and they appeared to be sampling broadly the same areas of health. I finally investigated patients' perception of their own quality of life after stroke. The data suggested that many disabled stroke survivors might not view survival in a dependent state as badly as one might expect. This somewhat surprising finding will inform decisions about whether to accept the high risks associated with certain treatments (e. g. thrombolysis) in order to reduce the chances of survival in a dependent state. Assessments of health related quality of life may therefore provide a more comprehensive and relevant view of the patients' outcome than simple measures of disability or impairment.

Master of Public Health / Food, Nutrition, Dietetics and Health / Sandra B. Procter / Purpose: The objective of this study was to compare characteristics of urban and rural counties in Kansas in order to identify and seek explanations for differences in health factors and population health outcomes. Methods: Select data from the County Health Rankings and Roadmaps program were examined within or using the context of the USDA, Economic Research Service 2013 Rural-Urban Continuum Code (RUC) classification scheme. A comparison of all 19 urban counties vs. all 86 rural counties was conducted, followed by a comparison of counties as they were classified on the rural-urban continuum. Findings: More evidence of health disparities was observed when using the rural-urban continuum comparison than by the strict urban vs. rural comparison. Health determinants, behaviors, and outcomes, were generally more unfavorable in rural counties, but this was mostly captured through the RUC comparison. On average, RUC 4 and RUC 5 communities (both rural) were most disadvantaged when compared to counties that fell somewhere else on the continuum. Overall, there were higher rates of injury death, preventable hospital stays, and premature death in rural areas. Conclusions: The favorable and unfavorable health factors and health outcomes did not present only in urban areas nor only in rural areas nor did they present only in one RUC. These findings showed that there is a complexity to health disparities that cannot be easily captured or addressed without careful attention to the nature of the specific communities in which they are found.

The Hispanic Paradox is the finding that Hispanic immigrants living in the United States have better health than Anglo Americans despite being socioeconomically disadvantaged (Crespo et al., 1996; Stern et al., 1999; Sundquist et al., 1999; Dixon et al, 2000; Lariscy et al., 2015; Overton et al., 2015; Thomson et al., 2013). The literature surrounding the Hispanic Paradox has studied these effects primarily in Mexican-American Immigrant populations (Sundquist et al., 1999; Dixon et al, 2000; Lariscy et al.); however, additional research has found similar findings for various other Hispanic countries such as Cuba and Puerto Rico (Abraido-Lanza, A F. et al., 1999). It is not known if there is a Hispanic Paradox advantage during the menopausal transition. This study compared the health outcomes of 90 Mexican immigrant women between the ages of 40-60 living in the Utah to 78 Anglo American women of the same age in order to test the hypothesis that Mexican immigrant women are healthier than their Anglo-counterparts during the menopausal transition. We compared the health of the two groups of women across various health outcomes including blood pressure, C-reactive protein, BMI, fasting glucose, and cholesterol. Contrary to our hypotheses, Anglo Americans had better health across the board on all health outcome variables (BMI; F (1)= 3.63, p =.050; C-Reactive Protein; F (1)= 9.05, p =.003; Cholesterol; F (1)= 43.51, p =.000; Blood Pressure; F (1)= 43.32, p =.000; Fasting Glucose; F (1)= 12.25, p =.001). We speculate that our findings are not consistent with Hispanic Paradox theory because of the religious culture in Utah that lends itself to healthier individuals who refrain from cigarette smoke and alcohol consumption.

The overall goal of this research study is to determine if there is a correlation between electronic health (e-Health) adoption, e-Health investment and better health outcomes in a hospital setting. To carry out this research, data with respect to e-Health spending, e-Health adoption and relevant health outcome indicator results for Ontario hospitals were analyzed to determine if there is a correlation between the variables. There were significant positive correlations between e-Health adoption and investment variables; indicating that higher e-Health investment is associated with greater e-Health adoption. There were significant correlations between variables related to e-Health adoption, investment and certain health outcomes. For example, increased e-Health adoption was significantly and negatively correlated with variables related to Length of Stay (LOS), which suggests that increased e-Health adoption is associated with lower LOS. This study attempts to create a foundation upon which Return On Investment (ROI) may be calculated for e-Health technology.

The overall goal of this research study is to determine if there is a correlation between electronic health (e-Health) adoption, e-Health investment and better health outcomes in a hospital setting. To carry out this research, data with respect to e-Health spending, e-Health adoption and relevant health outcome indicator results for Ontario hospitals were analyzed to determine if there is a correlation between the variables. There were significant positive correlations between e-Health adoption and investment variables; indicating that higher e-Health investment is associated with greater e-Health adoption. There were significant correlations between variables related to e-Health adoption, investment and certain health outcomes. For example, increased e-Health adoption was significantly and negatively correlated with variables related to Length of Stay (LOS), which suggests that increased e-Health adoption is associated with lower LOS. This study attempts to create a foundation upon which Return On Investment (ROI) may be calculated for e-Health technology.

No description available.

Introduction: Beta-Blocker Evaluation Survival Trial (BEST) sub-analyses indicated a likely interaction between bucindolol and race disadvantaging black heart failure (HF) patients (Domanski J Cardiac Fail 2003); Arg389 homozygotes having adjusted reductions of 38% in mortality and 34% in mortality/hospitalization over other genotypes (Liggett PNAS 2006). Bucindolol is being evaluated in Arg389 genotype patients in the GENETIC-AF trial (NCT01970501). Objective: To conduct parallel (using Domanski et al and Liggett et al) ex ante economic evaluations of Arg389 genetic testing in stage III/IV HF to support bucindolol treatment decisions (if Arg389-positive) and carvedilol (if Arg389-negative) treatment versus no such testing and empirical bucindolol; using Domanski et al and Liggett et al BEST sub-analyses. Methods: In both Domanski et al and Liggett et al analyses, we used a decision tree model with time horizon of 18 months divided into 3 six-month cycles to estimate the cost-effectiveness and cost-utility of Arg389 genetic testing, considering overall survival (OS) from Domanski et al and Liggett et al BEST sub-analyses. Costs and utilities were retrieved from literature except for assumed cost for bucindolol treatment (1.5x cost of carvedilol) and genetic testing ($250). Discount rate was set at 3%/yr. Weibull distributions were fitted to OS data. Life-years (LY) and quality-adjusted life-years (QALY) were used to estimate incremental cost-effectiveness (ICER) and cost-utility ratios (ICUR), and results were validated using probabilistic sensitivity analyses (PSA). Results: In the Domanski et-based analysis, Arg389 genetic testing versus no testing was associated with incremental gains of 0.29LYs and 0.27QALYs at incremental cost of $726; yielding ICER of US$2,503/LY and ICUR of US$2,688/QALY gained. In the Liggett et al-based analysis, Arg-389 genetic testing versus no testing was associated with incremental gains of 0.35LYs and 0.32QALYs at savings of -$1.081; for ICER of -US$3,089/LY and ICUR of -US$3,378/QALY gained. Both analyses were confirmed in PSAs. Conclusion: Arg389 genetic testing to support bucindolol treatment in stage III/IV HF patients prevails economically over bucindolol treatment without genetic testing due to superior OS. If bucindolol is priced at 1.5x the cost of carvedilol. this economic benefit is likely to disappear if bucindolol and/ or genetic testing are priced higher. The clinical and economic benefits of bucindolol treatment with versus without Arg389 genetic testing versus empiric carvedilol remains to be assessed.

Health reformers, especially in developing countries, have applied decentralisation to enhance the performance of health systems which in turn improve health outcomes. Proponents of decentralisation argue that increasing the authority of local government promotes resource allocation according to local needs. Yet critics point out that decentralisation is harmful as resources are more likely to be redistributed in favour of poorer areas in countries with centralised governments. Shedding light on those endless debates, this study aims to examine the association between decentralisation, performance of health providers and health outcomes in Indonesia. In 2001 Indonesia embarked on decentralisation in the form of devolution and fiscal decentralisation. Devolution transfers the responsibilities of providing health services from central government to local government, while fiscal decentralisation allows local government to manage its local economies. Following those reforms, Indonesia raised the authority of public hospitals’ managers through corporatisation in 2004. Those reforms aim to provide better health services for the population. Evaluating whether all three forms of decentralisation in Indonesia have achieved their aim or not, this study uses both primary and secondary data. The primary data was collected in 54 public hospitals in East Java province during summer 2013. The secondary data combined individual and household level data and local government data. The Indonesia socio-economic survey (Susenas) 2004-2013 and Indonesian Family Life Survey (IFLS) 2007 are the sources of individual and household data, while the national village census (Podes) 2003-2010 provides district-level data. I supplement these with local government fiscal data from the Ministry of Finance and the consumer price index 2004-2013. The assembled data possesses a multilevel structure in which individuals or households are nested within districts. The main findings show that health outcomes among Indonesians continue to vary across districts after decentralisation. Passing authority down from central government to lower-level institutions does not automatically bring about better performance of health providers and health outcomes regardless of the type of authority devolved and the characteristics of the delegated institutions. However, further analysis on multiyear data suggests that there is an important learning curve throughout the process of decentralisation implementation. Both local governments and hospital managers need time to learn how to utilise the authority they are given after decentralisation. These findings suggest that improving capacity and accountability of local authorities and an understanding of why some local authorities are better than others at learning during the process of decentralisation are vital to improve performance of health providers and health outcomes in decentralised Indonesia.