<p> HIV/AIDS-related stigma and discrimination (S&amp;D), lack of social support, poverty, and gender inequalities have been identified as factors in the increased prevalence rate of HIV transmission in Enugu, Nigeria, especially among women ages 15 to 49 years. Despite the funding of reduction programs, HIV/AIDS-related S&amp;D remain a major driving force in the increased rate of new HIV cases in Enugu. This study addressed a perceived need for behavioral change intervention approaches that span all societal factors to reduce the HIV infection rate in Enugu Nigeria. The study was guided by Goffman&rsquo;s (1963) social S&amp;D theory. The sample was composed of 132 women living with HIV/AIDS WLWHA ages 21 to 54 years, purposefully sampled from the 4 HIV and AIDS comprehensive initiatives care centers in Enugu, Nigeria. Fifteen WLWHA were interviewed and 114 participated in an online survey. The descriptive statistics and a multiple linear regression analysis and comparison revealed a convergent significant relationship between the S&amp;D determinants (social, political, psychological, environmental, and cultural) and HIV/AIDS-related S&amp;D towards WLWHA in Enugu F (4,109) = 45.09, p &lt;.001). It also revealed that the cultural determinant of S&amp;D was a significant predictor of HIV/AIDS-related S&amp;D towards WLWHA in Enugu (? = 0.81, p &lt; 0.001). The implications for positive social change include providing public health professionals evidence-based data to inform policy change, plan and to implement programs that will change societal attitudes and mobilize broad-based community actions to eradicate HIV/AIDS&ndash;related S&amp;D toward WLWHA in Enugu, Nigeria, and in Sub-Saharan African Countries.</p>

<p> <b>Objectives:</b> This research identified the potential predictors of medication adherence and studied the impact of medication adherence on healthcare utilization and costs among elderly with diabetes who were enrolled in a State Pharmaceutical Assistance Program (SPAP). </p><p> <b>Methods:</b> Pharmaceutical Assistance Contract for Elderly (PACE) programs&rsquo; database was used to identify study population and estimate medication adherence as proportion of days covered (PDC) for 12-months post-index observation period (adherent: PDC &ge; 80%; nonadherent: PDC &lt; 80%). Healthcare utilization and costs for the study period were estimated using Pennsylvania Health Care Cost Containment Council&rsquo;s hospital inpatient discharge records. Healthcare utilization measures included all-cause, diabetes-specific, diabetes-related and diabetes-specific &amp; related number of inpatient hospital admissions and length of stay (LOS). Multiple regression analyzes were performed to determine the predictors of medication adherence and to assess the association of medication adherence with risk of hospitalization, hospital service utilization and costs. </p><p> <b>Results:</b> Among 9,497 elderly PACE enrollees with diabetes, 81% were adherent and 21% were hospitalized. Race, marital status, number of unique medications and out-of-pocket payment were the significant predictors of medication adherence. The odds of being hospitalized were higher for nonadherent patients by the factor 2.030 than adherent patients (95% CI: 1.784&ndash;2.310). After controlling for covariates, non-adherent patients had significantly a greater number of all-cause (IRR 1.2727; 95% CI 1.1937&ndash;1.3569), more diabetes-related (IRR 1.2210; 95% CI 1.0492&ndash;1.4210) and more combined diabetes-specific &amp; related (IRR 1.2106; 95% CI 1.0495&ndash;1.3965) hospital visits than adherent patients. After adjusting for covariates, LOS for non-adherent patients was longer for all-cause (IRR 1.2388; 95% CI 1.1706&ndash;1.3111), diabetes-related (IRR 1.1341; 95% CI 1.0415&ndash;1.2349) and for diabetes-specific &amp; related (IRR 1.1271; 95% CI 1.0357&ndash;1.2267) hospitalization than adherent patients. GLM models showed that medication nonadherence was associated with significant increase in all-cause hospitalization costs ($22,670 vs $16,383; p &lt; 0.0001) and diabetes-related hospitalization costs ($13,518 vs $12,634; p = 0.0003). </p><p> <b>Conclusions:</b> Medication nonadherence was associated with an increased risk of hospitalization, greater number of hospital visits, longer hospital LOS and substantial hospitalization costs among elderly SPAP beneficiaries with diabetes. Utilization of our findings to develop interventions or policies to improve medication adherence would significantly impact the US healthcare system particularly while allocating limited healthcare resources.</p><p>

<p> In the United States, type 2 diabetes mellitus (T2DM) has been categorized as a major health-threatening problem affecting a wide cross section of people. About one third of the population is unaware that they have the disease; however, early recognition of symptoms would lead to prevention, diagnosis for a better prognosis, and, in some cases, the reversal of the disease. Researchers have shown that late diagnosis leads to high mortality, morbidity, disability, loss of productivity, and high costs of health care to individuals, families, and the government. The main purpose of this study was to establish a new model mechanism for the detection and prevention of T2DM using the lived experiences of the primary care physicians. This qualitative study investigated the lived experiences of seven primary care physicians from the Northern California Bay area community. The primary data collection method was by interview through e-mail correspondences and the data were organized, coded, and analyzed on the responses to the interview questions and research questions. The research study resulted in four major themes: (a) lifestyle choices to reduce T2DM, (b) desire to improve the lives of patients, (c) government involvement, and (d) shared perception of T2DM. Recommendations were developed based on the compiled data from this study and future studies could involve health-care accessibility and treatment interventions of T2DM for patients with low socioeconomic status and use of the new model mechanism to improve early detection and prevention of T2DM.</p><p>

<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>

<p> The disparities in healthcare and the challenges of healthcare leaders in achieving positive health outcomes are a priority in America. Much discourse and policy is currently evolving in the legislative and executive branches of government. The United States has the highest health expenditures in the world and is classified as one of the unhealthiest countries. Many factors contribute to the disparities. These factors include socioeconomic, cultural competency, social determinants, policy, and health leadership. The challenge for health leaders is to identify strategies to improve the trends and e the status of health quality and well-being for all Americans. This study employed qualitative research using a phenomenological approach; surveying healthcare leaders in the United States. Data collection employed in-depth interviews of healthcare leaders with at least two years of experience in their current role. This qualitative study identified challenges of leaders in health care, best practices of successful healthcare leaders to improve patient access, narrow the gap of health-related disparities, and evaluated techniques and methods to improve health outcomes across racial and ethnic groups.</p><p>

Technology plays an increasingly important role in modern health care. This thesis presents an approach to usability evaluation of mobile information and communications technologies designed for diabetes patients&rsquo / use in their daily lives. According to our study conducted on 60 diabetes patients, several important findings were obtained. Fifty nine (98.3%) diabetes patients were highly satisfied with the mobile health technology and expressed that they would use it, and found the measured values reliable. For 57 (95%) diabetes patients / measuring, checking and accessing the blood glucose level easily anytime and anywhere were very important. Fifty six (93.3%) said that they would wish to send their blood glucose levels to their physicians via e-mail. When participants were asked to provide a decision on future health care, predominate number of participants said they would change their lifestyle rather than visit a doctor regardless of their blood glucose level. In conclusion, little is known about such effects of mobile information and communications technologies in self-management care situations. It is clear that usability studies in the field are more difficult to conduct than laboratory evaluations. Further studies with larger sample sizes are needed to further evaluate these initial findings.

<p> <b>Background:</b> Obesity has recently been classified by the American Medical Association (AMA) as a disease which, if unrecognized and unaddressed in childhood, causes multiple medical and psychological complications that can impact both personal and population health. Unprecedented funding is being invested in electronic health records to improve quality, safety, and delivery of healthcare and reduce healthcare costs. Scant literature has evaluated the use of aids in the electronic health record (EHR) to identify obesity. </p><p> <b>Objectives:</b> The purpose of this study was to determine to what extent the tools available in an EHR for automatic Body Mass Index (BMI) calculation based on height and weight documentation are used by pediatricians to correctly identify obesity in children. Secondary objectives were to evaluate quality of data input (discrete vs. free text) and see if there is any variation in rates of identification among patients of different socio-demographic characteristics and trainees of different levels. </p><p> <b>Methods:</b> We conducted a retrospective chart review for patients aged 2&ndash;18 years seen for a well-child visit at New York Presbyterian Hospital between January 2011 and January 2014, where it is standard practice at these visits to take height and weight measurements. The EHR automatically populates these values onto growth curves, converting them into BMI with percentiles. Standardized definitions from the Centers for Disease Control and Prevention (CDC) 2010 were used to qualify overweight and obese based on BMI. We determined the percentage of patients who were overweight or obese (based on CDC percentiles) that had the diagnosis identified by the pediatrician, and then assessed the quality of data input. We assessed laboratory follow up and referrals for all patients, and assessed for demographic differences among patients properly and not properly documented by providers as obese or overweight. </p><p> <b>Results:</b> We reviewed 700 charts in total. Inclusion criteria were all of the patients who had a BMI between 85&ndash;95% (these were grouped as overweight) and a BMI over 95% (obese). 209 patients were overweight or obese and therefore eligible for inclusion. Of the 209 clinically overweight/obese children, 72.2% had some form of documentation of this diagnosis, although the diagnosis was documented more often in the obese vs. overweight child. The diagnosis was most often captured electronically in the free text progress note. Over half of clinically overweight/obese children aged &ge;8 years did not receive follow-up standard laboratory testing, and only about one-quarter of clinically overweight/obese children had documented in-office nutrition guidance. Diagnosis of overweight was higher in females, but it was almost twice as likely that an obese male would be documented as such. Results showed no identification variation based on age or race/ethnicity. There was no difference in recognition of obesity/overweight based on postgraduate year (PGY) or nurse practitioner (NP) status. </p><p> <b>Conclusion:</b> Despite its importance as a public health priority for children, automatic calculation of BMI by use of an EHR led to documentation by a provider as a child being overweight/obese only three quarters of the time. This study suggests that despite increasing focus on using EHRs to improve individual and population health, including for obesity, clinical decision support remains underutilized.</p>

<p> In today's modern world of medicine, most, if not all, physician employment contracts contain non-compete clauses. Non-competes, also known as restrictive covenants, essentially function as restraints on trade. Non-competes act as a restraint in the medical arena by preventing physicians from taking patients with them when physicians begin new employment or, alternatively, depart on a self-employment basis. They also restrain physicians from competitively practicing medicine in a predetermined geographic area for a specified period of time. </p><p> Restraints on trade have a long noteworthy history. One case that emphasized the importance of having checks and balances on such restraints is Lochner v. New York. While not relating to the practice of medicine and non-compete provisions, Lochner is nonetheless an important case to the analysis of non-compete provisions in physician employment contracts. Lochner is necessary to the discussion of non-competes because it emphasizes how the history of restrictions on restraints on trade have changed so that now private parties, and not just the government, are allowed to implement restrictions. Additionally, these restrictions vary depending on the profession and where professionals practice. </p><p> Non-compete provisions are found in contracts created by both small private medical practices, as well as bigger entities, such as hospitals and managed care organizations. Therefore, this is not an issue limited to the size of the practice. The physician-patient relationship has gradually become more and more of an impersonal one due to managed care organizations and legislation such as the Affordable Care Act (ACA). This does not, however, mean that physicians and patients approve of this interference and push towards an impersonal relationship. Thus, if patients are unhappy with the resulting impersonal relationship from managed care plans and legislation, patients may suffer further from these non-compete clauses interfering with the patients' utilization of physician services. </p><p> These clauses hurt not only the physicians trying to practice, but also have the capacity to conflict with patient choice in regard to selecting the physician they want for treatment purposes. More importantly, such non-competes negatively interfere with the continuity of patient care. It is for these aforementioned reasons that it would behoove the American Medical Association (AMA) to model its non-compete guidelines after those found in the American Bar Association (ABA), which strictly limit the use of such non-compete provisions in attorney employment contracts.</p>

Thesis (Ph. D.)--University of New South Wales, 1999. / Also available online.

Thesis (Ph.D.)--University of Adelaide, Dept. of Dentistry, 2000. / Bibliography: p. 320-341.