O paciente portador de necessidades especiais pode ser descrito como aquele indivíduo que não se adapta de maneira física, intelectual ou emocional aos parâmetros normais, considerando os padrões de crescimento, desenvolvimento mental e controle emocional, além dos relacionados à conservação da saúde. A Organização Mundial de Saúde (OMS) estima que a prevalência das deficiências no mundo seja de uma pessoa a cada dez e mais de dois terços não recebe nenhum tipo de assistência odontológica. O objetivo do estudo foi verificar a percepção dos profissionais odontólogos sobre a acessibilidade do paciente com Síndrome da Imunodeficiência Adquirida (SIDA/AIDS) em estabelecimentos odontológicos na cidade de São Paulo e comparar com um grupo controle, representados por pacientes com Diabetes Mellitus. A informação para o estudo foi baseada em conversações telefônicas com cirurgiões-dentistas, onde foi realizada uma entrevista semi-estruturada. A análise de conteúdo das entrevistas foi executada segundo método de Lefèvre e Lefèvre (2000) e foi realizada destacando-se a idéia central. Do total de entrevistados, 55,14% eram do gênero feminino e 53,27% trabalhavam em consultório particular. Em relação à acessibilidade, 96,26% já tinham tratado de pacientes com Diabetes, 55,14% com SIDA/AIDS. Concluiu-se que a principal dificuldade para tratar pacientes com diabetes é a prática clínica, principalmente relacionada com problemas de coagulação. Entre os pacientes com SIDA/AIDS embora tenham sido citadas dificuldades clínicas, pôde ser verificado que a maior dificuldade ainda é o preconceito contra eles. / The patient who has special needs can be described as the individual that can´t adapt himself to normal physical, intellectual or emotional parameters, considering the growing patterns, mental development and emotional stability, in addition to those related to the health maintenance. The World Health Organization (WHO) estimates that the deficiencies prevalence is about one in ten individuals allover the world and more than two thirds don´t have any dental assistance. The objective of the study was to verify the dental professional perception with relation to the accessibility among patients with Acquired Immunodeficiency Syndrome (SIDA/AIDS) in clinical settings in the city of São Paulo, and to compare this perception with a control group, patients with Diabetes Mellitus. The study information was based on telephone conversations with Dentistis. A semi-structured interview was prepared. Content analysis was performed as per Lefèvre and Lefèvre (2000) with the relief of the central ideas. Among the participants, 55.14% were female and 53.27% worked in private settings. Regarding the accessibility, 96.26% had already treated patients with Diabetes, 55.14% with SIDA/AIDS. It was concluded that the main difficulty to treat diabetes patients is the clinical practice, mainly with problems related to blood coagulation. Among SIDA/AIDS patients, even though it had been listed clinical difficulties, it could be verified that the main difficulty is still prejudice amongst them.

The objective of this study was to determine whether 11 independent variables or combinations of variables help to predict a diabetes-related hospital readmission for patients with diabetes within 60 days from discharge. The variables were categorized into four main groups: (a) patient characteristics, (b) lifestyle, (c) biomarkers, and (d) disease management aspects. A convenience sample of 389 historical medical records of patients who were admitted to a rural hospital in northeastern North Carolina with a diagnosis of, or relating to, diabetes was studied. After comparing predictive discriminant analysis (PDA) and logistic regression (LR), PDA performed better and was chosen to analyze a convenience sample of patients admitted to the hospital for a diabetes-related diagnosis from January, 2004 to December, 2006. The best overall subset accurately classified 27 cases with six predictors that included (a) systolic blood pressure, (b) smoking status, (c) blood glucose range, (d) ethnicity, (e) diabetes education, and (f) diastolic blood pressure. In an effort to simplify the prediction process, the subsets of two predictors were examined. The results of the analysis returned four subsets of 2-predictor variable combinations that correctly classified cases for readmission. Each of the four subsets has two predictors that are statistically and practically significant for predicting readmissions for a diabetes-related problem within fewer than 60 days. These combinations are the predictor subsets of (a) smoking status and being treated by a specialist or non-specialist physician, (b) a religious affiliation or a lack thereof and smoking status, (c) gender and smoking status, and (d) smoking status and ethnicity. / by Darwin E. Asper. / Vita. / Thesis (Ph.D.)--Florida Atlantic University, 2009. / Includes bibliography. / Electronic reproduction. Boca Raton, Fla., 2009. Mode of access: World Wide Web.

Discrimination is not only a human and civil rights offense, but also a detrimental influence on the health outcomes of affected populations. The Muslim population in the United States is a growing religious minority increasingly encountered by health care professionals in the clinical setting. This group has been subject to heightened discrimination since the tragic events of September 11, 2001 and often is misunderstood within the context of American society today. While research has been conducted on discrimination against Muslims in the employment and educational segments of society, more studies are needed which quantify the extent and type of discrimination faced by this group in the health care setting. This inquiry focused on the crossover of anti-Muslim discrimination from society to the health care setting. A newly developed tool to measure anti-Muslim discrimination in health care and an established perceived discrimination scale were used to create the questionnaire employed in this investigation. The items of this newly created tool addressed culturally congruent care practices based on the principles of cultural safety within the nurse-patient relationship and the cultural care beliefs of the Muslim patient/family to ascertain discriminatory occurrences in the health care setting. Ray’s (2010) transcultural caring dynamics in nursing and health care model served as a framework for this quantitative, univariate, descriptive, cross-sectional design. Findings revealed that nearly one-third of Muslim subjects perceived they were discriminated against in the health care setting in the United States. Being excluded or ignored was the most frequently conveyed type of discrimination, followed by problems related to the use of Muslim clothing; offensive or insensitive verbal remarks; and problems related to Islamic holidays, prayer rituals, and physical assault, respectively. Age was positively correlated with perceived anti-Muslim discrimination in society. Education was negatively correlated with perceived discrimination in both society and the health care setting. Findings revealed that three out of five of those surveyed reported that they wear Muslim clothing; the most frequently reported of which was the hijab, the most popular Muslim garment reported to be worn. Participants who wore Muslim clothing, especially females, reported more anti-Muslim discrimination than those who did not. Scores for self-reported perceived anti-Muslim discrimination were found to be higher after the Boston Marathon bombings, April 15, 2013, an act perpetrated by Muslims, which occurred during the time of data collection. The number one Muslim care preference reported was same sex caregiver followed by respect for modesty, prayer rituals, respect for privacy, family involvement in care, and dietary concerns. Implications for practice, policy, education, political science, and recommendations for further research are discussed. / Includes bibliography. / Dissertation (Ph.D.)--Florida Atlantic University, 2013.

The last decade has been defined by the forced displacement of an unprecedented number of people, on a scale not seen since World War II. As of 2018, more than 71 million people across the globe have been forced to migrate as a result of conflict, natural disasters, drought and famine. More than 19 million crossed international borders seeking safety, and were formally registered as refugees. Forced migration has placed stress and pressure on surrounding low-and middle-income countries. This has been most notable in the Middle East and North Africa as a result of the crisis in Syria. Host countries in the Middle East and North Africa are overwhelmed by this rapid influx, particularly by the healthcare needs of this population. Stakeholders face difficulties providing health services to refugees, owing to the increased number of refugees in urban settings, the large demands on host country health systems and the epidemiologic transition towards non-communicable diseases (NCDs). Health challenges have been exacerbated by weaknesses in the global humanitarian architecture, that result in a fragmented and competitive sector that is unprepared for the current context. Few comparative analyses have examined the diversity of policies and practices aimed at improving services for urban-based refugees with NCDs in the MENA region. Furthermore, a variety of quantitative studies examined NCD incidence, prevalence and service utilization. However, these studies have quickly become outdated and do not explore, in adequate depth, the refugee experience and perspective on accessing NCD services in urban settings. Lastly, numerous NCD interventions have been recommended for LMICs. However, very little guidance exists to support actors addressing these health concerns in crisis-affected contexts. As a result, this dissertation is presented in three papers and responds to these gaps in the literature. Each paper focuses on a specific aim and research question and together they identify and provide recommendations for improvement to service delivery and policy formulation. Paper 1 identifies policies and practices, implemented by host countries and humanitarian actors, aimed at improving access to NCD services for urban refugees in the Middle East and North Africa. Paper 2 examines, using qualitative methods, the healthcare access experience of urban-based Syrian refugees who have been diagnosed with NCDs in Jordan. The third portion of this dissertation (Paper 3) is a policy series that provides recommendations for the government of Jordan and humanitarian actors to improve healthcare access for urban-based refugees with NCDs. It is anticipated that this series of publications will be relevant to traditional and non-traditional actors that respond to the health needs of refugees in urban settings in the MENA region.

Opioid dependence and opioid related deaths are a public health problem which the United States Centers of Disease Control have declared an epidemic. While opioid agonist therapy for opioid addiction has been accepted as the most effective treatment for opioid dependence among academics, and office based buprenorphine treatment has been available in the Unites States for over 10 years, OB buprenorphine faces many barriers to widespread adoption. Empirical data on the geographic distribution of physicians able to prescribe buprenorphine and the prescribing patterns of those physicians show considerable unevenness in access and utilization of treatment services. Federal-level policies have recently been implemented to expand access to opioid agonist therapy, but the medium and long term impacts of these policy changes on individual outcomes, public health, and geographic access equity are not yet clear. This dissertation compares two recent federal level policies on expanding access to buprenorphine treatment: raising the regulatory limit on the number of patients a provider can treat (implemented July, 2016), and extending prescribing privileges to nurse practitioners and physician assistants (implemented February, 2017), using an empirically supported Agent Based Simulation model. Policies are assessed by a novel, at-a-glance, quantitative access equity metric: the Spatial Potential Access Gini Index, in addition to year-end treatment utilization, opioid overdose deaths, and the amount of illicit medication diversion. In the simulation, expanding access by increasing the patient limit did not result in more equitable spatial access, while extending prescribing to NPs and PAs increased both utilization and spatial access equity. This is likely due to empirically supported model assumptions that NPs and PAs providing primary care often serve in medically underserved areas including rural and remote regions. Extending prescribing to these practitioners opens up new treatment locations changing the spatial distribution of treatment opportunities. Changing patient limits does not change the overall spatial distribution of services, so spatial access equity does not change even if overall treatment supply gets better or worse. The primary contribution of this work is the Spatial Potential Access Lorenz Curve and the Spatial Potential Access Gini Index, measures that aggregate individual-level Spatial Potential Access Scores commonly used in health care geography to map and identify areas of access disparity within a region. The equitability of Spatial Potential Access is calculated by using the Lorenz Curve, which is commonly used to characterize the distribution of wealth or income in a society, from which a Gini Index is calculated. The Spatial Potential Access Gini Index allows for direct comparison of complex quantitative information about the geographic distribution of supply and demand in a region with other regions, or in response to policies that impact supply or demand within the region. The measure has potential applications in simulation studies on the spatial allocation of services, allowing equity assessment of policy alternatives, as well as in empirical work, allowing equity comparisons of different regions, or in hybrid studies in which policy experiments are conducted on data-rich maps.

Source: Dissertation Abstracts International, Volume: 70-03, Section: B, page: 1577. Adviser: Charles E. Begley. Includes bibliographical references.

Thesis (M.A.) - Simon Fraser University, 2005. / Theses (Dept. of Gerontology) / Simon Fraser University. Also issued in digital format and available on the World Wide Web.

Thesis (M.B.A.)--Naval Postgraduate School, June 2003. / "MBA professional report"--Cover. Advisor(s): Tarek Abdel-Hamid and Bill Gates. Includes bibliographical references (p. 61-64). Also available online.

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To better understand Anglophone elderly experience in accessing health care services in a Francophone area, it is important to look beyond availability of healthcare services near their homes. This study explored factors such as language competence, preference, motivation, reaching and waiting times, as contributors to elderly people's choice. / A questionnaire designed for this study was administered to 199 males and females, aged 55 years and older, recruited from the only Anglophone Seniors' Centre in East-End Montreal. It was found that elderly people with limited French proficiency were more likely to travel out of their area for healthcare services, resulting in significantly longer average travel and waiting times. Of those who would have liked an interpreter, very few were actually able to get one. The most frequently expressed need was for more English or bilingual workers and services. / To improve access and enhance elderly people's quality of life, training and intervention programs need to be developed in collaboration with the government.