ABSTRACT Despite changing demographics, policy, technology, and economics; medical education curriculum has changed very little from its inception over 100 years ago. The United States medical system has been under scrutiny for delivery of affordable, quality and accessible care for years. In order to address these challenges, we need to train physicians to consider these criteria when treating patients. A way to do this is through a curriculum that includes Health Systems Science (HSS). The challenge of HSS is that it adds additional topics and competencies to an already full medical education curriculum. In order to move forward in medical school, students are tested on their knowledge of basic science. Because HSS topics are not included in the required testing, students who have not been exposed to an HSS curriculum perceive HSS topics as less valuable than traditional medical school topics. This research sought to understand if students changed their perception of the value of HSS after exposure to an HSS curriculum. First-year medical students from a large, urban medical school were surveyed using a pre-test and post-test survey before and after exposure to an HSS curriculum. This study was conducted with two cohorts over two years to see if there was a change in student perceptions of HSS. An Institutional Cycle design was applied to compare the post-test from the students in cycle 1 to the pre-test of students in cycle 2. This approach was deployed for two reasons. The first because of restrictions placed on the data collection; the pre-test for each person could not be directly linked to the post-test. The second, because there was no way to create a control group. These cohorts could not be randomly assigned to another curriculum. Comparing the post-test of Cohort 1 to the pre-test of Cohort 2 allows for the analysis of change between the two cohorts. Student perceptions did not change significantly between the pre-test in cycle 2 and the post-test in cycle 1. More research is needed to provide guidance for the development of an HSS curriculum that aligns with traditional medical education components. / Educational Administration

This study explores the influence of chronic stress in college students. It focuses on the broader chronic stressors that college students experience related to physical and mental health, financial health and wellbeing, and presence of social supports, then addresses the more specific chronic stressors related to intersecting identities of race, ethnicity, gender, and sexual orientation. This phenomenon is analyzed under the theoretical frameworks of social determinants of health, intersectionality, and systems theory. An online survey with both open and closed-ended questions was conducted with undergraduate social work students from the Bachelors of Social Work program at the University of Central Florida. The results of the study found that there was links between intersecting identities of participants with higher levels of chronic stress based on their chronic stress scores and participant responses on the influence of their identities on barriers to their physical, mental, and financial health.

Despite the development of an Aboriginal Healing and Wellness Strategy (AHWS), which implemented Aboriginal Health Access Centres (AHACs) to provide integrated healthcare including both mainstream and traditional services, health inequalities persist among the urban Aboriginal population in Ontario. There are multiple social determinants of health (SDOH) besides access to healthcare that affect Aboriginal health. The objectives of this study were to describe the past and current policy strategies to address Aboriginal health in Ontario, and to investigate the ways that service providers perceive health inequalities, demonstrating whether the SDOH are considered in service provision to urban Aboriginal clients. In addition to a document review, interviews were held with representatives from three provincial ministries involved with the AHWS. Through a community engagement research strategy, nine semi-structured interviews were conducted with service providers from various departments within an urban AHAC. Interviews were analyzed using a modified grounded theory, which was guided by the SDOH framework. In understanding policy development, themes included: collaboration with Aboriginal communities and improving access to holistic care. In approaching service provision, themes included: perceived health inequalities and their determinants, what is being done and what must be done to address health inequalities and the use of the SDOH framework in practice. Findings suggest that service providers accurately identify the health needs of their clients, and utilize the SDOH to understand the causes of inequalities, however the SDOH cannot be fully addressed at the service provision level. The SDOH framework must be utilized at the policy level, in order to effectively address the wider determinants of health through intersectoral collaboration between provincial ministries and Aboriginal communities. / Thesis / Master of Arts (MA)

Even if child mortality has decreased significantly since 1990, it is still a substantial issue that is prevalent all over the world. Regional differences are significant, and Sub-Saharan Africa is the most affected area. Traditionally, researchers have turned to the medical field for health-related issues. However, social, and structural factors, among them gender inequality, are also crucial in determining health and life conditions. The purpose of this thesis was to investigate how intrahousehold gender inequality affects child mortality in Sierra Leone. The study was made through a cross-sectional study using data from the Sierra Leone Demographic Health Survey. A quantitative method was used, and analysis was conducted using OLS regression. In contrast to previous research, the results do not show a significant covariation between maternal education and child mortality. Likewise, paternal education and the difference in education between men and women showed no significant covariation with child mortality. However, polygyny, the number of wives and the first event of intimate partner violence were positively associated with child mortality. More studies about gender inequality in relation to child mortality should be conducted to strengthen the results and increase the knowledge and understanding of this subject.

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No description available.

Child mortality rates do not only reflect the development in a society but also reflect access to basic health interventions and socio-economic conditions. The uneven distribution of child mortality rates is a matter of inequity. Even though there has been a reduction in the child mortality indicator neonatal mortality rate on the global level, the rate is still unacceptably high. Data indicates that it in a few countries, such as Lesotho, the neonatal mortality has an arrested decrease even though being a focus area within the sustainable development goals. This explorative case study aims at finding and explaining the factors behind the arrested decrease in neonatal mortality in Lesotho. Framing this study are the social determinants of health. The results indicate that the combination of HIV and droughts with exacerbated poverty and increased requirements for adequate care as a result, in combination with the vulnerable situation of women has aggravated the situation for new-borns in Lesotho. In order to improve the survival of new-borns in Lesotho measures cannot solely be aimed at improving health care but also have to be directed beyond the direct cause of death such as measures to improve the factors causing poor health. In order to achieve better prerequisites for new-borns measures have to overcome health inequity. It is a fundamental human rights concern.

By 2034 there is predicted to be a shortage of between 17,800 and 48,000 physicians in primary care, (Association of American Medical Colleges, 2021). Nurse practitioners have proven to be a versatile tool in helping to bridge this gap in health care. As the need for family nurse practitioners grows so also the need for quality educational experiences for these providers must continue to expand. Currently, employment turnover rates for family nurse practitioners are twice those of physicians, (Barnes, 2015). Formal transitions into advanced practice, such as residency programming have been found to ease new family nurse practitioners into practice. However, few residency programs exist to help aid in this transition, (Flinter, 2005, 2012). This project aims to develop a program that provides educational opportunities for post-graduate family nurse practitioners as they transition to advanced practice nursing. The project will develop a nurse practitioner residency program specific to the needs of this region guided by the Social Determinants of Health. The program will provide new graduate family nurse practitioners with an opportunity to take part in a year-long post-graduate residency program. Providing an intense on-the-job training experience from veteran practitioners. This program will then be written into a grant to help fund the project in our region.

Health encompasses our lives in various ways; where we live, how we work, and how we play. These differentiating factors, or “social determinants”, may impact physical and mental health in a prominent manner. Screening for social determinants of health in pediatric primary care may help to identify important areas to intervene with families to address barriers to receiving care and improve health outcomes. East Tennessee State University (ETSU) Pediatrics aimed to find the prevalence of varying social determinants in their patient population through a 6-item screening tool—the Team Care screener. A Team Care screener was administered to the caregiver(s) of every child that came into the clinic for a newborn appointment, six month appointment, or one year well child examination. Caregivers responded with Yes or No to the screener's six items concerning the following: (1) ability to understand written and spoken English; (2) experiencing financial stress related to housing, food, and utilities; (3) stress around substance use; (4) incidents of domestic abuse; (5) feelings of depression and possible suicidal ideation; and (6) if transportation has been a barrier to attending medical appointments. After the screener was collected, if any social determinants were marked as Yes on the screener, a needs assessment was completed with the caregiver(s). The family then received resources to address needs at the appointment or by phone follow up, if applicable. This procedure is ongoing at the clinic. Results indicated that of the 1,009 Team Care screeners administered over a four-month period, 15% (n=153) of patients' caregivers reported a deficit in at least one social determinant. More specifically, 8% (n=79) endorsed experiencing financial stress, 5% (n=49) reported strain from acquiring transportation to appointments, 4% (n=17) expressed concerns related to substance use, 1% (n=14) noted difficulties with comprehending English, and less than 1% (n=6) reported possible incidents of domestic abuse. After discussion with caregivers, the most frequently reported stressors were determined to be access to adequate food, housing, and utilities as well as distress concerning transportation to medical appointments. Overall, our results suggest that a large portion of the patient population demonstrates varying social needs which have the potential to influence health outcomes. The Team Care screener has elucidated which patients are at particular risk, which allows clinic staff to provide more efficient patient-centered care.

Purpose: Rural communities often experience higher rates of mortality than their urban counterparts, with gaps widening in the foreseeable future. However, the underlying level of socioeconomic vulnerability (area deprivation) among rural communities can vary widely. This study examines rural‐urban differences in mortality‐related outcomes within comparable levels of deprivation. Methods: Rural‐urban differences in Years of Potential Life Lost (YPLL), derived from the County Health Rankings, were examined across comparable levels of area deprivation using a quantile regression approach. Rural‐urban differences in YPLL were estimated at the 10th, 25th, 50th, 75th, and 90th percentiles across levels of deprivation. Findings: Compared to the reference population (urban counties/least deprived) a clear increase in YPLL among both rural and urban counties was noted across levels of deprivation, with the highest level of YPLL occurring in counties with the most deprivation. While YPLL increased across levels of deprivation, the magnitude of these differences was markedly higher in rural counties compared to urban, particularly among the most deprived counties. Rural counties experienced an advantage at the lowest percentiles and levels of deprivation. However, this advantage quickly deteriorated, revealing significant rural disparities at the highest level of deprivation. Conclusions: This study noted a differential effect in mortality‐related outcomes among rural counties within comparable levels of community deprivation. Findings contribute to evidence that many, but not all rural communities face a double disadvantage. This underscores the need for a continued focus on the development and implementation of multiple policies aimed at reducing differences in poverty, education, and access to care.