The increasing prevalence of substance use disorder (SUD) is a major public health crisis in the Unites States. Adolescence is an ideal period for early intervention to reduce the risk of SUDs in adulthood, as research has shown that up to 60% of adult SUD could have been avoided by early intervention in youth. Prior research has typically focused on urban metropolitan areas when describing adolescent substance use. However while the data is varied, several studies have shown that the prevalence of rural adolescent substance use is equal or greater than that of their urban peers, particularly alcohol, tobacco, and prescription drug use, and begin use at an earlier age. There are several methods of treatment for adolescent substance use and SUD, centered on evidence-based practices, which have been shown to be moderately effective at reducing substance use. Despite the existence of these treatment strategies, substantial disparities exists with respect to the number of adolescents who could potentially benefit and the number who actually enroll in treatment. It has been estimated that 90% of adolescents in need of treatment are not able to succeed in receiving it. This highlights the importance of understanding the circumstances in which youth initiate drug use and the unique barriers they must overcome to receive treatment when these behaviors develop into a pattern that impacts daily life. With this information, interventions can be targeted to reduce the magnitude of the most significant barriers in order to increase treatment utilization, especially in rural areas where adolescents face unique challenges to treatment access as a consequence of their remote locations. A literature review was conducted and found the major barriers in access to substance use treatment for adolescents to be a lack of available treatment programs, lack of treatment options including medication treatment, lack of perceived need or motivation for treatment, social stigma, socioeconomic status (SES), familial relationships, and referral services. These studies were all conducted in the United States and published from 2011-2020. The aim of this thesis is to propose a protocol for the completion of a systematic review to determine which barriers exist to adolescents receiving substance use treatment and to examine them in the context of rurality. Healthcare decisions and policy are informed by the best available evidence from systematic research and incorporated into evidence-based practices. A systematic review will summarize the findings of all relevant studies thereby making the key information more accessible to decision makers, including clinicians and policy makers, in order for substance use treatment to become more accessible to adolescents.

Indiana University-Purdue University Indianapolis (IUPUI) / Access to healthcare services is important for improving health outcomes, preventing and managing illness, and achieving health equity. The geographic maldistribution of physicians has a negative impact on rural areas compared to urban, particularly as it relates to access to healthcare. Rural hospitals have been closing or converting to another form of healthcare service at an increasing rate, adding another element to the existing complexities in rural access to care. Although a hospital closure in any location may have a considerable impact on the community, the closure of a rural hospital may have disproportionately more substantial implications for the economy and employment, health outcomes, and access to care. The contributing factors preceding rural hospital closures have been studied, but less is known about the full impact of rural hospital closures on the community. There is some evidence of shortages in healthcare providers and services, and therefore communities may employ multiple strategies to mitigate the shortages and provide services, including utilizing telehealth/virtual services. This dissertation proposes to examine the effects of rural hospital closures on the community, healthcare services, access to care, and provide a qualitative assessment of telehealth as a strategy to bridge gaps in provider access. This dissertation includes three studies: 1) a systematic review of the literature to examine the impact of rural hospital closures on the community; 2) an empirical study that utilizes a generalized difference in difference design with county and year fixed effects to estimate the relationship between rural hospital closures and nursing homes; and 3) a qualitative study exploring the perceptions and experiences of the nurses that piloted a virtual care support project, providing insights into crucial elements important to the implementation of similar models and the role of telehealth in bridging healthcare workforce gaps.

Bakgrund: Hemlöshet är ett utbrett globalt problem. I Sverige lever cirka 33 000 personer i någon form av hemlöshet. Personer i hemlöshet har ofta både fysisk och psykisk ohälsa förutom multipla sociala besvär. För att personer i hemlöshet, med komplexa behov, ska få adekvata insatser gällande vård-och omsorgsinsatser behövs individuella åtgärder och samverkan mellan olika instanser. Ledorden för Agenda 2030 understryker att ingen ska lämnas utanför och möjlighet till hälsa och tillgång till vård ska ses som mänskliga rättigheter. Samtidigt undviker personer i hemlöshet att söka vård i större utsträckning än andra. Att vård- och omsorgsinsatser samordnas och organiseras så att de används och uppskattas av personer som lever i hemlöshet är en förutsättning för att nå ambitionen om jämlik vård. Syfte: Syftet var att beskriva vilka erfarenheter personer som lever i hemlöshet har kring samverkan av vård- och omsorgsinsatser.   Metod: En litteraturöversikt vars resultat grundas på tio vetenskapliga artiklar. Resultat: Resultat presenteras i två kategorier; Brister i planering, samverkan och utskrivning och Behov att skapa tillgänglig kontinuerlig och individanpassad vård. Det framkom att de hinder som fanns för att personer i hemlöshet skulle söka vård reducerades genom uppsökande verksamhet och samverkan vilket gav tillgång och kontinuitet i vård- och omsorgsinsatser. Med hjälp av vårdsamordnare kunde förtroendefulla vårdrelationer formas där komplexa behov tillgodosågs.  Sammanfattning: Personer som lever i hemlöshet upplever bristande tillgång till vård och stöd de är i behov av. Bristande kommunikation mellan huvudmän leder till att personer i hemlöshet känner sig negligerade. Ansvar läggs idag på att personer i hemlöshet själva ska navigera i svårtolkade strukturella system. Vårdsamordnare behövs för att kunna främja vårdkontinuitet. Personcentrerade insatser behövs för att tillgodose behov hos personer som lever i hemlöshet. / Background: Homelessness is a widespread global problem. In Sweden, approximately 33,000 people live in some form of homelessness. People in homelessness often have both physical and mental illnesses in addition to multiple social struggles. In order for homeless people with complex needs to receive adequate care and care interventions, individual measures and cooperation between different agencies are needed. The guiding word for Agenda 2030 emphasize that no one should be left out and the opportunity for good health and access to care should be seen as human rights. At the same time, people in homelessness avoid seeking care to a greater extent than others. That care and care interventions are coordinated and organized so that they are used and appreciated by people living in homelessness is a prerequisite for achieving the ambition of equal care. Aim: The aim was to describe the experiences people who live in homelessness have regarding health and welfare interventions.  Method: A literature review based on ten scientific articles. Results: The results are presented in two categories; Deficiencies in planning, collaboration and discharge and the need to create accessible continuous and individually tailored care. The results showed that the obstacles that existed for homeless people to seek care were reduced with the help of outreach services and cooperation. This gave homeless people access and continuity of care and social care efforts. Through a care coordinator, trusting care relationships could be formed where complex needs were met.  Summary: People living in homelessness feel that they do not receive the care and support they need. Lack of communication between organizers leaves people experiencing homelessness feeling neglected. Today, responsibility is placed on people living in homelessness to navigate difficult-to-interpret structural systems themselves. Care coordinators are needed in order to promote continuity of care. Person-centered interventions are needed to meet the needs of people living in homelessness.

The tremendous need for comprehensive healthcare among underserved populations has been well documented. Most of the healthcare resources have been allocated to major metropolitan areas and largely populated cities. In Massachusetts alone, 500,000 people are not serviced by proper healthcare because they are unemployed or underinsured. They do not have a home base for their needs, most visit emergency rooms or minute clinics for care. They lack continuity of care. For minorities and underserved populations, there is a gap in the healthcare system. Statistics have shown that the lower your socioeconomic status, the more advanced the disease has progressed before it is diagnosed, leading to fewer treatment options and poorer outcomes. This is often due to Healthcare Deserts / Health Professions Shortage Areas in the US where there is a true lack of access to healthcare resources. One effective system for healthcare belongs to the Cuban government. Since the revolution in 1949, one of the main goals of the Cuban government was to provide primary care to all its population. The system before the revolution was centralized in the cities and was available mostly to the wealthy and urban populations while the remaining population was left with a substandard and underfunded system like many developed and undeveloped countries. In this paper, we will explore the success of the Cuban system and extrapolate some aspects of its system to use in the underserved populations that inhabit Healthcare Deserts. Implementation of systems will create an Oasis of providers that will naturally improve the well-being of populations leading to the well-being of federally funded state and local resources. The Cuban system divided the country into a grid system and each grid was subsequently divided into even smaller areas with a population of approximately one thousand. A primary care team consisting of a doctor and a nurse was assigned to each grid, including a dental component, and charged with the health and well-being of the population. This system was so successful that it was exported to other countries such as Venezuela, and it was adopted by the World Health Organization as the healthcare model standard to be followed in their world efforts. These programs have been implemented in Latin America, Africa, and Asia with different levels of success due to resource availability and financial constraints. In Venezuela during the Chavez administration, the system was implemented and achieved its highest level of success by benefiting the poor and underserved while Chavez was in power, creating thousands of clinics and improving the healthcare of the population. In Africa, Tanzania adopted the primary care approach at its new dental school and is producing strong clinicians versed with this approach. In Asia, the WHO has made progress in some areas; however, success has proven dependent on the country’s political and financial situation. The primary care approach that the system embraces, emphasizes prevention and education at a very early stage. This is key, and the data proves the success of campaigns even with limited resources provided there is the involvement of the local population. In contrast, United States resources are concentrated on the coasts and urban locations such that the rural areas have the least resources, and people in rural locations often travel long distances to access healthcare. A few states in the US have implemented programs that have been successful – Colorado, North Carolina, and New Mexico. If we successfully transplant teams of healthcare providers, including doctors, dentists, nurses, pharmacist, optometrist, obstetrics /gynecology, pediatricians, and a complete and sustainable health center into empty grids, slowly a series of Oasis will be created and access to care will improve. This change needs to happen at multiple levels, it is a task that must be taken collectively, from the teaching institutions exposing healthcare students to the need for providers in these rural and underserved areas, increasing funding to provide more scholarships and programs that funnel recent graduates into these areas with a sustainable and self-replenishing model, and most important, emphasizing education and prevention in dental school curriculum as the key to improving healthcare, and creating Oases in the current deserts.

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Background: Invasive mechanical ventilation is common in an intensive care unit. The nurse works closely with the patient and should strive for person-centred care in accordance with guidelines and directives. Aim: To review and synthesize qualitative research exploring adult patients' experiences of being treated with invasive mechanical ventilation in intensive care. Method: A structured literature review of qualitative research. Structured searches were conducted in the databases CINAHL and PubMed, resulting in 14 articles. The methodology of the included articles was reviewed using a structured instrument and the results of the articles were analyzed using an inductive thematic analysis. Result: Four main themes: ‘A different perception of reality’, ‘The perceived discomfort’, ‘Including thepatient’ and ‘The suffering patient’. All with associated sub-themes. Conclusion: The experiences of being treated with invasive mechanical ventilation are many and complex. The results illustrate the importance of person-centred care, which can play a crucial role in promoting good care and providing alternative communication for patients. The results can provide aknowledge base for nurses to be able to alleviate suffering that may occur during treatment of invasive mechanical ventilation.

A contract to lease an enterprise A contract to lease an enterprise (Act No. 513/1991 Coll., the Commercial Code) was replaced by an agreement of usufructuary lease of an establishment with effect from 1. January 2014, when the New Civil Code came into force. Due to a new legislation, thesis in some chapters mentions comparison between present and former legal regulations, especially represented by Act No. 513/1991 Coll., the Commercial Code. Some chapters explain concept of usufructuary lease of an establishment from the historical point of view. The thesis deals with Czech legal regulation of the agreement of usufructuary lease of an establishment. It is an agreement regulated by Section 2349 atc. Act No. 89/2012 Coll., the New Civil Code. Usufructuary lease of an establishment is a contractual type related to contract of purchase of an establishment. Firstly, the thesis explains term establishment and defines objects we can classify as an establishment. The work also deals with the term part of an establishment ( branch) and other contextual terms. The main part is devoted to contracts essentialia negotii and the content of the contract from the view of the changes that have occurred with the effect of the Civil Code No. 89/2012 Coll. Especially problematic issues are rights and obligations,...

The purpose of this study was to find out the attitudes and beliefs of minority college students enrolled at Missouri College in Brentwood, Missouri in reference to the dental hygiene profession. In particular, does their oral health and dental knowledge relate to their knowledge of profession of dental hygiene? One hundred and six students gave their consent to participate in the study via Survey Monkey. The study was conducted in May 2015 for a period of four weeks. Four statements were designed to gauge minority students’ knowledge of dental hygiene as a career. No differences were found based on gender, age, education and ethnicity. A difference was found based upon the respondent’s program of study. Further research is needed spread the word about dental hygiene programs and to explain the role of the dental hygienist.

The purpose of this study was to examine patient attitudes and opinions regarding the advancement of a mid-level dental provider, such as the ADHP, in an effort to better understand the perceptions of those who may one day be in a position to receive care from this type of provider. In this quantitative study, I analyzed the differences between those with and without access to dental care and evaluated differences among respondents based upon their socioeconomic and demographic attributes. I collected data from patients treated at Mt. Juliet Family & Cosmetic Dentistry and at the Coweta Samaritan Clinic via a 17-item questionnaire. Most respondents would be willing to accept treatment from someone in this role. The majority of respondents also believed it would be a positive step towards meeting the needs of the uninsured and underserved. Demographic data had no significant impact on their opinion of this role.