No description available.

ABSTRACT OBJECTIVES: The objectives of this project are to review current literature regarding conjunctivitis including the pathogens that cause conjunctivitis, how to diagnose and differentiate between viral and bacterial conjunctivitis, and the different modalities to treating the disease with limited resources in rural communities. Then examine an outbreak of viral hemorrhagic conjunctivitis in rural Belize in October of 2017. This includes examining data collected by ETSU Family Medicine Department during health outreach clinics regarding diagnosis made, treatment provided, and comparing this information to a survey collected about social determinants of health. Finally, discuss the importance of disseminating public health education regarding how to limit the spread of contagious infections to a rural population with limited health literacy and access to resources. METHODS: In October of 2017 East Tennessee State University (ETSU) Quillen College of Medicine medical students, primary care physicians, and residents traveled to rural Belize to provide free primary care. The clinics consisted of seeing patients at both an established clinic in Roaring Creek, Belize and at remote health clinics in even more rural locations. Many of the patients who presented to the clinics had similar complaints of itchy, red, and productive eyes. Quantitative data was recorded from patient charts regarding their presenting symptoms, diagnosis, and the treatment. The data was organized utilizing microsoft excel and evaluated using SPSS and measures of central tendency. Qualitative data was also collected from interactions with patients and newspaper articles published in Belize about the conjunctivitis outbreak. RESULTS: The results showed that a total of 431 patients received care and 52% of them were diagnosed with conjunctivitis. 46.9% of the patients were determined to have viral conjunctivitis, while 2.8% of them had bacterial conjunctivitis. It was discovered that many patients utilized one reusable cloth to wipe their children's eyes repeatedly thus spreading the disease across and throughout the rural communities. It was found through careful conversations with patients that they were putting urine and breast milk into their eyes in hopes that it would help their pink eye. The Belize Ministry of Health Reported that there were 5,343 cases of pink eye countrywide, with a viral strain being more predominant than bacterial. CONCLUSION: In conclusion, extremely contagious diseases like conjunctivitis are dangerous in rural developing countries because of lack of education about hygiene and limited resources necessary to contain such diseases. While medication is not effective for viral conjunctivitis, it can have devastating consequences (e.g blindness) if a superinfection is not caught early in the course. Education can be the best medicine especially in cases of viral diseases. Patients were also provided with resources to wash their hands often, sterilized water to flush their eyes, and single use towels. A lesson on conjunctivitis, its complications, and how to prevent the spread of the disease was aired on public television. This reports provides examples of both practice creative ways to spread health literacy in rural populations with limited access to resources.

Twenty years ago, a seminal study on adverse childhood experiences (ACEs) and subsequent increased health risks catapulted ACEs into the zeitgeist of research and application. Though a validated construct, the questionnaire, particularly the child sexual abuse (CSA) item is not without limitation and yet is used by the Centers for Disease Control and state agencies to quantify need and allocate resources to services accordingly. Currently, CSA is counted only when the perpetrator is 5-years or older than the victim. This requirement makes neglect of sibling and peer assault very likely. Accordingly, this study aimed to assess whether individuals with CSA experiences within an age gap smaller than 5 years are missed by the 5-year modifier embedded in CSA assessment wording and whether this missed group would otherwise qualify for services if detected. The study also aimed to assess whether this missed group has equivalently poor health outcomes to CSA groups currently captured by the 5-year modifier and whether outcomes for all CSA groups were higher than those who did not have a CSA history. An international sample of 974 women aged 18 to 50 completed an online survey hosted by Reddit regarding their substance use, multiple domains of current health, and CSA history using the original ACEs questionnaire and an experimental version of the CSA item without the 5-year modifier. All statistical analyses were completed in R. Results indicated there was a group of survivors with CSA experiences missed by the 5-year modifier and this had implications for reducing their total ACE scores. This group was nearly equal in size to CSA groups captured by the 5-year modifier and demonstrated equivalently poor health and substance use outcomes. On nearly all variables, CSA groups demonstrated poorer health outcomes than those who had never experienced CSA. These findings suggest the language of how CSA is assessed must be thoughtfully revised to include all CSA experiences as all are equally at risk for adverse outcomes and thus all warrant consideration for services currently afforded those with CSA histories and high ACE scores.

Purpose The Johnson City Downtown Day Center (JCDDC) provides integrated inter-professional primary care, mental health, and social work case management services to homeless and under-served persons who have difficulty accessing traditional systems. Because of the exponential rise in substance abuse in the Appalachian region, the JCDDC providers and staff initiated SBIRT as recommended standard of care, as endorsed by SAMHSA, United States Public Health Services Task Force, and the National Institute on Alcohol Abuse and Alcoholism. The JCDDC has two mechanisms by which patients can choose to participate in substance abuse treatment: SMART Recovery, and psychiatric nurse practitioner (NP) referrals. The purpose of the project evaluates use of SBIRT at the JCDDC by determining process of (1) referral and (2) follow-up rates of those who received SBIRT; analyzing outcomes by measuring numbers of: (1) screens administered; (2) brief interventions; (3) positive screens; (4) referrals to either SMART Recovery or to the psychiatric NP; (5) participation in one follow-up. Review of Literature: Approximately 6.4 million people, or 2.4% of the U.S. population 12 years and older, currently misuse prescription medications. There is an undeniable and tangible correlation between the chronic disease of substance use disorder and unstable housing or homelessness (de Chesnay & Anderson, 2016). Similarly, substance use disorder was found to be much more common in people facing homelessness than in people who had stable housing (National Coalition for the Homeless, 2009). Substance Abuse and Mental Health Services Administration (SAMHSA) has been the most significant funding source for SBIRT proliferation in the United States. Despite a demonstrated need for substance abuse services among this vulnerable population, people who are homeless have substantially greater barriers to obtaining treatment and often go without. Summary of Innovation or Practice The current SBIRT process includes use of DAST-10 and AUDIT tools. Evaluating clinic processes and outcomes in vulnerable populations who have inconsistent erratic follow-up is challenging. However, new ways of understanding patterns and incremental outcomes is essential to addressing clinic practice that can impact outcomes in vulnerable groups. Implications for NPs The heterogeneity of the homeless population is often precipitated by a host of complicating factors including co-occurring mental illness, multiple chronic conditions, unstable income, and lack of transportation. Therefore, the importance of finding effective, cost-conscious processes that are population specific and patient-centered is essential for future research and policy. The inter-professional model of care also informs future practice by evaluating the feasibility of administering all of the elements of SBIRT in a single facility.

Tennessee is a state in the United States South region, which is disproportionately burdened with higher levels of chronic disease and mental health disorders. Despite its unique cultural heritage and close-knit communities, the region faces a range of challenges related to access to mental health services, stigma, social and economic factors that can negatively impact mental health outcomes. Racial disparities in mental health among Black people are a significant challenge in the region that requires urgent attention. There is a need for increased funding for mental health initiatives in rural and underserved areas of Tennessee. The proposed study examines the association between physical health and depression among Blacks in Tennessee. We used cross-sectional data from the 2021 Behavioral Risk Factor Surveillance System a nationally representative U.S. telephone-based survey of adults aged 18 years and extracted data for participants who self-identified as race/ethnicity Black, and who reside in Tennessee (n=476). Logistic regression analyses were conducted to test the association number of past month physically unhealthy days and depression (outcome). We controlled for income, race/ethnicity, educational status, gender, health insurance status, and age. Results indicate that 19.9% (n=195) reported having been diagnosed with depression, while 25.0% (n=119) reported 1-14 physically unhealthy days in the past month, and 15.3% (n=73) reported 15-30 unhealthy days. Our logistic regression analysis revealed that 15-30 physically unhealthy days (OR=4.47, 95% CI, 2.37, 8.40), 1-14 physically unhealthy days (OR=3.59, 95% CI, 2.07, 6.24), and female gender (OR=2.00, 95% CI, 1.14, 3.49). The findings reveal a strong association between physically unhealthy days and depression among Black people in Tennessee. Greater efforts to address both poor physical health and mental health among Blacks are essential. Efforts to improve access to mental health services, reduce mental health stigma, and address social and economic factors that can negatively impact mental health outcomes are essential to addressing this challenge, particularly among Blacks in Tennessee.

Home visits are a required training component of many Family Medicine residency programs in the United States. However, they are becoming less popular due to such factors as increasing resident responsibilities, decreasing reimbursement, and a decline in resident intention to incorporate home visits into future practice. This study’s aims are: (1) to evaluate the current practices of one Family Medicine residency training program’s time and resource expenditure to conduct home visits, and (2) to evaluate resident and faculty experiences of home visits. Residents and faculty in a Family Medicine training program were provided with a 12- question survey immediately after completing a home visit. A total of 19 surveys from residents and faculty were collected and analyzed. Average reported time spent per home visit was 90 minutes (range = 50-180 minutes), and the home visit teams included an average of 4 members (range = 2-6 members). The providers felt that they knew their patients and the patients’ circumstances better after the home visit with a score of 4.1 (on a 1-5 scale with 5 being a positively framed statement). Resident opinions were neutral (average score 3.1 on a 1-5 scale) regarding whether they found home visits to be educational to their residency training in Family Medicine. Residents also had mixed feelings (average score 2.9) regarding whether they would perform more home visits during their residency training if given the opportunity. Most faculty members (5/7) indicated they had done home visits during their residency training and all faculty (7/7) felt that home visits added value to their training in Family Medicine. Finally, qualitative recommendations were collected from respondents which may allow this training program to improve home visits in the future. Overall, significant time is currently being spent conducting home visits, with a difference in perceived efficacy between residents and faculty. Future research may include a cost analysis to quantify financial value, as well as expanding data collection to other Family Medicine residency training programs to improve generalizability.

No description available.

The purpose of this research was to examine potential sustainable delivery methods for Oral Health Promotion (OHP) in developing populations in India, utilising non-dental rural community development groups, specifically those led by Non-Governmental Organizations (NGO) involved in community development. The focus of this research was based on a longitudinal cohort study experimental design for exploratory purposes conducted over a period of one year, using a randomised cluster sampling of community developmental projects within the rural-tribal villages of Ambernath, Maharashtra, India. The study was measured in 4 phases: oral health knowledge of village parents through a questionnaire, dental screenings of children, and integration of a ‘train-the-trainer’ type of Oral Health Awareness Programme (OHAP) for three test groups, followed by one-year comparison follow-up data. Findings show evidence of comprehension and dissemination of the information in the OHAP course. Screening data also showed a reduction in decay in primary and permanent teeth in the children, after one year, and a positive change in oral hygiene behaviours. The collaboration and utilisation of non-dental NGO teams and local participatory groups from a ‘grass-roots’ level was proven to be effective for disseminating information and activities for oral health awareness and promotional programmes within these populations. Evidence supports a collaboration of these groups can be recommended for introducing a structured and understandable oral health programme utilising non-dental NGO and local participatory groups.

Since the mid-1970s, top managers, politicians, and officials in both public and private institutions have promoted contracting-out services (privatization) as a means of increasing efficiency, flexibility, and quality. The privatization trend has occurred in many public sector organizations particularly in city services and prisons. Public health services are not immune to this trend. Today many county health departments have contracted the provision of public health services like womens health, primary care, and laboratory services. However, very few studies have analyzed the impact of these privatizations on cost, access, and health outcomes. Proponents favoring the private provision of these services argue that private providers are more efficient and can deliver these services at a lower cost. Also, because of better innovation, private providers can even improve quality. However, among opponents there is concern that a for-profit private provider might cut costs that adversely affects the quality of these services. The purpose of this dissertation is to analyze the effects of the privatization of primary care services on cost, access, and health outcomes in nine large counties in the state of Florida. In a survey of county health departments conducted in 1999, 61 out of 67 counties had outsourced at least one service. Primary care was the second most frequently privatized program. Womens health was the program most often privatized by counties. Using mixed models and logistic regression, a comparison was made between large counties that outsourced primary care services and counties that did not. Multiple years of data were obtained from federal and state sources for analysis.

Background: Ballad Health participates in the Centers for Medicare and Medicaid Services’ (CMS) Accountable Health Communities (AHC) model. The AHC model is evaluating if universal screening, referral, and navigation services for health-related social needs (HRSN) can improve outcomes and reduce unnecessary utilization and costs of health care services. To ensure the evaluation of the model has sufficient statistical power, navigation services are expected to be provided to a minimum number of individuals. The purpose of this study is to analyze the characteristics of Ballad Health’s AHC navigation services that could be modified to improve opt-in rates. Methods: The primary outcome measure was identified as whether a beneficiary contacted via telephone opted-in or –out of the navigation program. Andersen’s Behavioral Model for Health Service Use was used as the conceptual framework for selecting covariates of interest. Enabling factors were of primary interest because alternate interventions may be designed around them. Data was pulled for the time period of November 17, 2018 through February 14, 2019. Where possible, covariates were associated with data from CMS’ AHC Data Template v3.1 to accommodate replication for all AHC bridge organizations, though additional internally-collected data, which may not be available for all bridge organizations, were needed for some variables. Chi-squared tests were performed for each covariate. Results: No statistical differences were found for the primary covariates of interest. Opt-in rates by Navigator were lowest for Navigator 5 and highest for Navigator 4 (67.53% and 88.24%). Opt-in rates by weekday of decision were lowest on Thursdays and highest on Wednesdays (64.91% and 77.42%). Opt-in rates based on time of day were lowest between 8:00am and 9:59am, and highest between 12:00pm and 1:59pm (62.50% and 100%). Opt-in rates were lowest when the decision was made six days after the screening and highest when made the same day (53.57% and 83.33%). Opt-in rates were lowest when there were five weekdays between screening and navigation decision, and highest when there were three weekdays between the screening and decision (60% and 90%). Other non-process covariates of interest that were statistically significant for opt-in rates were the presence of either food, safety, or utility needs. Conclusions: Several groups had higher opt-in rates that were not statistically significant; small sample sizes may have impacted the significance of these differences. For example, opt-in rates were higher when made the same day as the screening than when made one day after (83.33% and 74.79%). However, only 18 beneficiary decisions were made on the same day, while 119 were made one day after. Increasing the number of same-day phone call attempts may be a method to improve opt-in rates. Importantly, date and time data for contact attempts before a beneficiary decides to opt-in or opt-out were unavailable as of the time of the analysis. These data are captured and will be added to the analysis when available, which could provide more insight into whether a beneficiary is more likely to opt-in or opt-out.