Sexual minority women experience a number of physical and mental health disparities compared to their heterosexual peers. One factor contributing to this disparity is access to care, of which sexual minority women also report having less than heterosexual women. In this study I examine predictors of sexual minority women's access to care in three ecological contexts: structural, community, and interpersonal. Eighty-eight sexual minority women 22 and older from Davidson County, TN responded to an online survey that gathered information about demographic factors and various aspects access to care including accessing healthcare systems, gaining access within the system, and patient/provider relationships. Multiple regression analysis was used to determine whether demographic factors were significant predictors of access to care. Age, education, and degree to which participants were open with others about their sexual orientation were significant predictors of access. Results point to significant differences in access to care within this population that has multiple marginalized identity statuses, indicating a need for attention to within-population access needs. Sexual minority women who are younger, less educated, and less out to others about their sexual orientation may be at increased risk to face barriers to care. Implications for practice and policy include a need for increased cultural competence of healthcare providers, and changes in policies that will close the insurance gap between heterosexual and sexual minority adults in the U.S.

El texto completo de este trabajo no está disponible en el Repositorio Académico UPC por restricciones de la casa editorial donde ha sido publicado. / Drug counterfeiting or adulteration is a worldwide concern due to the serious consequences they generate, especially in the health and economic sectors. This concern is greater in Peru, as it is among the top five countries with drug counterfeiting incidents in the Americas, according to a study carried out in 2018 by the Pan American Health Organization. In this paper, we present our project, which aims at implementing a technological solution that provides reliable information on the origin and authenticity of these products in Peru to the drug consumer user, preserving the security and integrity of the exposed information using Blockchain technology. Likewise, it allows showing detailed drug characteristics, such as: composition, pharmaceutical form, active ingredients, among other relevant information. The technological solution, proposed by our project, aims at publishing the commercial origin of drugs from their sale in laboratories and distributors to the sale to the public in pharmacies. In the development of this paper, a bibliographic review of research on the use of blockchain technology is presented, as well as its benefits in the health sector, the architecture used by the system and the conceptual commercialization chain that supports it, and the qualitative and quantitative validation for the drug query service is shown. / Revisión por pares

Thesis advisor: Joseph Quinn / The ease of spread of COVID-19 has posed a great challenge for governments, public health officials, and healthcare workers around the world. Leaders and officials need to make decisions that protect the health and well-being of their citizens, while balancing their rights as citizens and the stability of their economies. This study conducts a review of literature on COVID-19, the Spanish Flu, and the Swine Flu in an effort to understand the economic and health impacts of pandemics. Results show a clear trend suggesting the poor bear a greater burden of the impact of pandemics in regards to economic and health impacts. Further analysis suggests that these inequities are not limited to the United States healthcare system and remain apparent in national single-payer healthcare systems, like in the United Kingdom. To prevent similar disparities in future pandemics, governments should attempt to decrease inequality present in baseline health and economic measures. / Thesis (BA) — Boston College, 2021. / Submitted to: Boston College. College of Arts and Sciences. / Discipline: Department Honors and Scholar of the College. / Discipline: Economics.

In the last two decades, Innovation in healthcare has brought about a significant transition from the conventional methods relating to activities within the healthcare system such as medical record journaling and patient diagnosis and additionally to the way clinical care is delivered to the patients. Service innovation as opposed to product innovation is the integration or positive increment of new or existing services cumprocesses in the system through the introduction of new methods, techniques, or abstract services. Healthcare industry is primarily a service driven sector. As compared to other industries it is unique given its setting. It is emotionally vulnerable, highly sophisticated and encounters life-death situations on a daily. Service innovation holds the key for large private multi-speciality to move forward.As of now, numerous challenges plague the healthcare sector such as increased healthcare costs, reduced monetary and ethical quality of clinical value care. Service innovation holds the key especially for large private multi-speciality to move forward towards. Inclusion of ancillary services such as rehabilitation,testing, nursing, emotional care coupled with digital service innovation (Telemedcine, Electronic health records, billing systems) overcome challenges of efficient billing, remote diagnosis, emotional burnout, and high medical expenditure for patients.The purpose of this thesis to underline the need for service-based innovation and its framework in correlation to a complex healthcare system. Case of an upcoming super-speciality Venkateshwara hospital located in New Delhi, India is analysed to answer the research question and understand theoretically the conflicting nature of barriers of different stakeholders involved in the process. Currently, most literature is centred around the importance of product innovation, with lacking focus on concept of service science. The study fills the gap by providing an exhaustive approach of defining service-based innovation within healthcare setting and addressing difference between product drive logic and service dominant logic. Additionally, a new service model is implemented utilizing NK Kauffman model and Greenhalgh’s (2008)eight pillar model.Since the Hospital is a private entity, paradox specific to healthcare that is “ethical vs economical” conundrum is assessed through primary empirics. Complexity of a tertiary healthcare organization is addressed in relation to the level of interrelatedness between services innovation. Venkateshwara as a multispeciality service system ranks into a highly complex organisation with high interrelatedness between varying components. Study is qualitative with explorative nature. Primary data is collected via semi-structured interviews and physical observation of the organization, while secondary data is collected via official website and brochures. Triangulation method serves the purpose of data analysis and rigour. Data Analysis section uses thematic coding to generate themes and complexity of Venkateshwara Hospital is mapped through component and interrelatedness graph.The discussion section puts forth detailed overview of over-arching and sub-themes coupled with collected data(Primary and secondary) to highlight the significance in need for service innovation. Results formally answer the research question. New services such as value-based care and telemedicine are discussed. Challenges specific to Venkateshwara hospital are put forth and categorized by needs of different stakeholders when implementing the service innovation framework. Concluding remarks include future need of service innovation. Lastly, theoretical, and practical implications of the study are provided.

TITLE: Racial disparities associated with colon cancer screening in a nationally representative sample; A cross-sectional study AUTHOR INFO Yorandos Tafesse MD1 Manik Ahuja PhD, MA1 Author Affiliations: 1College of Public Health, East Tennessee State University, Johnson City, TN 37614, United States Colon cancer impacts nearly 2 million individuals in the U.S. each year. Early detection of colon cancer using colonoscopy can reduce the risk of mortality. The United States Preventive Services Task Force (USPSTF) recommends routine screening for colon cancer for all adults 50 to 75 years of age. Colon cancer screening behavior is different across a variety of predictor variables. Previous studies have identified older age, male gender, higher education, higher income, marriage, and the presence of chronic diseases to be associated with increased odds of colon cancer screening. However, less is known about the role of racial differences in screening. This study aims to determine if colon cancer screening rates are different between Whites and racial minorities in the United States controlling for potential confounders. This research can help bridge the existing gap on this topic and aid in identifying high-risk racial groups that could be targeted by future intervention strategies. We used cross-sectional data from the 2019 Behavioral Risk Factor Surveillance System, a nationally representative U.S. telephone-based survey of adults aged 18 years or older. We extracted data for adults age 50 or older (n=10,972). Logistic regression analyses were conducted to test the association between race and colon cancer screening. We also included chronic disease status, alcohol use, smoking, gender, and age in our model. Chronic disease status was coded as self-report 2 or more, 1 and 0 chronic diseases (referent), which included the summation of heart disease, hypertension, COPD, and diabetes. Overall, colon cancer screening is as follows among Whites (77.2%), Blacks (72.4%), Asian (60.1%), American Indian/Alaska Native (69.7%), and Hispanic (68.6%). Logistic regression results revealed that having 2 or more chronic diseases (OR=1.73; 95% CI 1.53,1.96), 1 chronic disease (OR=1.45; 95% CI 1.31,1.65), and female gender (OR=1.14; 95% CI 1.04,1.23) were associated with higher odds of screening. Race/ethnic minority status (OR=0.72; 95% CI 0.65, 0.81), low income (OR=0.64; 95% CI 0.57,0.70), and less than high school education (OR=0.71; 95% CI 0.59,0.84) were associated with lower odds of screening. Our research showed that racial minorities have lower odds of colon cancer screening after adjusting for gender, age, chronic diseases, income, and education status. Preventive practices should focus on increasing awareness on and availability of colon cancer screening means to racial minorities in the United States. Further research on the association between race and other screening modalities will help maximize the impacts of targeted interventions.

Psychology and religiousness/spirituality continue to be perceived as incongruent and incompatible, often resulting in a disconnection and suboptimal level of collaboration between the two fields to the detriment of healthcare. Nevertheless, forgiveness, or an absence of ill will, is a construct central to both mainstream world religion/spirituality and the field of psychology. Understanding and recognizing the construct of forgiveness and its mutually central application can foster increased collaboration between the fields. As a result, individually and collectively, the two fields will be better able to expand and further develop their many shared principles in the service of better healthcare.

No description available.

Post-traumatic stress disorder (PTSD) is characterized by fear extinction deficit; chronic stress worsens this deficit. Using a Chronic Unpredictable Stress (CUS) model, we previously found that CUS increased fear extinction deficit in female mice and knockout of Ciliary Neurotrophic Factor (CNTF) attenuated it. The amygdala, specifically the medial amygdala, is strongly associated with fear conditioning and extinction. CUS increased CNTF and reduced Urocortin 3 (UCN3) in the medial amygdala, suggesting CNTF-mediated UCN3 inhibition may be involved in CUS-induced deficit of fear extinction. The medial amygdala connects to the hypothalamic paraventricular nucleus (PVN) via posterior bed nucleus of stria terminalis (pBNST) and mediates the stress response (Fig. 1). The objective of this project is to determine whether CUS affects CNTF, UCN3, and CNTF-related cytokine leukemia inhibitory factor (LIF) and interleukin-6 (IL-6) in the pBNST and hypothalamic PVN. Hippocampal CNTF expression was also examined as a brain region outside of the medial amygdala-pBNST-hypothalamic PVN circuitry. 4 groups (5 mice/group) of CNTF+/+ and CNTF-/- mice were treated with 4 weeks of CUS or control handling. At the end, fresh brain samples were collected. The hypothalamic PVN, pBNST and hippocampus were punched out from 600-700 um cryostat frozen sections. CUS was applied for 4 weeks. The control mice were handled daily for 4 weeks. RNA was extracted from tissue using QIANGEN Rneasy mini kit. BCA assay was performed to analyze protein concentration, then 10% SDS gel was used to run the protein samples. Statistical analysis included one-way ANOVA followed by Bonferroni multiple comparison or 2-tailed T test. p <0.05 was defined as significant difference. In the pBNST, CUS did not affect CNTF and UCN3 mRNA expression. However, UCN3 protein was upregulated by CUS in CNTF+/+ but not CNTF-/- mice, suggesting CNTF inhibits UCN3 expression, possibly through post-transcriptional mechanism. CUS did not alter LIF and IL-3 in the pBNST. CUS did not alter CNTF mRNA expression in the PVN and further study will measure UCN3 mRNA and protein in the PVN. Finally, there was no CUS effect on CNTF, LIF and IL-6 mRNA in the hippocampus. These results and further studies are useful in development of therapeutic medications and drug targets in the case of chronic stress.

Abstract Introduction and Background: Euthanasia has expanded significantly around the world over the past years. The debate concerning euthanasia has focused on the legalization, complex issues faced by the medical team, and perspective on assisted dying. Euthanasia known as assisted suicide is a deliberate medical procedure of intentionally withholding treatment or withdrawing life-support measures to end the life of a suffering patient. Purpose Statement: To define euthanasia and its background as well as discuss the psychological and moral effects that surround the subject. Literature Review: Five articles were selected. Quantitative and exploratory qualitative studies were obtained from existing literature, collection of data and statistics from relevant publications, peer-reviewed analysis, and original research papers with a focus on psychological and moral effects on participating, healthcare professionals. Findings: Participation in euthanasia can have significant emotional and psychological impacts on participating healthcare professionals which can lead to long-term personal and professional effects. Some are unsupportive of this practice while some were supportive of it. Conclusion: Despite the importance of this topic to medical practice, there are limited studies on addressing the psychological and moral impacts of euthanasia on participating healthcare professionals. Future research needs to explore how health professionals are negatively emotionally affected by their involvement in assisted suicide

This thesis explores the experiences of the health care system for East African refugees in Boston. I argue that refugee experiences lie on a spectrum ranging from inadequate to exceptional, and that by exploring what makes care both a negative and positive experience for refugees it may be possible to better serve the community. I conceptualize these experiences using the metaphor of a rope bridge: at the beginning, refugees are stuck in a formal structure that limits their movements and agency; throughout the middle, they are forced into a liminal space in which both their identity and experiences are made ambiguous; on the far end of the bridge; they have mitigated the deleterious effects of structural violence and liminality through practices involving selective acculturation, resilience, and self-verification. My participants reported being dissatisfied with the bureaucratic barriers to health care they encountered and with the power imbalances they felt when interacting with clinicians. They also spoke about the encounters they had with clinicians that made them feel listened to, cared for, and empowered. Much of the distinction between good and bad care relied on whether the patient felt like they were respected by their doctor, and whether they felt like they had a say in their own care and treatment. Due to the limited nature of this endeavor, further research is recommended on: 1) the role of memory in recovery; 2) liminality as it applies to the resettlement experience; 3) maintaining and bolstering the assets that allow refugees to mitigate the effects of structural violence; and 4) in what ways the health care system is working for refugees, and how those can be expanded upon.