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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.

The purpose of this study was to determine the awareness and attitudes of dental hygienists in Ohio regarding the Advanced Dental Hygiene Practitioner (ADHP) as an occupation proposed by the American Dental Hygienists’ Association and to determine whether the ADHP could be a viable career option for Ohio dental hygienists. I developed a survey to assess dental hygienists’ awareness, attitudes, and their views regarding the new mid-level dental provider. The study was limited to licensed dental hygienists in Ohio. The study included a simple random sample of 400 of the 4100 dental hygienists in Ohio obtained by a systematic approach, a random start and selection of subjects at a constant interval. The method of data collection was electronic surveys. Fifty-four dental hygienists (13% of the sample) participated in the study. The results show that most of those responding were aware of the ADHP. Also, their attitude regarding the new mid-level dental provider was positive. Attitudes varied more when the respondents provided data on the adoption of legislation for the new provider. There was no consensus among respondents regarding the ADHP as a viable career option. More robust research is needed on the viability of the ADHP in Ohio.

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As the cost for health care delivery increases, so does the demand for access to care. However, individuals in a rural community often do not have access to the care they need. Shortages of rural health care professionals are an ever-increasing problem. The Affordable Care Act of 2010 sought to increase health care access by focusing on team-based care delivery. Thus, the need to educate health care students in the fundamentals of team-based practice has led to an increased emphasis on Interprofessional Education (IPE). While past research focused on urban IPE, a literature gap exists for the effects of a rural team-based educational experience on practice location decisions. This study examined how rural IPE influenced health profession students' perspectives of what it means to be a member of a rural health care team and explored what factors go into making decisions of where to live and provide care. Motivational Theory provided the framework for a mixed methods approach with data from student reflective journaling and a post-experience Q sort. Analysis yielded important understandings about the impact of rural IPE. Accordingly, having a rural IPE experience provided positive motivation for returning after graduation. Further, the time spent in rural IPE generated understandings of what it means to live and provide care to a rural community. One important new discovery gained is the clinical setting is not where most IPE took place. As a result, social interactions with fellow students and community members achieved the goals of rural IPE. Despite these influential findings, noted barriers to genuine rural IPE persisted. In the end, students, educators, and rural health care professionals need to be aware of the multiple factors that guide decisions of where to live and provide care.

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.

A large number of English language learners (ELLs) in secondary school are long-term ELLs who have attended public schools in the United States for at least seven years, having received English language support services, yet have not acquired English proficiency (Capps, Fix, Murray, Ost, Passel, & Herwantoro., 2005). Formal or informal programs and educational services to address the particular needs of long-term ELLs are scant to non-exist (Zehr, 2010). In spite of the growing presence of long-term ELLs in secondary schools, little research has been conducted about their academic challenges. Due to the scarcity of research, effective practices for long-term ELLs in secondary school are very limited (Ruix-de-Velasco & Fix, 2000). Research is needed to better understand risk factors associated with dropping out, retention, and the high incidence of disproportionate representation of long-term ELLs in special education programs. Equally absent from available literature are the voices of students themselves. This study aims to expand the existing database about long-term ELLs' academic challenges from the perspective of students themselves about their language and academic learning experiences. A qualitative, naturalistic inquiry (NI) approach was utilized to explore the perceptions of long-term ELLs about their learning experiences in the context of their school history, including program placements, special education referral, and academic outcomes. Thirteen long-term ELLs at a high school in metropolitan area of Texas were participated in this study. Data were generated from semi-structured, in-depth interviews and various documents, including students' cumulative folders, language proficiency assessment records, and the state assessment data, and analyzed using a grounded theory approach. The findings of the study indicate that participants experienced multiple layers of lack of opportunity to learn as they moved through the educational process. Participants perceived themselves as English-proficient, motivated learners who were successful in spite of challenges they had experienced, which they attributed mainly to their limited development of academic language proficiency in English. The study also revealed a gap between participants' postsecondary aspirations and the reality of their academic underachievement, which raises questions about the adequacy of general educational programs for this population and appropriate identifications of ELLs with disabilities. / text

It is estimated that 10% of the global population is impaired to a significant degree by a decrease in hearing sensitivity. With the greatest proportion of these persons residing in developing countries where communities are grossly underserved, it is incumbent on hearing healthcare professionals to seek means of offering equitable hearing health care services to these communities. The delivery of conventional diagnostic hearing services to these population groups is challenged by limitations in human resources, financial constraints and by the dearth of audiometric testing facilities that are compliant with permissible ambient noise levels for reliable testing. Valid diagnostic hearing assessment without an audiometric test booth will allow greater mobility of services and could extend hearing healthcare service delivery in underserved areas. The purpose of this study was to investigate the validity of diagnostic pure tone audiometry in a natural environment, outside a sound treated room, using a computer-operated audiometer with insert earphones covered by circumaural earcups incorporating real-time monitoring of environmental noise. A within-subject repeated measures research design was employed to assess elderly adults with diagnostic air (250 to 8000 Hz) and bone (250 to 4000 Hz) conduction pure tone audiometry. The study was of a quantitative nature and the required data was collected by testing subjects initially in a natural environment and subsequently in a sound booth environment to compare the threshold measurements. One experienced audiologist used audiometric KUDUwave test equipment to evaluate subjects in both environments. A total of 147 adults with an average age of 76 (± 5.7) years were tested. Ears had pure tone averages (500, 1000, 2000 and 4000 Hz) of ≥ 25 dB in 59%, >40 dB in 23% and ˃ 55 dB in 6% of cases. Analysis of collected data showed air conduction thresholds (n = 2259) corresponding within 0 to 5 dB in 95% of all comparisons between testing in the natural and sound booth environments. Bone conduction thresholds (n = 1669) corresponded within 0 to 5 dB in 86% of comparisons and within 10 dB or less in 97% of cases. Average threshold differences (–0.6 to 1.1) and standard deviations (3.3 to 5.9) were within typical test-retest reliability limits. Recorded thresholds showed no statistically significant differences with a paired samples t-test (p ˃ 0.01) except at 8000 Hz in the left ear. Overall the correlation between the air-conduction thresholds recorded in the sound booth environment and the natural environment was very high (˃ 0.92) across all frequencies while for bone conduction threshold correlation for the two environments fell between 0.63 and 0.97. This study demonstrates that valid diagnostic pure tone audiometry in an elderly population can be performed in a natural environment using an audiometer employing insert earphones covered by circumaural earcups with real-time monitoring of ambient noise levels. Mobile diagnostic audiometry performed outside of an audiometric sound booth may extend current hearing healthcare services to remote underserved communities where booths are scarce or inaccessible. In combination with Telehealth applications this technology could offer a powerful and viable alternate diagnostic service to persons unable to attend conventional testing facilities for whatever reasons. / Dissertation (MCommunication Pathology)--University of Pretoria, 2013. / gm2014 / Speech-Language Pathology and Audiology / Unrestricted

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.

INTRODUCTION: The United States is currently experiencing a shortage of physicians that is projected to worsen substantially over the next decade. Rural regions are most affected by this shortage, with some statistics estimating that the physician-to-patient ratios reach 1 to 2500 in certain areas. While some measures have been taken to help combat this shortage, such as increases in medical school enrollment and the development of more residency training programs, additional interventions are needed that target rural regions specifically. One of the most powerful methods to improve this rural maldistribution of physicians is to make changes in medical education so that it trains and deploys more individuals who wish to practice in rural areas. The Quillen College of Medicine (QCOM) places tremendous focus on training rural physicians, with around 25% of students selecting an alternate educational curriculum that provides them with specific training in rural communities. To further QCOM’s commitment to improving rural healthcare, we hosted a no-cost, week-long camp for high school students. We specifically recruited students from the surrounding rural regions, as studies have demonstrated that students with rural origins are more likely to train in primary care and return to practice in rural areas. We hypothesize that earlier exposure to the medical field through summer camps is an effective method to increase the number of students from rural communities who wish to pursue careers in medicine. METHODS: The 2018 camp was held the week of June 4-8 and hosted 20 students from surrounding high schools. Throughout the week, the students engaged in a variety of fun and engaging activities that taught them about many important aspects of medicine such as proper patient care, communication skills, physical exam techniques, and critical thinking skills. We utilized both the Medical Simulation Lab and Standardized Patient Center at the Quillen College of Medicine, which allowed the students to interview, diagnose, and treat patients with various conditions in a simulated environment. Our objective was not to have the students accurately diagnose and treat the conditions, but rather to utilize teamwork, employ critical thinking skills, and enjoy doing it. Our data was collected pre- and post-surveys which contained closed-ended questions, Likert scales, and free-response questions. The surveys assessed demographic information, previous exposure to the medical field, interest in the medical field, and perceived potential obstacles in pursuing a career in medicine. RESULTS: Student feedback was positive overall. 65% of students stated they were more knowledgeable about the steps they needed to take to become a physician. 55% of participants reported an increased desire to pursue a career in healthcare. 45% of students reported an increased desire to become a physician. CONCLUSIONS: We conclude that earlier medical exposure through summer camps is an effective method for increasing the number of students from rural East Tennessee who are interested in pursuing a career in medicine. We believe that similar opportunities should be offered to a greater degree in other areas to help combat the physician shortage affecting rural regions nationwide.