Public health informatics: A consensus on core competencies

Richards, Janise Elaine The University of Texas at Austin 2000 해외박사(DDOD)

This descriptive study identified competencies and the supporting skills and knowledge in public health informatics for public health informaticians and for general public health practitioners. Within the study's integrationist research design, which combines both qualitative and quantitative methods, the methods used were telephone interviews and a web-based Delphi survey. The interviews were substituted for round one of the traditional Delphi method. The interview data were analyzed using a constant comparison method and the final results were used to develop the Delphi survey items. A snowball sampling technique identified the study participants who met the selection criteria of expertise in public health informatics, public health education, public health practice or informatics education. Nine experts participated in the interview process and 23 in the Web-based Delphi. The interview results provided a new definition for public health informatics: Public health informatics is the innovative application of information science, computer science and information technology to improve management of information in public health practice and research, ultimately improving the health of the community. The interview results also indicated that public health informatics had four core domains: organizational and systems management, information systems, information technology, and public health sciences. Within these domains were 12 competencies and 60 supporting skills and knowledge items. After two rounds of the Web-based Delphi survey, the items reached consensus. Nine of the 12 competencies were determined to be critical and three were determined to be important for public health informaticians. For the general public health practitioner, two competencies were determined to be important, eight moderately important, and two insignificant. Of the supporting skills and knowledge, 55% were considered critical, 42% important, and 3% moderately important for public health informaticians. For general public health practitioners 20% were critical, 26% important, 36% moderately important and 18% insignificant or not important. This research can provide a foundation for developing public health informatics curricula in graduate programs and schools of public health and public health workforce training programs.

Barriers to Care Among Adults With Chronic Liver Disease in the United States

Wong, Carrie Ruby University of California, Los Angeles ProQuest Dis 2023 해외박사(DDOD)

Chronic liver disease is increasingly prevalent with high rates of morbidity and mortality, yet it receives less attention than other similar chronic diseases such as cardiovascular disease and chronic obstructive pulmonary disease. Barriers to timely medical care may preclude diagnosis and management and thus, exacerbate potentially avoidable morbidity and mortality for persons with chronic liver disease. This dissertation explored the extent of health care barriers among adults with chronic liver disease compared to other chronic conditions and identified latent classes derived from different health care barriers to phenotype those at highest risk for recurrent acute care use within the adult population with chronic liver disease in the United States.The first paper, "Evaluation of the Extent of Health Care Barriers among Adults with Chronic Liver Disease vs. Other Chronic Diseases in the United States," compared estimates of any and the number of health care barriers and the association of recurrent acute care use by prevalence of barriers to care among adults with chronic liver disease versus those with cardiovascular disease and/or chronic obstructive pulmonary disease. Using a multivariable hurdle model, the study found that adults with chronic liver disease were significantly more likely to have any barriers to care (incident rate ratio, 1.12), but such a significant difference did not exist for the frequency of health care barriers. There was a dose-dependent relationship between likelihood of recurrent acute care use and prevalence of barriers to care. Inclusion of chronic liver disease as a high-risk group in future health policies that aim to improve access to care may help reduce challenges that persons with chronic liver disease encounter when seeking timely medical care and potentially reduce preventable acute care use. The second paper, "Identification of Hidden Phenotypes Using Self-Reported Barriers to Care to Predict Risk of Recurrent Hospitalization or Emergency Department Visits among Adults with Chronic Liver Disease in the United States," identified latent classes within the adult population with chronic liver disease using self-reported barriers to care and assessed each phenotype's likelihood of recurrent acute care use. The best fitting model to the data included four latent classes or phenotypes: minimal barriers, unaffordability, care delays, and inability to establish care. The study used a multivariable multinomial logistic regression model to identify likelihood of class membership. The unaffordability phenotype was significantly associated with younger age, fair or poor health, functional limitation due to health, and uninsurance. Membership in the care delays class was significantly associated with Hispanics, fair or poor health, and functional limitation due to health. The inability to establish care phenotype was significantly associated with younger age, female sex, functional limitation due to health, and non-private insurance. The inability to establish care group had the highest odds of recurrent acute care use, followed by the care delays and unaffordability groups. An emphasis on risk stratification using health care barriers can potentially help improve interventions that aim to reduce recurrent acute care use among adults with chronic liver disease, particularly for those who struggle to establish care.In summary, both chapters highlighted the prevalence of health care barriers and its association with recurrent acute care use for adults with chronic liver disease. Findings from the second chapter showed the consistent disparity in health care barriers for adults with chronic liver disease versus other chronic diseases and aimed to capture the attention of health policy makers to include chronic liver disease in future iterations of existing health policies or new programs that strive to improve outpatient care access to reduce preventable hospitalizations. The third chapter identified novel phenotypes of persons with chronic liver disease with different associated sociodemographic, health, and insurance characteristics and risks of recurrent acute care use. The third chapter also introduced the concept of using self-reported barriers to care as a way to risk stratify and allocate resources to the most vulnerable individuals with chronic liver disease. Both chapters intend to help improve health care access, reduce preventable acute care use, and potentially improve the morbidity and mortality trends among adults with chronic liver disease in the United States.

Pathways to poor health outcomes for children of low income teen mothers

Liberatos, Penny Columbia University 2007 해외박사(DDOD)

Background. Child-bearing during adolescence is a serious social and public health concern with well-documented negative consequences for adolescent mothers and their children. Two causal hypotheses have been proposed to explain negative health consequences for offspring: (1) parenting: young maternal age and suboptimal parenting behaviors; and (2) social factors: social/family characteristics (e.g., poverty, single parenthood, low education, stress). Purpose. To identify and assess variables and causal pathways that influence the health of children of adolescent mothers and to evaluate the two causal hypotheses above. Methods. Subjects were 162 predominantly African-American and Latino adolescent mother-child dyads from low-income families receiving care from mainly publicly-funded facilities in New York City. Interviews were conducted with mothers about their health and that of their child. Pediatricians conducted medical examinations of the children (ages 12-48 months). The Notre Dame Parenting Project model of adolescent parenting was modified and expanded to focus more broadly on child health. Relationships among constructs in the revised model (i.e., stress, social support, maternal health, parenting) and their role in affecting child health outcomes were explored. Causal pathways supporting the influence of the social factors and parenting hypotheses on these outcomes were compared. Direct and indirect effects of model constructs were identified through a series of multivariate linear models organized sequentially using an approach by Alwin and Hauser (1975). Results. Key findings: (1) stress played an important role influencing the mother's and child's health both directly and indirectly; (2) role of social support was independent of stress and inconsistent, especially from the grandmother and child's father; and (3) education and poverty both influenced the mother's parenting behaviors and child health. Overall, findings showed that model constructs play an important role in child health. Comparison of pathways for the two causal hypotheses showed that both made an almost equal contribution in explaining child health outcomes. Conclusion. This study has combined the disciplines of public health and developmental psychology to address a serious public health issue. Future work can focus more closely on the pathways identified to gain a better understanding of the determinants of child health for offspring of adolescent mothers.

Enumeration and health-related characteristics of hired farm workers in Cherokee County, Texas

Cooper, Cheryl Maureen Texas Woman's University 2005 해외박사(DDOD)

Hired farm workers are among the most vulnerable persons living in the United States. Because they are often recent, undocumented immigrants, who do not speak English, it is difficult to obtain accurate counts of their numbers, and to understand their health risks. After the publication of a 1997--98 enumeration of migrant/seasonal farm workers, in Cherokee County, East Texas, several community professionals expressed doubt that the study reflected the "real" numbers, and expressed a need for an enumeration of all hired farm workers in the county. The apparent undercount of the migrant/seasonal group, and lack of information about total numbers of hired farm workers, and their health risks, was seen as an obstacle to health care planning and to obtaining outside funding. This broad exploratory study was conducted to address the apparent undercount and to address the knowledge gap related to farm worker health. During 2003--04, 78 interviews were conducted with employers of farm workers and with others knowledgeable about this population, in an attempt to obtain an accurate estimate of their current numbers, and to obtain perspectives about their health. Other resources, which involved direct counting of greenhouses and workers, examining school and county records, and data from the U.S. Department of Agriculture, were used to validate the findings. A second component of this study, drawn from a larger study---the East Farm Worker Health and Safety Survey (ETFHSS), involved the analysis of selected health characteristics of farm workers in East Texas, including Cherokee County. The enumeration study indicated that more seasonal and fewer migrant workers were employed in the county, than indicated in the 1997--98 study, and that employers generally perceived the workers as "young healthy people," without any particular health problems. Selected data from the ETFHS study indicated that a majority of the study participants perceived themselves to be in good health, lacked health insurance, experienced obesity at levels similar to the U.S. population, and that several had a strong family history of diabetes. Overall, this study affirms the difficulty in counting farm workers, emphasizes some of the problems related to current definitions used in farm worker research, and provides some information on the health status of this population in East Texas.

Periodontitis and three lifestyle characteristics: Obesity, diet quality and physical activity

Al-Zahrani, Mohammad Salem Case Western Reserve University (Health Sciences) 2004 해외박사(DDOD)

Obesity, diet quality and physical activity are three lifestyle characteristics known to be associated with the risk for several chronic diseases such as coronary heart disease and diabetes. The relation of these characteristics and periodontitis, another chronic condition, is not thoroughly examined. The overall goal of the present study is to examine the relation between the three lifestyle characteristics (obesity, diet quality and physical activity) and periodontitis. A subset of the third National Health and Nutrition Examination Survey data was used. Analytic approaches included descriptive statistics and multivariate logistic regression analyses. Sociodemographic and established risk factors for periodontitis were evaluated as potential confounders and/or effect modifiers. In the multivariate model, obesity (as measured by body mass index or waist circumference) was associated with higher prevalence of periodontitis among individuals 18--34 years of age but not among older individuals (35--90). Independent of sociodemographics, obesity, physical activity and established risk factor for periodontitis, good overall diet quality (i.e. healthy eating index >80) was associated with lower periodontitis prevalence among Non-Hispanic Whites (p < 0.001) and Mexican American (p = 0.092) who were never smokers. Among Non-Hispanic Blacks or ever smokers, such an association was not significant. Long-term physical activity (for at least 10 years) was significantly associated with lower periodontitis prevalence among never and former smokers (controlling for sociodemographics, obesity, diet quality and established risk factor for periodontitis), whereas among current smokers the association was not significant. The increase in the number of health enhancing characteristics (maintaining normal weight, eating healthy food and engaging in the recommended level of exercise) was significantly associated with lower periodontitis prevalence, independent of sociodemographics and established risk factor for periodontitis. Collectively, the present findings support strong association between the three studied lifestyle characteristics (obesity, diet quality and physical activity) and periodontitis. Confirming these results in longitudinal and/or randomized clinical trials is needed. Additionally, dental health professionals are encouraged to promote health-enhancing characteristics (e.g. maintaining normal weight, eating healthy food and engaging in the recommended level of exercise) for improving overall health and possibly periodontal health as well.

Predictors of Health-related Quality of Life of Adults with Heart Failure

Simms, Susan E University of Pittsburgh 2013 해외박사(DDOD)

Background: Heart failure patients experience low health-related quality of life and poor health outcomes. Objective: The purpose of this study was to examine interrelationships among and predictors of health-related quality of life of adults with heart failure. Methods: This cross-sectional secondary analysis of 161 older (M=56.09 years +/- 11.74), white (93.2%), male (69.6%) heart failure patients was prescribed angiotensin converting enzyme inhibitors and used electronic Medication Event Monitoring System. Ejection fraction, comorbid conditions, vitality, age, gender, income, prescription insurance, social support (appraisal, belonging, self-esteem, and tangible support by Interpersonal Support Evaluation List), medication regimen (number of prescribed medications and times per day medication is prescribed), medication adherence (days adherence and on-time adherence), general health perceptions, and health-related quality of life (Short Form-36 physical and mental component scores) were analyzed by simple and multiple linear regression. Results: Vitality was positively associated with mental (p=<.001) and physical (p=<.001) component scores of health-related quality of life. Females (p=.033) and those with prescription insurance (p=.032) had decreased mental component scores, while on-time adherence (p=.043) was positively associated with mental component scores. Greater number of prescribed medications (p=.038) was associated with decreased physical component scores, while increased general health perceptions (p<.001) were associated with increased physical component scores. More comorbid conditions (p=.024) and increased social support (appraisal, p=.016) were associated with decreased vitality, whereas increased social support (self-esteem, p=.035) was associated with increased vitality. Higher income (p=.023) was associated with increased days adherence. Greater number of times per day medication is prescribed (p=.002) was associated with decreased on-time adherence, and higher ejection fraction (p=.032) was associated with increased on-time adherence. Vitality (p<.001) was positively associated with general health perceptions. Conclusions: Interventions that incorporate these variables may reduce negative impacts on health-related quality of life and improve health outcomes in heart failure patients.

The importance of time and place: Neighborhoods and health throughout the life course

Jokinen-Gordon, Hanna The Florida State University 2014 해외박사(DDOD)

This research contributes to medical sociology, neighborhood research, and life course studies by synthesizing relevant concepts from each field in order to offer a more complete understanding of how and why place impacts health. This achieved through the use of a life course framework that examines the influence of neighborhoods on self-rated health and allostatic load from adolescence through the transition into adulthood using a longitudinal, nationally representative data set that includes detailed information on early life health, as well as detailed data regarding adult health and well-being. Specifically, this dissertation contributes to the aforementioned by examining the following questions: 1) What are the effects of neighborhood structural characteristics on two measures of physical health at three different time points and 2) What mediating mechanisms account for their effects? The findings of this research further bolster existing evidence regarding the importance of the neighborhood environment for physical health. However, the results also extend the existing knowledge base in important ways. This work demonstrates that neighborhood structural characteristics, measured as disadvantage, affluence, and immigrant concentration, influence both subjective and objective measures of physical health at multiple points throughout the life course. Health outcomes such as allostatic load, self-rated health, and mean health are sensitive to compositional structural attributes of the community environment, but there are differences in which aspects of place matter most, the timing of the neighborhood effects, as well as differences in the way that traditional identified mediating mechanisms operate.

Teaching preventive mental health skills to functional college students: A comparison of three classroom-based interventions

Brown, Stephen L University of Maryland College Park 2001 해외박사(DDOD)

Mental illness, especially anxiety and depression, causes lower individual and national productivity and has become a major public health concern. This suffering and expense is a tragedy since research clearly demonstrates the efficacy of the treatments currently available. Leading mental health groups are calling for more emphasis for: removing stigmas associated with mental illness, researching and delivering preventive measures, and improving access to effective treatments. Small-group educational approaches may partially fill these therapy gaps. Unfortunately, research regarding such preventative interventions has been scarce. This is partially due to the commonly held belief that psychological skills can be effectively taught only by licensed counselors. However, Albert Ellis and others argue that these skills can and should be taught by trained educators. The college classroom may provide an ideal setting for teaching preventive mental health skills. This study examined the degree to which three different classroom-based interventions lowered reported symptoms of anxiety and depression and increased reported self-esteem. The groups consisted of all willing participants in one of three college courses: a mental health skills course [MENTAL] (n = 27), a conventional stress management course [STRESS] (n = 72), and a non-stress or mental health-related course, death education [CONTROL] (n = 92). High internal-consistency reliability was observed for all the measures used in the study. The three groups were found to be statistically equivalent on all but two demographic variables: GRADE LEVEL and TIME WORKING, which were slightly higher for the groups drawn from 400 level classes. Analysis of Covariance showed significant differences between the MENTAL group and the CONTROL group on the anxiety measure and one of two depression measures. Significant differences were also observed between the MENTAL group and the STRESS group on the same measures plus a self-esteem measure. Although the effects in this study were small to moderate, the intervention used in the MENTAL group appears to hold some promise as a cost-effective strategy for primary prevention of mild to moderate mental health problems. Further research should use more rigorous design, employ longer follow-up, and attempt to isolate which components or skills in the intervention are the most powerful.

Our Health Counts -- Unmasking Health and Social Disparities among Urban Aboriginal People in Ontario

Firestone, Michelle University of Toronto (Canada) 2013 해외박사(DDOD)

In Canada, accessible and culturally relevant population health data for urban First Nations, Metis and Inuit people are almost non-existent. There is a need for Aboriginal community centric research and data systems, specifically in the area of mental health and substance misuse. The goal of this research was to address these knowledge gaps. The three linked studies being presented were nested in the Our Health Counts (OHC) project, a multi-partnership study aimed at developing a baseline population health database for urban Aboriginal people living in Ontario. In the first study, concept mapping was used to engage urban Aboriginal stakeholders from three culturally diverse communities in identifying health priorities. After completing brainstorming, sorting and rating, and map interpretation sessions, three unique community specific maps emerged. Map clusters and their ratings reflected First Nations, Inuit, and Metis understandings of health. Concept mapping encouraged community participation and informed the development of three health assessment surveys. The second study generated a representative sample of First Nations adults and children living in Hamilton, Ontario by utilizing Respondent Driven Sampling (RDS), a modified chain-referral sampling approach. Population estimates were generated for household and personal income, mobility, over-crowding and food availability. Results revealed striking disparities in social determinants of health between First Nations and the general population. The third study used the RDS generated sample to examine mental health and substance misuse among First Nations adults living in Hamilton. Prevalence estimates were generated for diagnosis and treatment of a mental illness, depression, anxiety, post-traumatic stress disorder (PTSD), suicide, alcohol and substance misuse, and access to emotional supports. Findings indicated that First Nations adults living in Hamilton experience a disproportionate burden of mental health and substance misuse challenges. The three linked studies make innovative contributions to Aboriginal health research. Results clearly exemplify the effective application of community-based research methods that are grounded in local knowledge and built on existing community strengths and capacities. Representative population health data for urban First Nations will contribute to current deficiencies in health information; will shape policy and programming priorities as well as future research directions, particularly with respect to health and social disparities among this population.

African American pastors' perceptions of their congregants' mental health needs

Vassol, Elverta L Kansas State University 2005 해외박사(DDOD)

The purpose of this study was to examine the factors that influenced African American pastors' perceptions of mental health issues and to explore how those perceptions influenced the propensity of the pastor to counsel, consult, and or refer to mental health professionals. This study is divided into two parts. Part one examines the perceptions of the pastors and their beliefs about mental health. Part two concretized these perceptions by employing the Contextual Model of Family Stress as a guide for structuring the relationships between a pastor's perception and their attitudes toward mental health issues. Data for this investigation were gathered from a sub-sample of African American pastors originally generated from a listing of churches throughout the country. Initially, 300 locally based institutions were identified. A survey was mailed to the churches explaining the purpose and goals of the study. Nearly one-third of the pastors completed the sixty-one item questionnaire. Of those who returned the original questionnaires (102), nearly three-quarters were from African American pastors (73) all of whom were included in this study. There were four hypotheses developed for this exploratory investigation: they examined the pastor's propensity to make mental health referrals; the tendency to spiritualize mental health issues; pastor's lack of support for congregants with mental health problems; and the influence of mental health training on the willingness to refer to mental health professionals. None of the hypotheses were directly supported. The application and adaptation of the Contextual Model of Family Stress to how African American pastors perceived, utilized, and responded to mental health issues was explored via path analysis. Overall, the final model explained 39% of the variance in why pastors chose to make referrals to mental health professionals. The findings suggested that the African American pastors are concerned with the mental health of their congregants. Moreover, these pastors exhibited uncommon knowledge about mental health and displayed greater willingness to work with mental health professionals than originally believed. These findings reveal that African American pastors are in touch with their congregants on multiple plains---spiritual, soul, and body---three vital dimensions, according to church doctrines and beliefs.