Vulnerable Populations

A Qualitative Study of Patients’ Attitudes toward HIV Testing in the Dental Setting

A Qualitative Study of Patients’ Attitudes toward HIV Testing in the Dental Setting
Nursing Research and Practice, vol. 2012, Article ID 803169, 6 pages, 2012. doi:10.1155/2012/803169

Van Devanter, N., J. Combellick, M.K. Hutchinson, J. Phelan, D. Malamud, and D. Shelley
01/01/2012

An estimated 1.1 million people in the USA are living with HIV/AIDS. Nearly 200,000 of these individuals do not know that they are infected. In 2006, the CDC recommended that all healthcare providers routinely offer HIV screening to adolescent and adult patients. Nurse-dentist collaborations present unique opportunities to provide rapid oral HIV screening to patients in dental clinic settings and reach the many adults who lack primary medical providers. However, little is known about the feasibility and acceptability of this type of innovative practice. Thus, elicitation research was undertaken with dental providers, students, and patients. This paper reports the results of qualitative interviews with 19 adults attending a university-based dental clinic in New York City. Overall, patients held very positive attitudes and beliefs toward HIV screening in dental sites and identified important factors that should be incorporated into the design of nurse-dentist collaborative HIV screening programs.

Trajectories of cognitive decline over 10 years in a Brazilian elderly population: the Bambuí Cohort Study of Aging

Trajectories of cognitive decline over 10 years in a Brazilian elderly population: the Bambuí Cohort Study of Aging
Cadernos de Saude Publica, Vol. 27, supp. 3. 10.1590/S0102-311X2011001500003

Macinko, J., V. Camargos, J.O.A. Firmo, and M.F. Lima Costa
12/01/2011

We use data from a population-based cohort of elderly Brazilians to assess predictors of hospitalizations during ten years of follow-up. Participants were 1,448 persons aged 60 years and over at baseline (1997). The outcome was self-reported number of hospitalizations per year. Slightly more than a fifth (23%) experienced no hospitalizations during the 10 year follow-up. About 30% had 1-2 events, 31% had between 3 and 7 events, and about 18% had 8 or more events during this time. Results of multivariable hurdle and Cox proportional hazards models showed that the risk of hospitalization was positively associated with male sex, increased age, chronic conditions, and visits to the doctors in the previous 12 months. Underweight was a predictor of any hospitalization, while obesity was an inconsistent predictor of hospitalization.

Integrated delivery of HIV and tuberculosis services in sub-Saharan Africa: a systematic review

Integrated delivery of HIV and tuberculosis services in sub-Saharan Africa: a systematic review
The Lancet Infectious Diseases, Vol. 11, no. 11. 10.1016/S1473-3099(11)70145-1

Uyei, J., D. Coetzee, J. Macinko, and S. Guttmacher
11/01/2011

Tuberculosis is a major cause of morbidity and mortality in people with HIV and about a quarter of HIV-related deaths are attributed to tuberculosis. In this Review we identify and synthesise published evidence for the effectiveness and cost-effectiveness of eight integrated strategies recommended by WHO that represent coordinated delivery of HIV and tuberculosis services. Evidence supports concurrent screening for tuberculosis and HIV, and provision of either co-trimoxazole during routine tuberculosis care or isoniazid during routine HIV care and at voluntary counselling and testing centres. Although integration of antiretroviral therapy into tuberculosis care has shown promise for improving health outcomes for patients, evidence is insufficient to make conclusive claims. Evidence is also insufficient on the accessibility of condoms at tuberculosis facilities, the benefits of risk reduction counselling in patients with tuberculosis, and the effectiveness of tuberculosis infection control in HIV health-care settings. The vertical response to the tuberculosis and HIV epidemics is ineffective and inefficient. Implications for policy makers and funders include further investments in implementing integrated tuberculosis and HIV programmes with known effectiveness, preferably in a way that strengthens health systems; evaluative research that identifies barriers to integration; and research on integrated strategies for which effectiveness, efficiency, and affordability are not well established.

An Intervention to Improve Care and Reduce Costs for High Risk Patients with Frequent Health Services Use

An Intervention to Improve Care and Reduce Costs for High Risk Patients with Frequent Health Services Use
BMC Health Serv Res. 2011; 11: 270.

Maria C Raven, Kelly M Doran, Shannon Kostrowski, Colleen C Gillespie and Brian D Elbel
10/13/2011

Background

A small percentage of high-risk patients accounts for a large proportion of Medicaid spending in the United States, which has become an urgent policy issue. Our objective was to pilot a novel patient-centered intervention for high-risk patients with frequent hospital admissions to determine its potential to improve care and reduce costs.

Methods

Community and hospital-based care management and coordination intervention with pre-post analysis of health care utilization. We enrolled Medicaid fee-for-service patients aged 18-64 who were admitted to an urban public hospital and identified as being at high risk for hospital readmission by a validated predictive algorithm. Enrolled patients were evaluated using qualitative and quantitative interview techniques to identify needs such as transportation to/advocacy during medical appointments, mental health/substance use treatment, and home visits. A community housing partner initiated housing applications in-hospital for homeless patients. Care managers facilitated appropriate discharge plans then worked closely with patients in the community using a harm reduction approach.

Results

Nineteen patients were enrolled; all were male, 18/19 were substance users, and 17/19 were homeless. Patients had a total of 64 inpatient admissions in the 12 months before the intervention, versus 40 in the following 12 months, a 37.5% reduction. Most patients (73.3%) had fewer inpatient admissions in the year after the intervention compared to the prior year. Overall ED visits also decreased after study enrollment, while outpatient clinic visits increased. Yearly study hospital Medicaid reimbursements fell an average of $16,383 per patient.

Conclusions

A pilot intervention for high-cost patients shows promising results for health services usage. We are currently expanding our model to serve more patients at additional hospitals to see if the pilot's success can be replicated.

Evaluation of Community-Academic Partnership Functioning: Center for the Elimination of Hepatitis B Health Disparities

Evaluation of Community-Academic Partnership Functioning: Center for the Elimination of Hepatitis B Health Disparities
Progress in Community Health Partnerships: Research, Education, and Action, 5(3), 219. 10.1353/cpr.2011.0043.

Van Devanter, N., S. Kwon, S.C. Sim, K. Chun, and C. Trinh-Shevrin
09/01/2011

To conduct a process evaluation using surveys and interviews of the B Free CEED partnership coalition, a community–academic partnership created to address hepatitis health disparities in Asian American and Pacific Islander communities

Credit is Not a Right

Credit is Not a Right

Gershman, John and Jonathan Morduch.
01/01/2011

Is credit a human right? Muhammad Yunus, the most visible leader of a global movement to provide microcredit to world’s poor, says it should be. NYU’s John Gershman and FAI’s Jonathan Morduch disagree. In their new paper, Credit is Not a Right, they ask whether a rights-based approach to microcredit will in fact be effective in making quality, affordable credit more available to poor families – and, more importantly, whether it is a constructive step in terms of the broader goal of global poverty reduction. Jonathan Morduch argues his case in this video.

A School-Randomized Clinical Trial of an Integrated Social-Emotional Learning and Literacy Intervention: Impacts on Third-Grade Outcomes

A School-Randomized Clinical Trial of an Integrated Social-Emotional Learning and Literacy Intervention: Impacts on Third-Grade Outcomes
Journal of Consulting and Clinical Psychology, 78(6): 829-842

Jones, S.M., Brown, J.L, Hoglund, W.L.G., & J.L. Aber.
12/01/2010

Objective: To report experimental impacts of a universal, integrated school-based intervention in social–emotional learning and literacy development on change over 1 school year in 3rd-grade children's social–emotional, behavioral, and academic outcomes. Method: This study employed a school-randomized, experimental design and included 942 3rd-grade children (49% boys; 45.6% Hispanic/Latino, 41.1% Black/African American, 4.7% non-Hispanic White, and 8.6% other racial/ethnic groups, including Asian, Pacific Islander, Native American) in 18 New York City public elementary schools. Data on children's social–cognitive processes (e.g., hostile attribution biases), behavioral symptomatology (e.g., conduct problems), and literacy skills and academic achievement (e.g., reading achievement) were collected in the fall and spring of 1 school year. Results: There were main effects of the 4Rs Program after 1 year on only 2 of the 13 outcomes examined. These include children's self-reports of hostile attributional biases (Cohen's d = 0.20) and depression ( d = 0.24). As expected based on program and developmental theory, there were impacts of the intervention for those children identified by teachers at baseline with the highest levels of aggression ( d = 0.32–0.59) on 4 other outcomes: children's self-reports of aggressive fantasies, teacher reports of academic skills, reading achievement scaled scores, and children's attendance. Conclusions: This report of effects of the 4Rs intervention on individual children across domains of functioning after 1 school year represents an important first step in establishing a better understanding of what is achievable by a schoolwide intervention such as the 4Rs in its earliest stages of unfolding. The first-year impacts, combined with our knowledge of sustained and expanded effects after a second year, provide evidence that this intervention may be initiating positive developmental cascades both in the general population of students and among those at highest behavioral risk.

At Rope’s End: Single Women Mothers, Wealth and Asset Accumulation in the United States

At Rope’s End: Single Women Mothers, Wealth and Asset Accumulation in the United States

Mariko Chang, PhD and C. Nicole Mason, PhD
10/01/2010

A commissioned report for the Opportunity Series of the Women of Color Policy Network, this report examines the economic security and vulnerability of single mothers through the lens of wealth and asset accumulation as opposed to income and employment.

“You fix my community, you have fixed my life”: The disruption and rebuilding of ontological security in New Orleans

“You fix my community, you have fixed my life”: The disruption and rebuilding of ontological security in New Orleans
Disasters: Journal of Policy & Management, 35(1), 143 – 159.

Hawkins, R. L. & Maurer, K.
08/23/2010

Using the concept of ontological security, this paper examines the physical and psychological loss of home and community following Hurricane Katrina. This qualitative longitudinal study includes 40 heads of households with school-age children who lived in New Orleans during Hurricane Katrina. Participants describe a breakdown in their social fabric at the individual and structural/community levels that contributes to a sense of community loss and social displacement, disrupting their ontological security--their notion of safety, routine and trust in a stable environment. Three interrelated reactions were common: 1) experiencing nostalgia for their old neighbourhoods specifically and New Orleans in general; 2) experiencing a sense of loss of people and things that represented a level of security or constancy; 3) initiation of a process for re-establishing ontological security whether or not they returned to New Orleans. The paper concludes that intangible losses have an important psychological effect on community redevelopment and recovery from trauma.

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