Does rapid urbanization aggravate health disparities? Reflections on the epidemiological transition in Pune, India

Background: Rapid urbanization in low- and middle-income countries reinforces risk and epidemiological transition in urban societies, which are characterized by high socioeconomic gradients. Limited availability of disaggregated morbidity data in these settings impedes research on epidemiological profiles of different population subgroups. Objective: The study aimed to analyze the epidemiological transition in the emerging megacity of Pune with respect to changing morbidity and mortality patterns, also taking into consideration health disparities among different socioeconomic groups. Design: A mixed-methods approach was used, comprising secondary analysis of mortality data, a survey among 900 households in six neighborhoods with different socioeconomic profiles, 46 in-depth interviews with laypeople, and expert interviews with 37 health care providers and 22 other health care workers. Results: The mortality data account for an epidemiological transition with an increasing number of deaths due to non-communicable diseases (NCDs) in Pune. The share of deaths due to infectious and parasitic diseases remained nearly constant, though the cause of deaths changed considerably within this group. The survey data and expert interviews indicated a slightly higher prevalence of diabetes and hypertension among higher socioeconomic groups, but a higher incidence and more frequent complications and comorbidities in lower socioeconomic groups. Although the self-reported morbidity for malaria, gastroenteritis, and tuberculosis did not show a socioeconomic pattern, experts estimated the prevalence in lower socioeconomic groups to be higher, though all groups in Pune would be affected. Conclusions: The rising burden of NCDs among all socioeconomic groups and the concurrent persistence of communicable diseases pose a major challenge for public health. Improvement of urban health requires a stronger focus on health promotion and disease prevention for all socioeconomic groups with a holistic understanding of urban health. In order to derive evidence-based solutions and interventions, routine surveillance data become indispensable

Proceedings of the 39th Annual Scientific Conference of The Association of Public Health Physicians of Nigeria

No Abstract

Transforming medical equipment management in digital public health: a decision-making model for medical equipment replacement

IntroductionIn the rapidly evolving field of digital public health, effective management of medical equipment is critical to maintaining high standards of healthcare service levels and operational efficiency. However, current decisions to replace large medical equipment are often based on subjective judgments rather than objective analyses and lack a standardized approach. This study proposes a multi-criteria decision-making model that aims to simplify and enhance the medical equipment replacement process.MethodsThe researchers developed a multi-criteria decision-making model specifically for the replacement of medical equipment. The model establishes a system of indicators for prioritizing and evaluating the replacement of large medical equipment, utilizing game theory to assign appropriate weights, which uniquely combines the weights of the COWA and PCA method. In addition, which uses the GRA method in combination with the TOPSIS method for a more comprehensive decision-making model.ResultsThe study validates the model by using the MRI equipment of a tertiary hospital as an example. The results of the study show that the model is effective in prioritizing the most optimal updates to the equipment. Significantly, the model shown a higher level of differentiation compared to the GRA and TOPSIS methods alone.DiscussionThe present study shows that the multi-criteria decision-making model presented provides a powerful and accurate tool for optimizing decisions related to the replacement of large medical equipment. By solving the key challenges in this area as well as giving a solid basis for decision making, the model makes significant progress toward the field of management of medical equipment

The Fair Labor Standards Act Exemptions and the Pharmaceuticals Industry: Are Sales Representatives Entitled to Overtime?

This article discusses the battle in the courts as to whether highly compensated pharmaceutical sales representatives are entitled to overtime pay under the Fair Labor Standards Act, or whether they are excluded from such an entitlement under one or more of the Act’s “exemptions.” This article also conducts a review of the courts’ various conflicting positions and charts a course for addressing the issue before the Courts of Appeals and ultimately the Supreme Court

Mediation and Moderation of Intergenerational Epigenetic Effects of Trauma

Trauma and early-life stress have been linked to poor mental and physical health outcomes. In fact, research has identified trauma and stress can influence epigenetic marks on genes that can alter gene activity. It is suspected that epigenetically altered gene activity is involved in behavior and mental health. This may help explain why some individuals don’t experience great benefit from treatment for the effects of stress, and severe mental health symptoms can be chronic for decades or a lifetime. Moreover, some trauma-related mental health symptoms have shown generational patterns that appear linked to epigenetic marks. Therefore, this study sought to investigate the potential inter-generational influence of mother’s trauma history and mental health on her offspring’s DNA methylation and gene expression in umbilical cord blood. Standardized measures were used to assess mother’s trauma history and cumulative experienced fear (TLEQ), as well as mother’s mental health status during pregnancy (BSI). Genome-wide and candidate gene analyses were conducted after standard quality control data cleaning procedures. Batch and chip adjustments were made using the Combat package in R software, and the False Discovery Rate was employed to control for multiple comparisons. Results indicate mother’s exposure to trauma in childhood predicts DNA methylation and gene expression in offspring. Additionally, mother’s mental health status during pregnancy significantly predicts differential gene expression on 245 genes in males only. Finally, mother’s fear completely mediates the influence of trauma on her mental health functioning. In conclusion, a mother’s traumatic experience has potential to influence gene regulation in her offspring. Most importantly, mother’s mental health during pregnancy appears to exert a great influence on gene regulation in males compared to female offspring

Implementation of a School-Based Sexual Health Curriculum for Fayette County, Kentucky Public Schools

Adolescents in the United States are vulnerable to negative sexual health outcomes such as unplanned pregnancy and sexually transmitted infections (STIs) due to a high prevalence of risky sexual behaviors in this population. Research demonstrates that providing adolescents with comprehensive sexuality education that addresses sexual health knowledge, attitudes, and behaviors can increase protective behaviors, such as condom use and decrease negative health outcomes over the long term. Implementing a comprehensive sexuality education program in a public school setting is an effective strategy to reach a large number of adolescents and targeting early adolescents can influence student sexual health knowledge, attitudes, and behaviors before most students initiate sexual activity. Therefore, we plan to implement a school-based comprehensive sexuality education program in all 7th grade health classrooms in the Fayette County, Kentucky public school system. The University of Kentucky Department of Adolescent Medicine will partner with the Fayette County Public School System to build their capacity to deliver the HealthSmart middle school curriculum “HIV, STI, & Pregnancy Prevention”, an evidence-based comprehensive health education program. Community stakeholders including local school administrators, teachers, parents, adolescents, and community organizations that serve adolescents will assist in planning and monitoring the program through an Adolescent Health Advisory Board. We will evaluate clinical outcomes of the program using a pretest/posttest design to identify changes in students’ sexual health knowledge, attitudes, and behaviors. We will also evaluate implementation outcomes including program fidelity, reach, dose delivered, dose received, and barriers & facilitators to implementation to identify key successes and to continuously improve the program

Would You Know What to Do? A framework for thinking about design ethics developed in response to the creation of a digital tool that facilitates end-of-life decsion making.

Master of DesignArt and DesignUniversity of Michiganhttp://deepblue.lib.umich.edu/bitstream/2027.42/156118/1/DeepBlue_Keelean_2018_Mdes_Thesis.pd

Risk-based maintenance of critical and complex systems

Tableau d’honneur de la Faculté des études supérieures et postdoctorales, 2016-2017.De nos jours, la plupart des systèmes dans divers secteurs critiques tels que l'aviation, le pétrole et les soins de santé sont devenus très complexes et dynamiques, et par conséquent peuvent à tout moment s'arrêter de fonctionner. Pour éviter que cela ne se reproduise et ne devienne incontrôlable ce qui engagera des pertes énormes en matière de coûts et d'indisponibilité; l'adoption de stratégies de contrôle et de maintenance s'avèrent plus que nécessaire et même vitale. Dans le génie des procédés, les stratégies optimales de maintenance pour ces systèmes pourraient avoir un impact significatif sur la réduction des coûts et sur les temps d'arrêt, sur la maximisation de la fiabilité et de la productivité, sur l'amélioration de la qualité et enfin pour atteindre les objectifs souhaités des compagnies. En outre, les risques et les incertitudes associés à ces systèmes sont souvent composés de plusieurs relations de cause à effet de façon extrêmement complexe. Cela pourrait mener à une augmentation du nombre de défaillances de ces systèmes. Par conséquent, un outil d'analyse de défaillance avancée est nécessaire pour considérer les interactions complexes de défaillance des composants dans les différentes phases du cycle de vie du produit pour assurer les niveaux élevés de sécurité et de fiabilité. Dans cette thèse, on aborde dans un premier temps les lacunes des méthodes d'analyse des risques/échec et celles qui permettent la sélection d'une classe de stratégie de maintenance à adopter. Nous développons ensuite des approches globales pour la maintenance et l'analyse du processus de défaillance fondée sur les risques des systèmes et machines complexes connus pour être utilisées dans toutes les industries. Les recherches menées pour la concrétisation de cette thèse ont donné lieu à douze contributions importantes qui se résument comme suit: Dans la première contribution, on aborde les insuffisances des méthodes en cours de sélection de la stratégie de maintenance et on développe un cadre fondé sur les risques en utilisant des méthodes dites du processus de hiérarchie analytique (Analytical Hierarchy Process (AHP), de cartes cognitives floues (Fuzzy Cognitive Maps (FCM)), et la théorie des ensembles flous (Fuzzy Soft Sets (FSS)) pour sélectionner la meilleure politique de maintenance tout en considérant les incertitudes. La deuxième contribution aborde les insuffisances de la méthode de l'analyse des modes de défaillance, de leurs effets et de leur criticité (AMDEC) et son amélioration en utilisant un modèle AMDEC basée sur les FCM. Les contributions 3 et 4, proposent deux outils de modélisation dynamique des risques et d'évaluation à l'aide de la FCM pour faire face aux risques de l'externalisation de la maintenance et des réseaux de collaboration. Ensuite, on étend les outils développés et nous proposons un outil d'aide à la décision avancée pour prédire l'impact de chaque risque sur les autres risques ou sur la performance du système en utilisant la FCM (contribution 5).Dans la sixième contribution, on aborde les risques associés à la maintenance dans le cadre des ERP (Enterprise Resource Planning (ERP)) et on propose une autre approche intégrée basée sur la méthode AMDEC floue pour la priorisation des risques. Dans les contributions 7, 8, 9 et 10, on effectue une revue de la littérature concernant la maintenance basée sur les risques des dispositifs médicaux, puisque ces appareils sont devenus très complexes et sophistiqués et l'application de modèles de maintenance et d'optimisation pour eux est assez nouvelle. Ensuite, on développe trois cadres intégrés pour la planification de la maintenance et le remplacement de dispositifs médicaux axée sur les risques. Outre les contributions ci-dessus, et comme étude de cas, nous avons réalisé un projet intitulé “Mise à jour de guide de pratique clinique (GPC) qui est un cadre axé sur les priorités pour la mise à jour des guides de pratique cliniques existantes” au centre interdisciplinaire de recherche en réadaptation et intégration sociale du Québec (CIRRIS). Nos travaux au sein du CIRRIS ont amené à deux importantes contributions. Dans ces deux contributions (11e et 12e) nous avons effectué un examen systématique de la littérature pour identifier les critères potentiels de mise à jour des GPCs. Nous avons validé et pondéré les critères identifiés par un sondage international. Puis, sur la base des résultats de la onzième contribution, nous avons développé un cadre global axé sur les priorités pour les GPCs. Ceci est la première fois qu'une telle méthode quantitative a été proposée dans la littérature des guides de pratiques cliniques. L'évaluation et la priorisation des GPCs existants sur la base des critères validés peuvent favoriser l'acheminement des ressources limitées dans la mise à jour de GPCs qui sont les plus sensibles au changement, améliorant ainsi la qualité et la fiabilité des décisions de santé.Today, most systems in various critical sectors such as aviation, oil and health care have become very complex and dynamic, and consequently can at any time stop working. To prevent this from reoccurring and getting out of control which incur huge losses in terms of costs and downtime; the adoption of control and maintenance strategies are more than necessary and even vital. In process engineering, optimal maintenance strategies for these systems could have a significant impact on reducing costs and downtime, maximizing reliability and productivity, improving the quality and finally achieving the desired objectives of the companies. In addition, the risks and uncertainties associated with these systems are often composed of several extremely complex cause and effect relationships. This could lead to an increase in the number of failures of such systems. Therefore, an advanced failure analysis tool is needed to consider the complex interactions of components’ failures in the different phases of the product life cycle to ensure high levels of safety and reliability. In this thesis, we address the shortcomings of current failure/risk analysis and maintenance policy selection methods in the literature. Then, we develop comprehensive approaches to maintenance and failure analysis process based on the risks of complex systems and equipment which are applicable in all industries. The research conducted for the realization of this thesis has resulted in twelve important contributions, as follows: In the first contribution, we address the shortcomings of the current methods in selecting the optimum maintenance strategy and develop an integrated risk-based framework using Analytical Hierarchy Process (AHP), fuzzy Cognitive Maps (FCM), and fuzzy Soft set (FSS) tools to select the best maintenance policy by considering the uncertainties.The second contribution aims to address the shortcomings of traditional failure mode and effect analysis (FMEA) method and enhance it using a FCM-based FMEA model. Contributions 3 and 4, present two dynamic risk modeling and assessment tools using FCM for dealing with risks of outsourcing maintenance and collaborative networks. Then, we extend the developed tools and propose an advanced decision support tool for predicting the impact of each risk on the other risks or on the performance of system using FCM (contribution 5). In the sixth contribution, we address the associated risks in Enterprise Resource Planning (ERP) maintenance and we propose another integrated approach using fuzzy FMEA method for prioritizing the risks. In the contributions 7, 8, 9, and 10, we perform a literature review regarding the risk-based maintenance of medical devices, since these devices have become very complex and sophisticated and the application of maintenance and optimization models to them is fairly new. Then, we develop three integrated frameworks for risk-based maintenance and replacement planning of medical devices. In addition to above contributions, as a case study, we performed a project titled “Updating Clinical Practice Guidelines; a priority-based framework for updating existing guidelines” in CIRRIS which led to the two important contributions. In these two contributions (11th and 12th) we first performed a systematic literature review to identify potential criteria in updating CPGs. We validated and weighted the identified criteria through an international survey. Then, based on the results of the eleventh contribution, we developed a comprehensive priority-based framework for updating CPGs based on the approaches that we had already developed and applied success fully in other industries. This is the first time that such a quantitative method has been proposed in the literature of guidelines. Evaluation and prioritization of existing CPGs based on the validated criteria can promote channelling limited resources into updating CPGs that are most sensitive to change, thus improving the quality and reliability of healthcare decisions made based on current CPGs. Keywords: Risk-based maintenance, Maintenance strategy selection, FMEA, FCM, Medical devices, Clinical practice guidelines

The Emergent Logic of Health Law

The American health care system is on a glide path toward ruin. Health spending has become the fiscal equivalent of global warming, and the number of uninsured Americans is approaching fifty million. Can law help to divert our country from this path? There are reasons for deep skepticism. Law governs the provision and financing of medical care in fragmented and incoherent fashion. Commentators from diverse perspectives bemoan this chaos, casting it as an obstacle to change. I contend in this Article that pessimism about health law’s prospects is unjustified, but that a new understanding of health law’s disarray is urgently needed to guide reform. My core proposition is that the law of health care provision is best understood as an emergent system. Its contradictions and dysfunctions cannot be repaired by some master design. No one actor has a grand overview—or the power to impose a unifying vision. Countless market players, public planners, and legal and regulatory decisionmakers interact in oft-chaotic ways, clashing with, reinforcing, and adjusting to each other. Out of these interactions, a larger scheme emerges—one that incorporates the health sphere’s competing interests and values. Change in this system, for worse and for better, arises from the interplay between its myriad actors. By quitting the quest for a single, master design, we can better focus our efforts on possibilities for legal and policy change. We can and should continuously survey the landscape of stakeholders and expectations with an eye toward potential launching points for evolutionary processes—processes that leverage current institutions and incentives. What we cannot do is plan or predict these evolutionary pathways in precise detail; the complexity of interactions among market and government actors precludes fine-grained foresight of this sort. But we can determine the general direction of needed change, identify seemingly intractable obstacles, and envision ways to diminish or finesse them over time. Dysfunctional legal doctrines, interest group expectations, consumers’ anxieties, and embedded institutional and cultural barriers can all be dealt with in this way, in iterative fashion. This Article sets out a strategy for doing so. To illustrate this strategy, I suggest emergent approaches to the most urgent challenges in health care policy and law—the crises of access, value, and cost

Exploring perceptions, barriers, and facilitators of access to primary health services among African immigrant women in the U.S. : a study of Ethiopian immigrant women

Access to healthcare services remains a top public health concern in the United States and immigrants are disproportionately affected by low rates of health insurance coverage and poor access to healthcare services. It is reported that 23 percent of lawfully present immigrants and 45 percent of undocumented immigrants are uninsured as compared to the 8 percent of uninsured citizens. Particularly, immigrant women experience multiple barriers in accessing healthcare services and are at higher risk of health problems. Within the immigrant women population, African immigrant women have the lowest access and utilization of healthcare, a high rate of HIV and STDs, high rate of employment in unskilled labor that is hazardous and with no protection. However, African immigrant women remained understudied and underrepresented in the immigrant health literature. This study explored the perceptions, barriers, and facilitators experienced by African immigrant women in accessing primary healthcare (PHC) with a particular focus on Ethiopian immigrant women (EIW). A qualitative design with a phenomenological approach was conducted to investigate what challenges were experienced by EIW and how they experienced them. Data were collected using in-depth interviews with EIW (N=21) aged 18 and older (M=36.6) conducted both in-person and virtually via phone and Zoom. Interviews were audio-recorded and transcribed verbatim. Data were analyzed thematically using Nvivo12 software. Findings showed that the transition and adjustment into a new country and healthcare system delayed EIW's timely access to PHC services. EIW believe that PHC in the U.S. is of better quality but inaccessible. Compared to their past experiences, EIW started using annual general checks ups in the U.S. but tended to avoid PHC unless they are faced with severe health issues or had maternal care needs. Lack of trust in the PHC system that was underlined by personal barriers including contradictory health beliefs, language and communication, and limited health literacy hindered EIW's access to PHC. Findings demonstrated that structural barriers, mainly immigration status, unaffordability of PHC, complexity, and discrimination in healthcare impeded EIW's access to PHC. Social support and having a stable job were the two major facilitators to accessing PHC. The findings suggested that in addition to expanding customized health information, translation, maternal health, and affordable care services; it is imperative to make immigration policy reform, decolonize the PHC system and diversify the health workforce. As the first known study on EIW's PHC experience, the study highlighted the need to view access through a lens of everyday life struggles of immigrant women, investigate the lack of trust, and move toward a structural approach in understanding and addressing barriers to access among immigrant women.Includes bibliographical references