14,168 research outputs found
Needs Assessment for a Patient Centered Medical Home Model of Care at the Providence Alaska Cancer Center
Presented to the Faculty
of the University of Alaska Anchorage
in Partial Fulfillment of the Requirements
for the Degree of
MASTER OF PUBLIC HEALTHIn order to better understand the needs of cancer patients and allocate resources, the Providence Alaska Cancer Center requested a needs assessment for an oncology focused patient centered medical home (PCMH). A PCMH allows for coordinated and comprehensive care through the use of a teamwork model that centers on the primary care physician. The Providence Alaska Cancer Center staff randomly selected the records of 200 cancer patients between 2010 and 2011, using the cancer tumor registry. Data were analyzed to answer four specific questions that addressed the 1) presence of a Primary Care Physician (PCP), 2) number and type of comorbidities, 3) cancer diagnosis and 4) insurance status impacted emergency room utilization. Individuals tended to utilize the emergency room more if they 1) had a PCP, 2a) had three or more comorbidities, 2b) were diagnosed with hyperlipidemia, chronic obstructive pulmonary disease (COPD) or hypertension, 3) were diagnosed with an âotherâ cancer as opposed to breast, lung or gynecological cancers or 4) had federal insurance. These data in particular show expected trends such as patients who have more medical complications have higher emergency room utilization rates than patients with less complicated medical history and that certain comorbidities (hyperlipidemia, hypertension and chronic obstructive pulmonary disease) may be predictors of emergency room utilization. These trends may allow providers to create more specialized treatment and care plans for patients at greater risk of emergency room utilization.Signature Page / Title Page / Abstract / Table of Contents / List of Figures / List of Tables / List of Appendices / Introduction to Cancer and its Treatment / Introduction to the Patient Centered Medical Home Model / Treatment of Cancer in Alaska / Study Goals, Rationale, Research Questions and Hypotheses / Methods / Sample Demographics and Description / Results and Discussion / Strengths and Limitations / Future Directions / References / Appendice
Decoupling social status and status certainty effects on health in macaques: a network approach.
BackgroundAlthough a wealth of literature points to the importance of social factors on health, a detailed understanding of the complex interplay between social and biological systems is lacking. Social status is one aspect of social life that is made up of multiple structural (humans: income, education; animals: mating system, dominance rank) and relational components (perceived social status, dominance interactions). In a nonhuman primate model we use novel network techniques to decouple two components of social status, dominance rank (a commonly used measure of social status in animal models) and dominance certainty (the relative certainty vs. ambiguity of an individual's status), allowing for a more complex examination of how social status impacts health.MethodsBehavioral observations were conducted on three outdoor captive groups of rhesus macaques (N = 252 subjects). Subjects' general physical health (diarrhea) was assessed twice weekly, and blood was drawn once to assess biomarkers of inflammation (interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-α), and C-reactive protein (CRP)).ResultsDominance rank alone did not fully account for the complex way that social status exerted its effect on health. Instead, dominance certainty modified the impact of rank on biomarkers of inflammation. Specifically, high-ranked animals with more ambiguous status relationships had higher levels of inflammation than low-ranked animals, whereas little effect of rank was seen for animals with more certain status relationships. The impact of status on physical health was more straightforward: individuals with more ambiguous status relationships had more frequent diarrhea; there was marginal evidence that high-ranked animals had less frequent diarrhea.DiscussionSocial status has a complex and multi-faceted impact on individual health. Our work suggests an important role of uncertainty in one's social status in status-health research. This work also suggests that in order to fully explore the mechanisms for how social life influences health, more complex metrics of social systems and their dynamics are needed
Melancholia or Not; The Mysterious Differences in Depression : A Study of Pathophysiological Differences Between Depressive Subtypes â Findings from The Helsinki Birth Cohort Study
Depressive symptoms are behaviors and thought processes typical of
depression. These symptoms can be classified into subtypes of depressive
symptomatology based on established criteria. The depressive subtypes are
known to differ in their presentation, but much is still unknown about their
possible pathophysiologic differences.
This study aimed to shed light on some of the pathophysiologic
differences between melancholic and non-melancholic depressive symptoms.
The study utilized the Helsinki Birth Cohort Study population. Depressive
symptoms were determined based on subtyping developed from the criteria for
melancholia in the Diagnostic and Statistical Manual of Mental Disorders.
Advanced glycation end products, pulse wave velocity, body composition, and
mortality were analyzed for each subtype and compared.
Depressive symptoms were more common among women, were
associated with less physical activity, lower likelihood of cohabitation, and
lower likelihood of financial satisfaction. Comorbidities were also more
common among those with depressive symptoms. Subtypes differed in regard to
cholesterol, blood pressure, body mass index and fat mass.
It was shown that melancholic depressive symptoms are more closely
related to advanced glycation end products and mortality, whereas nonmelancholic
depressive symptoms are more closely related to pulse wave
velocity, body composition and impaired glucose regulation.
In conclusion, the depressive subtypes seemed to show differing
pathophysiology. This may suggest that the two subtypes represent differing
disease processes that present with similar symptomatology.Depressiva symptom Àr beteenden och tankeprocesser som Àr typiska för depression. Dessa symptom kan bli klassificerade att tillhöra olika subtyper av depression baserat pÄ etablerade kriterier. Dessa depressiva subtyper Àr kÀnda för att variera i sin presentation, men mycket Àr Ànnu okÀnt nÀr det kommer till patofysiologiska skillnader.
Denna studie har försökt visa nÄgra patofysiologiska skillnader mellan melankoliska och icke-melankoliska depressiva symptom. Studien anvÀnde sig av Helsingfors Födelsekohort Studiens (HBCS) deltagare. Depressiva symptom var avgjorda pÄ basen av subtyper som Àr fastslagna som del av kriterierna för melankoli i den psykiatriska handboken DSM (Diagnostic and Statistical Manual of Mental Disorders).
Avancerade glykerade slutprodukter, pulsvÄgshastighet, kropssamansÀttning, och dödlighet analyserades för subtyperna och jÀmfördes. Depressiva symptom var vanligare hos kvinnor, var associerade med mindre fysisk aktivitet, var associerade med mindre sannolikhet för samboende samt mindre sannolikhet för finanssiell tillfredsstÀllelse. Komorbiditeter var vanligare hos dem med depressiva symptom. Subtyperna skillde sig Ät nÀr det kom till kolesterol, blodtryck, index för kroppsmassa, och fet massa.
Studien visade att melankoliska depressiva symptom Àr nÀrmare relaterade till avancerade glykerade slutprodukter och dödlighet, medan icke-melankoliska depressiva symptom Àr nÀrmare relaterade till pulsvÄgshastighet, kropssamansÀttning och nedsatt glukos reglering.
De depressiva subtyperna yhar visat sig ha skillnader i patofysiologin. Detta tyder möjligen pÄ att de tvÄ subtyperna representerar skilda sjukdomsprocesser som har liknande symptomatologi
Cardiovascular diseases, risk factors and cognitive decline in the general population
Cognitive function constitutes a critical dimension of the health status of
elderly individuals. Age-associated decline in cognitive function may partly be
attributed to the negative effects of systemic medical diseases and related factors,
including cardiovascular diseases (CVDs) and vascular risk factors. Cognitive
decline has been an understudied outcome in cardiovascular epidemiological
research. Few reports have comprehensively examined cognitive function in relation
to clinical manifestations of systemic atherosclerotic disease in different arterial
beds. Inconsistent findings are common in the literature and these arc likely to reflect
the vast differences between studies regarding the choice of population under study,
the methods applied for measuring and defining CVD, the types and timing of
administration of protocols used for assessing cognitive function, and the paths taken
in the analysis of data.The principal aim of the present study was to examine the longitudinal
change in cognitive test performance in relation to major clinical CVDs and vascular
risk factors in a population-based sample of older people. The administration of a
battery of neuropsychological tests on two separate occasions facilitated the study of
actual change in both general cognition and across different cognitive abilities
according to an objectively-determined CVD status. A valid estimation of peak prior
cognitive ability allowed the exploration of the impact of CVD and risk factors on
the imputed decline from best-ever level of cognitive function to that measured in old
age.The analysis is based on a cohort of 809 men and 783 women aged 55-74
years which in 1987/8 was randomly selected from the general population of
Edinburgh. A comprehensive assessment of the prevalence of major CVDs and
vascular risk factors was held at baseline and during two follow-up examinations.
Since baseline, the study sample has been followed up to determine the incidence of
angina pectoris, peripheral arterial disease (PAD), myocardial infarction (MI), and
stroke. Cognitive testing was first held in 1998/9 when the mean age of the surviving
cohort (n=1209) was 73.1 years (SD=5.0) and subsequently about four years later
using the same test protocol. The present investigation is based on the 452 study
participants who attended follow-up cognitive testing in 2002/3.Both general cognition, as indexed by a general cognitive factor representing
the variance common to all the cognitive tests used, and most individual cognitive
measures were negatively affected in participants with CVD but no evidence of
stroke relative to non-vascular controls. Of the specific CVD manifestations, stroke
was significantly associated with a steeper four-year decline in both general
cognitive function and verbal memory. When decline was estimated from peak, prior
cognitive level, stroke was related to a greater decline in both general cognition and
verbal fluency. In the absence of stroke, MI was associated with an accelerated fouryear
decline in non-verbal reasoning ability but the presence of angina was not
related to cognitive decline in this study. Symptomatic PAD also independently
predicted faster decline in both general cognition and verbal memory over the fouryear
follow-up. Several potentially modifiable vascular risk factors, including
education, body mass index, smoking, diastolic blood pressure, inflammatory
markers and blood viscosity were also related to decline in general and specific
cognitive abilities, independently of age, sex, prior cognitive ability and vascular
disease. The associations with decline in specific cognitive measures principally
resulted from the impact of atherosclerotic disease and risk factors on general
cognitive ability rather than the individual functions per se.The findings from the present study further add to those of previous
investigations demonstrating a relationship between CVDs, vascular risk factors, and
cognitive decline in older people. Specifically, they reveal that, even in the absence
of overt stroke, clinical CVDs are associated with a greater cognitive decline in the
elderly, independently of potential confounding by a wide range of vascular risk
factors. Also, the relationships between several vascular risk factors and cognitive
decline proved to be independent of overt co-existing vascular pathology. Based on
these findings, further study is needed to determine the combined effects of CVDs
and multiple risk factors on cognitive outcomes in samples of older people. In
addition, what the likely pathological mechanisms are underlying cognitive decline
associated with atherosclerotic disease and vascular risk factors needs to be
addressed in future studies. From a perspective of preventing or delaying vascular
based cognitive decline and impairment, more research is required to assess the
effectiveness of both individual and population-based strategies targeting vascular
disease and risk factors in older age groups. Finally, further investigation is needed to
address the potential impact of subtle cognitive deficits on indicators of the quality of
life and the capability of self-maintenance of elderly vascular patients, on adherence
to medical treatment and rehabilitation, and further cognitive decrements and
survival
Application of Natural Language Processing to Determine User Satisfaction in Public Services
Research on customer satisfaction has increased substantially in recent
years. However, the relative importance and relationships between different
determinants of satisfaction remains uncertain. Moreover, quantitative studies
to date tend to test for significance of pre-determined factors thought to have
an influence with no scalable means to identify other causes of user
satisfaction. The gaps in knowledge make it difficult to use available
knowledge on user preference for public service improvement. Meanwhile, digital
technology development has enabled new methods to collect user feedback, for
example through online forums where users can comment freely on their
experience. New tools are needed to analyze large volumes of such feedback. Use
of topic models is proposed as a feasible solution to aggregate open-ended user
opinions that can be easily deployed in the public sector. Generated insights
can contribute to a more inclusive decision-making process in public service
provision. This novel methodological approach is applied to a case of service
reviews of publicly-funded primary care practices in England. Findings from the
analysis of 145,000 reviews covering almost 7,700 primary care centers indicate
that the quality of interactions with staff and bureaucratic exigencies are the
key issues driving user satisfaction across England
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