Caring for Aging Prisoners is Taxing: How Missouri Can Ease Its Prison Health Care Burden

In 1976, the Supreme Court of the United States handed down the decision in Estelle v. Gamble which established the government’s obligation to provide medical care to incarcerated persons. The 1970s is also known as the “Tough-On-Crime Era,” where politicians began to take sides on crime and create mandatory minimum sentences. This led to a dramatic increase in the prison population and, more specifically, the aging prison population. Because of the government’s obligation to provide medical care to inmates based on the decision in Estelle, caring for the aging prison population has become more expensive and more burdensome on the taxpayer. Missouri has one of the highest incarceration rates in the world and one of the highest aging prisoner populations. This article examines the high cost of caring for the aging prisoner population nationally and in Missouri and compares methods other states are using to lessen the burden on their taxpayers. In so doing, this article will ultimately conclude that Missouri should expand its medical parole policy or its use of telehealth in prisons to release some of the aging prisoners

ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGY (ICT) IN HIV/AIDS HEALTH COMMUNICATION IN SLUMS (A Case of Kawangware Division, Nairobi Kenya)

Purpose: Information and Communication Technologies are key elements of a civil society response to the HIV/AIDS epidemic, enabling advocacy, mobilization, and empowerment of People Living with HIV (PLWHA), women, and other vulnerable groups. This study sought to investigate the role of Information and Communication Technology (ICT) in HIV/AIDS Health Communication in slums through a case study of a project sponsored by AfriAfya in Kawangware division, Nairobi Kenya. AfriAfya, also known as the African Network for Health Knowledge Management and Communication, is a consortium of health NGOs namely: Aga Khan Health Services; African Medical and Research Foundation (AMREF); CARE Kenya; Christian Health Association of Kenya; HealthNet Kenya; the Ministry of Health, Kenya; PLAN International; and World Vision International, Kenya. AfriAfya was set up in April 2000 to explore the ways of harnessing ICTs for community health in rural and marginalized communities.  The study was guided by the following specific objectives: (i) to analyze the ICT interventions and tools used in the fight against HIV/AIDS in Kenya; to examine the benefits derived from adoption of ICTs in the fight against HIV/AIDS in Kenyan slums; to assess the challenges faced in the adoption of ICTs in the fight against HIV/AIDS in the slums in Kenya; and to recommend strategies on how best to employ ICTs in the fight against HIV/AIDS in Kenyan slums. Methods: The data collected by this study was analyzed by descriptive statistics such as percentages, frequencies and tables. In addition, standard deviations and mean scores were used to present information pertaining to the study objectives. The information was presented and discussed as per the objectives and research questions of the study. Findings: Findings of the study indicate that all the four objectives were met as follows:- The tools used in the fight against HIV/AIDS in Kenya were established as being e-mail discussion groups, Internet, Dissemination of information on World Wide Web (www), Radio, Television, and  Distance learning systems. The interventions used in the fight against HIV/AIDS in Kenya were established as being Prevention:-Dissemination of prevention messages as well as prevention services to target groups such as commercial sex workers; School Based Education:- Education and life skills training in the schools for effecting appropriate behavioral changes among youth; and Education of Health Care Workers :- ICTs are being used to improve access to information, education, and communication for health workers using, Internet, email discussion groups, and distance learning systems. The benefits derived from adoption of ICTs in the fight against HIV/AIDS in Kenyan slums were determined as being Social change; empowerment and reduction of vulnerability; advocacy, mobilization, networking and capacity building; Remote consultations and diagnosis; Information sharing; Remote mentoring; Facilitation of Distance learning teaching; and Online Counseling. The challenges of adoption of the ICTs in HIV/AIDS Health Communication were established as being: - Limited connectivity; Poor ICT infrastructure status; High costs of accessing the Internet; and Language barrier. Key Words: Information & Communication Technology, HIV/AIDS, Community Based Organizations

HealthAssistantBot: A Personal Health Assistant for the Italian Language

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Digital Research Cycles: How Attitudes Toward Content, Culture And Technology Affect Web Development.

It has been estimated that one third of the world\u27s population does not have access to adequate health care. Some 1.6 billion people live in countries experiencing concentrated acquired immune deficiency syndrome (AIDS) epidemics. Many countries in Africa--and other low-income countries--are in dire need of help providing adequate health care services to their citizens. They require more hands-on care from Western health workers--and training so more African health workers can eventually care for their own citizens. But these countries also need assistance acquiring and implementing both texts--the body of medical information potentially available to them--and technology--the means by which that information can be conveyed. This dissertation looks at these issues and others from a multi-faceted approach. It combines a survey of the developers of Web sites designed for use by health workers in low-income countries and a proposal for a novel approach to communication theory, which could help improve health communication and other social marketing practices. It also includes an extensive review of literature regarding a number of topics related to these issues. To improve healthcare services in low-income countries, several things should occur. First, more health workers--and others--could visit African countries and other places to provide free, hands-on medical care, as this researcher\u27s group did in Uganda. Such trips are ideal occasions for studying the cultural differences between mzungu (white man) and the Ugandan people. A number of useful medical texts have been written for health workers in low-income countries. Others will be published as new health information becomes available. But on what medium will they be published? Computers? Personal digital assistants? During the past 10 years the Internet became an ideal venue for conveying information. Unfortunately, people in target countries such as Uganda encounter cultural differences when such new technologies are diffused. This dissertation looks at cultural and technological difficulties encountered by people in low-income countries who attempt to diffuse information and communication technologies (ICT). Once a technology has been successfully adopted, someone will look for ways to use it to help others. There are hundreds of sites on the Internet--built by Web developers in Western countries--that are designed for use by health workers in low-income countries. However, these Web developers also experience cultural and technological differences, based on their knowledge of and attitudes toward best practices in their field. This research includes a survey of Web developers which determined their attitudes toward best practices in their field and tested this researcher\u27s hypothesis that there is no significant difference among the developers\u27 attitudes toward the content on their sites, their audience\u27s cultural needs and the various technological needs their audience has. It was found that the Web developers agree with 17 of 18 perceived best practices and that there is a significant difference between Web developers\u27 attitudes toward their audience\u27s technological needs and their attitudes toward quality content and the audience\u27s cultural needs. Creation of the survey herein resulted in this researcher generating a new way of thinking about communication theory--called digital research cycles. The survey was based on a review of literature and is rooted in the belief that any successful communication of a computer-mediated message in the information age is a behavior which is influenced by the senders\u27 and receivers\u27 attitudes and knowledge about textual style, the audience, technology and the subject matter to which the message pertains

The Kids Are Not Alright: Leveraging Existing Health Law to Attack the Opioid Crisis Upstream

The opioid crisis is now a nationwide epidemic, ravaging both rural and urban communities. The public health and economic consequences are staggering; recent estimates suggest the epidemic has contracted the U.S. labor market by over one million jobs and cost the nation billions of dollars. To tackle the crisis, scholars and health policy initiatives have focused primarily on downstream solutions designed to help those who are already in the throes of addiction. For example, the major initiative announced by the U.S. Surgeon General promotes the dissemination of naloxone, which helps save lives during opioid overdoses. This Article argues that the urgency and gravity of the opioid crisis demand a very different approach. To stop the epidemic, interventions are needed long before people are on death’s doorstep. Rather, it must focus on upstream interventions that stop people from becoming addicted in the first place. To accomplish this, we should leverage an existing legal infrastructure that is already capable of such a preventive response. Although largely overlooked as a tool in tackling this epidemic, children’s Medicaid, known as the Early and Periodic Screening, Diagnostic and Treatment (EPSDT) benefit, provides a mechanism to identify at-risk children and the treatment necessary to shift their life trajectories off of the road to addiction. This Article lays out a blueprint for the ways in which EPSDT, the largest provider of children’s health insurance in the country, facilitates best practices in substance abuse prevention through (1) regular mental health and substance abuse screening in the doctor’s office and (2) the provision of medically necessary treatment for children at risk for and engaged in opioid and other substance abuse. This upstream approach is consistent with Lifecourse Health Development theory, which emphasizes strategies that address risk factors and burgeoning health conditions in childhood before they become debilitating. Indeed, through the Medicaid statute and its legislative history, executive branch guidance, and judicial precedent, all three branches of the federal government have endorsed the power of Medicaid EPSDT to address health conditions early and preventively. This Article argues that this existing infrastructure should be leveraged so that at-risk children can access mental health and substance abuse services before a next generation falls victim to the greatest public health crisis of our time

Black Pregnancy Matters: Racial Reproductive Bias in African American Maternal Mortality

This semester-long research project uncovers how racial biases demonstrated in the reproductive health field, and specifically before, during, and after childbirth, affect the rate of maternal mortality and morbidity for African American mothers in the United States. The rate of maternal mortality for this specific racial group is four times greater as compared to Caucasian women and this discrepancy will be investigated and analyzed throughout this capstone thesis. Interviews were conducted with key figures in the obstetric and gynecological field as well as with Black mothers themselves in an effort to uncover what factors, aside from medical anomalies, are leading to mortality of African American women at much higher rates than other racial groups. Studies suggest that implicit racial bias present between care providers and their patients can lead to solvable yet unaddressed complications which then result in unfavorable outcomes for postpartum Black women. This capstone project will incorporate these research studies and articles into an extensive literature review that include three main frameworks: racial bias, healthcare access and socioeconomic background. Racial bias will be the main framework that informs the other two frames as race in America cannot be separated from economic or healthcare justice. Finally, I offer recommendations that incorporate micro-level guidance and suggestions for interactions between patients and practitioners. I also zoom out on a macro-level and investigate policies that can be implemented on a more widespread scale from midwife and doula protocols to target racial and implicit bias in the larger structure of healthcare

Building Medical Homes in State Medicaid and CHIP Programs

Presents strategies, best practices, and lessons learned from ten states' efforts to advance the medical home model of comprehensive and coordinated care in Medicaid and Children's Health Insurance Programs in order to improve quality and contain costs

A Whole Woman Strategy and Action Plan to Raise National Awareness About Osteoporosis

The University of Maine Center on Aging, in partnership with the Maine Center for Osteoporosis Research and Education, was one of three grantees taking part in a U.S. Administration on Aging-funded project to develop a national osteoporosis awareness and action plan targeting postmenopausal womenThe University of Maine Center on Aging’s portion of the research entailed several phases of activity. Initially, focus groups were conducted with 147 ethnically and racially diverse older women around the country (Maine, New York, Pennsylvania, California, and Kansas) to determine where older women obtain their health information, what they consider reliable and unreliable informational sources, and where they’ve gotten information in the past that has resulted in changes in their health behavior. The second phase focused on researching existing osteoporosis education programs and previous or ongoing campaigns to ascertain what programmatic elements have been most and least effective. Phase three entailed obtaining feedback from 13 focus groups with 122 ethnically and racially diverse older women around the country (California, Illinois, Georgia, Maine, and New York), concerning mock brochures, graphics, and messages for the campaign as well as ideas about spokespeople and promotional items.The report concludes by making a series of recommendations for implementing a nation osteoporosis education program based on the data gathered through the three research phases