Equity and Access to Health Care in Rural Quang Nam Province, Vietnam

This paper will addresses access to health care in rural Quang Nam Province in Vietnam. In doing so, it will examine the existing literature surrounding healthcare in Vietnam and compare it with the shortage of physicians in the study area and how that impacts who is able to receive care. The research presented in this paper synthesizes this analysis with interviews conducted by the author with policymakers and health care professionals in the study area. The paper concludes by offering policy recommendations that may rectify the healthcare issues that pervade the study area

Represent: A community engagement roadmap to improve participant representation in cancer early detection research: An Oregon case study

INTRODUCTION: While authentic and sustained community involvement in the research process is critically important to making new technologies and interventions effective and socially acceptable, there is uneven participation across sociodemographic, racial, and ethnic communities in many research areas, including cancer early detection research. Currently, 18% of cancer in the United States impacts Hispanics and Latinos, this population accounts for < 10% of research participants. Understanding barriers and facilitators to cancer early detection research is imperative to the ultimate success of this research. Therefore, the objectives of this study were to: understand Hispanic and Latino community perspectives in participation in cancer early detection research; and identify sustainable and mutually beneficial approaches to community engagement and involvement. METHODS: The Oregon Case Study, led by Oregon Health & Science University's Community Outreach, Research and Engagement (CORE) in partnership with colleagues at Vocal, a partnership between Manchester University NHS Foundation Trust and the University of Manchester and Cambridge University, adopted a participatory research approach to better understand participation in cancer early detection research from the perspectives of Oregon's Hispanic and Latino community members. We implemented two evidence-based community engagement models, the Community Engagement Studio and the Community Readiness Assessment Model. Using a facilitated format prescribed by each community engagement model, community members helped us to answer two research questions: (1) What methods help us increase participation of underrepresented communities in cancer early detection research?; and (2) How can we build trust between researchers and underrepresented communities within cancer early detection research? Quantitative (i.e., descriptive statistic) and qualitative (i.e., thematic analysis) analytic methods were used to measure and assess community knowledge, leadership, beliefs, and resources regarding participation in cancer early detection research. RESULTS: A total of 36 Hispanic and Latino community members participated in the two community engagement models. We identified three emergent themes pertaining to participation in cancer early detection research that include: low-level awareness of cancer early detection research and opportunities for research participation, structural barriers to research participation, and uncertainty of the benefits of research participation. CONCLUSION: Our approach, using two evidence-based community engagement models, yielded valuable insights about perceptions of research participation for Hispanic and Latino community members. These findings, synthesized into three key themes, led to actionable recommendations to increase research participation

REPRESENT recommendations: improving inclusion and trust in cancer early detection research

Detecting cancer early is essential to improving cancer outcomes. Minoritized groups remain underrepresented in early detection cancer research, which means that findings and interventions are not generalisable across the population, thus exacerbating disparities in cancer outcomes. In light of these challenges, this paper sets out twelve recommendations to build relations of trust and include minoritized groups in ED cancer research. The Recommendations were formulated by a range of stakeholders at the 2022 REPRESENT consensus-building workshop and are based on empirical data, including a systematic literature review and two ethnographic case studies in the US and the UK. The recommendations focus on: Long-term relationships that build trust; Sharing available resources; Inclusive and accessible communication; Harnessing community expertise; Unique risks and benefits; Compensation and support; Representative samples; Demographic data; Post-research support; Sharing results; Research training; Diversifying research teams. For each recommendation, the paper outlines the rationale, specifications for how different stakeholders may implement it, and advice for best practices. Instead of isolated recruitment, public involvement and engagement activities, the recommendations here aim to advance mutually beneficial and trusting relationships between researchers and research participants embedded in ED cancer research institutions

Migrant Health Policies in the European Union: a Comparative Policy Analysis

There is an undeniable relationship between migration and health. Despite the fact that the concept of health as a fundamental human right has been enshrined in numerous international and supranational policy instruments, health disparities between migrants and host nation populations persist. Inequities in health are perpetuated by several factors that include, but are not limited to, immigration status, lack of knowledge of health system access points, appropriateness of health care services, language barriers, and unique health profiles of migrants. The literature firmly positions migrants as a vulnerable population due to their collective risk of poor health outcomes in multiple areas. Between 1998 and 2007, 10 European Union (EU) member states, plus Switzerland in a special partnership with the EU through the European Economic Area, adopted a migrant health policy to improve the health of migrants through targeted strategies. These national level migrant health policies go beyond statutory requirements outlined in international and supranational charters and treaties to protect the health migrants and address factors that contribute to health inequity between migrants and European host nation populations. Listed in alphabetical order, European nations with migrant health policies include: Austria, England, France, Germany, Ireland, Italy, the Netherlands, Portugal, Spain, Sweden, and Switzerland. While barriers encountered by migrants in accessing health care services in host nations and inequities in health between migrants and host nation populations have been well- documented in the literature, scholarly research on comparative analysis of the content of European-based migrant health policies is relatively limited and migrant health policy process or outcome analyses are virtually non-existent. Comparative analysis of eleven migrant health policies that broadly share the same objective to improve the health status of migrant populations provides insight into how a group of nations responded to addressing the health of migrant populations through a policy instrument. This study identified how the policies are similar and different through a two- phased analytic process that included content analysis followed by typological analysis. The coding scheme that emerged from content analysis was mapped onto a typology matrix. The result was the emergence of four themes that are a type of orientation toward the health of migrant populations. The theme-based typology goes beyond description and classification of the policy cases by offering a higher level of understanding of variation across the themes and cases. This is a new framework from which to compare concepts, explore dimensionality, and identify hierarchical relationships at macro and micro levels. The macro level occurs across and within emergent themes, while the micro level is the policy case. This study aims to inform future policy making processes concerning all areas of immigration and provide context for future migrant health policy process and outcomes research

Expanding Stewardship: Agriculture as Conservation

Rapid changes in the agriculture industry over the last century due to the innovations of the Green Revolution have led to a host of environmental impacts from soil degradation to compromised water quality. Farmers, researchers, and industry professionals are developing and implementing solutions to these environmental impacts locally, nationally, and globally, though substantial and complex barriers exist that limit their adoption at higher rates. The Stewardship Network (TSN), a conservation-focused nonprofit organization based in Ann Arbor, Michigan, is exploring the possibility of incorporating agricultural lands and stakeholders into its network-building work. This study identifies key considerations for TSN as it considers expanding its mission into agriculture. The social and professional organization of the farming community in Washtenaw County and the available resources for conservation agriculture were assessed through a series of semi-structured interviews with farmers and farmer resource organizations, as well as observations at events and meetings. The farming community in Washtenaw County can be divided along a spectrum from small-scale diversified to large-scale commodity farmers. Underserved farmers largely operate small-scale diversified farms and participate in that community, though they face particular needs and barriers due to a legacy of discrimination. Farmers in Washtenaw County expressed a variety of definitions and perspectives on conservation agriculture, which can also be organized along a spectrum from perceiving conservation as intrinsic to farming to perceiving it as an addition to farming. The farmers on either end of these spectra operate mostly independently, both socially and professionally. These divisions are reiterated at the institutional level, which has implications for resource accessibility. Over 50 farmer resource organizations support farmers in Washtenaw County at the intersection of agriculture and conservation. A network analysis revealed that these organizations can be divided into three communities based on the primary recipients of their resources. Despite the broad array of resources, gaps persist between farmer needs and available resources. These gaps reveal several opportunities for TSN including connecting farmers to research and helping farmers share equipment and labor. Insights from organizations similar to TSN indicate the importance of trust building, the challenge of working with farmers as an environmental organization, and the need to honor existing work in the field. It is important for The Stewardship Network to consider strategic dimensions associated with moving into agriculture, including audience and impact; and organizational dimensions such as staffing and capacity.Master of ScienceSchool for Environment and SustainabilityUniversity of Michiganhttps://deepblue.lib.umich.edu/bitstream/2027.42/143174/1/Currier_Hayley_Practicum_FINAL_4-22.pd

Community paramedicine in Central Oregon: A promising model to reduce non‐urgent emergency department utilization among medically complex Medicaid beneficiaries

Abstract Background Community paramedicine has emerged as a promising model to redirect persons with nonmedically emergent conditions to more appropriate and less expensive community‐based health care settings. Outreach through community paramedicine to patients with a history of high hospital emergency department (ED) use and chronic health conditions has been found to reduce ED use. This study examined the effect of community paramedicine implemented in 2 rural counties in reducing nonemergent ED use among a sample of Medicaid beneficiaries with complex medical conditions and a history of high ED utilization. Methods A cluster randomized trial approach with a stepped wedge design was used to test the effect of the community paramedicine intervention. ED utilization for non‐urgent care was measured by emergency medicine ED visits and avoidable ED visits. Results The community paramedicine intervention reduced ED utilization among a sample of 102 medically complex Medicaid beneficiaries with a history of high ED utilization. In the unadjusted models, emergency medical ED visits decreased by 13.9% (incidence rate ratio [IRR], 0.86; 95% confidence interval [CI], 0.76–0.98) or 6.1 visits saved for every 100 people. Avoidable emergency department visits decreased by 38.9% (IRR, 0.61; 95% CI, 0.44–0.84) or 2.3 visits saved for every 100 people. Conclusion Our results suggest community paramedicine is a promising model to achieve a reduction in ED utilization among medically complex patients by managing complex health conditions in a home‐based setting

Separating snow and forest temperatures with thermal infrared remote sensing

Thermal infrared sensing from space is a well-developed field, but mixed pixels pose a problem for many applications. We present a field study in Dana Meadows, Yosemite National Park, California to scale from point (~2-m resolution) to aerial (~5-m resolution gridded, 1 km × 6 km extent) to satellite (MODIS, ~1000-m resolution, global extent) observations. We demonstrate how multiple thermal bands on MODIS can be used to separate snow and forest temperatures and determine the fractional snow-covered area (fSCA) over a 3 km × 3 km array of 9 MODIS grid cells. During the day, visible, near-infrared, and shortwave-infrared bands provide a first guess of fSCA and help to constrain the solution. This technique, which has estimated errors &lt;2 °C and 10% fSCA for many expected conditions, enables better understanding of the snowpack energy balance, atmospheric inversions and cold air pools, and forest health

Patient Experiences in Behavioral Health Integrated Primary Care Settings: the Role of Stigma in Shaping Patient Outcomes over Time

Behavioral health integration (BHI) models seek to improve patient experience and outcomes by bridging physical and behavioral health services. Past BHI research has not focused on stigma in these settings, which has been previously found to impact patient engagement and outcomes. We surveyed patients over a two year period at 12 integrated clinics in Oregon using measures developed by a Patient Advisory Team. Over a quarter of respondents reported stigmatization (26.81%). Compared to non-stigmatized patients, those who reported stigma had five times the odds of reporting unmet health needs (OR=5.14,

Represent: A community engagement roadmap to improve participant representation in cancer early detection research: An Oregon case study.

Peer reviewed: TrueINTRODUCTION: While authentic and sustained community involvement in the research process is critically important to making new technologies and interventions effective and socially acceptable, there is uneven participation across sociodemographic, racial, and ethnic communities in many research areas, including cancer early detection research. Currently, 18% of cancer in the United States impacts Hispanics and Latinos, this population accounts for < 10% of research participants. Understanding barriers and facilitators to cancer early detection research is imperative to the ultimate success of this research. Therefore, the objectives of this study were to: understand Hispanic and Latino community perspectives in participation in cancer early detection research; and identify sustainable and mutually beneficial approaches to community engagement and involvement. METHODS: The Oregon Case Study, led by Oregon Health & Science University's Community Outreach, Research and Engagement (CORE) in partnership with colleagues at Vocal, a partnership between Manchester University NHS Foundation Trust and the University of Manchester and Cambridge University, adopted a participatory research approach to better understand participation in cancer early detection research from the perspectives of Oregon's Hispanic and Latino community members. We implemented two evidence-based community engagement models, the Community Engagement Studio and the Community Readiness Assessment Model. Using a facilitated format prescribed by each community engagement model, community members helped us to answer two research questions: (1) What methods help us increase participation of underrepresented communities in cancer early detection research?; and (2) How can we build trust between researchers and underrepresented communities within cancer early detection research? Quantitative (i.e., descriptive statistic) and qualitative (i.e., thematic analysis) analytic methods were used to measure and assess community knowledge, leadership, beliefs, and resources regarding participation in cancer early detection research. RESULTS: A total of 36 Hispanic and Latino community members participated in the two community engagement models. We identified three emergent themes pertaining to participation in cancer early detection research that include: low-level awareness of cancer early detection research and opportunities for research participation, structural barriers to research participation, and uncertainty of the benefits of research participation. CONCLUSION: Our approach, using two evidence-based community engagement models, yielded valuable insights about perceptions of research participation for Hispanic and Latino community members. These findings, synthesized into three key themes, led to actionable recommendations to increase research participation