Sexual Assault Prevention and Reporting on College Campuses in the US: A Review of Policies and Recommendations

Objective: Sexual violence within the collegiate environment is a pressing issue within American society.  One way to address sexual violence is through the adaptation and implementation of a sexual assault policy by colleges and universities. The purpose of this study is to review sexual misconduct and assault policies of ten public universities as well as federal policies in the US. This study contributes to increasing the knowledge of sexual assault policies on American campuses that would be helpful in the development of more effective prevention policies, increasing sexual assault reporting, and decreasing sexual assaults. Methods: The data included relevant legislation, and the university sexual assault and/or misconduct policies from ten selected public universities within the United States in Fall 2014. Results: The policies of the ten universities vary. Three of the universities do not have university policies that explicitly address sexual misconduct as assault.  Sexual harassment policies tend to focus on the threat of violence, as opposed to perpetrated sexual violence itself. Conclusions: Further efforts in policy revisions need to be made so that more universities will not only implement sexual assault policies, but also implement more comprehensive policies. Keywords: sexual assault, safety, violence prevention, college health promotion, US

Health Care Seeking for Intimate Partner Violence in the Tokyo Metropolitan Area.

Intimate partner violence (IPV) has a high prevalence in many nations and is a serious public health problem. IPV is associated with health problems as well as high medical expenditures. Both IPV and health care seeking are recurrent for victims throughout the life course. However, most previous studies that examine the impact of IPV on health care seeking are cross-sectional. Using life course data collected from Japanese women living in the Tokyo Metropolitan area, this study examines the factors influencing the first IPV specific health care seeking and IPV specific health care seeking over the life course and the trajectory of IPV specific health care seeking over the life course. The data were collected from 101 women from 2005 to 2006 through semi-structured interviews that utilized the Life History Calendar method. The data set included a total of 3,403 person years. The discrete-time models and hierarchical linear models were used for the data analysis. Anderson’s Behavioral Model of Health Service Utilization and cumulative risk theory provided the theoretical foundation of this study. Injury and formal help seeking increased the odds of the first IPV specific health care seeking. The current experience of injury, formal and informal help seeking, welfare status, smoking, and poor self-rated health status increased the likelihood of IPV specific health care seeking over the life course. The cumulative experience of sexual IPV and injury significantly increased the likelihood of IPV specific health care seeking over the life course. While the trajectory of injury was similar to that of IPV specific health care seeking, the trajectory of any form of IPV was different from that of IPV specific health care seeking. The occurrence of IPV was much more frequent than that of IPV specific health care seeking over the life course. These results highlight important policy implications for improving health care services for victims of IPV. Such policy implications, for example, include developing policies and programs to increase awareness of IPV as a health problem among victims of IPV, health care professionals and communities.Ph.D.Health Services Organization & PolicyUniversity of Michigan, Horace H. Rackham School of Graduate Studieshttp://deepblue.lib.umich.edu/bitstream/2027.42/75916/1/kamimura_1.pd

Rapid and highly sensitive analysis of chlorophylls and carotenoids from marine phytoplankton using ultra-high performance liquid chromatography (UHPLC) with the first derivative spectrum chromatogram (FDSC) technique

We developed a rapid and highly sensitive analytical method for chlorophylls and carotenoids derived from marine phytoplankton using ultra-high performance liquid chromatography (UHPLC). High-performance liquid chromatography (HPLC) has been widely used in phytoplankton pigment analysis since the 1980’s for estimating the abundance, composition, and photosynthetic physiology of natural algal assemblages or laboratory cultures. However, the run-time of the HPLC analyses is generally ca. 30 min or more, which is time-consuming for analysts. Our UHPLC technique enabled us to complete the separations of chlorophylls and carotenoids from marine phytoplankton within 7 min with similar resolution as conventional HPLC methods. The analytical method was tested on authentic pigment standards, marine phytoplankton cultures, and field samples that were collected from the central tropical and subarctic Pacific plus the neritic Bering Sea. Critical pigment pairs that generally co-eluted as a single peak were successively resolved by obtaining the first derivative spectrum chromatograms (FDSCs) with a photodiode array (PDA) detector based on differences in pigment absorption spectra, e.g., chlorophyll (Chl) c2 and Mg 2,4 divinyl (DV) pheoporphyrin a5 monomethyl ester (MgDVP), as well as DVChl b and Chl b. Because the maximum injection volume of UHPLC is generally lower than that of HPLC to minimize the unwanted broadening of chromatographic peaks, the detection sensitivity needed to be increased, especially for oligotrophic seawater samples with low pigment concentration. To overcome this sensitivity issue, a PDA detector equipped with an 85 mm path length capillary cell was used with a fluorescence detector. As a result, the limit of quantitation (LOQ) as determined by absorbance was of the order of 0.1 ng for chlorophylls and carotenoids. Furthermore, a bead-beating technique using N,N-dimethylformamide (DMF) and zirconia beads was used to minimize the volume of the organic solvent utilized for pigment extraction. Our UHPLC method can replace the conventional HPLC techniques, and allows us to yield high-throughput data of the chlorophylls and carotenoids derived from marine phytoplankton

An Analysis of Oppression and Health Education for Underserved Populations in the United States: The Issues of Acculturation, Patient-Provider Communication, and Health Education

The oppression of underserved populations is pervasive throughout the history of the United States (U.S.), especially in health care. Brazilian educator Paulo Freire’s controversial ideas about systems of power can be aptly applied to health care. This paper focuses specifically on arguably the most medically underserved group in the U.S. healthcare system, free clinic patients, and analyzes the effects oppression on acculturation and patient-provider communication, and the potential of health education classes to reduce oppression and health disparities in this population. One way in which oppression materializes within the realm of medical and health education is through acculturation. Spanish-speaking free clinic patients are less satisfied with overall interpersonal communication at a free clinic than US born and non-US born English-speaking free clinic patients. Oppression can also be seen in patient-provider communication, specifically, around communicating diagnoses. It is vital for providers and educators to consistently and accurately educate their patients, and to ensure that patients fully understand their diagnoses before concluding an office visit. Reduction of national deaths through preventative health measures, such as health education programming, is an achievable goal. However, one concern in health education classes amongst underserved populations is the underlying power dynamic associated with individuals from a privileged background educating less privileged populations. Engaging health education participants through informal discussions rather than lectures is something that can be applied in future health-related educational settings.    Further examining issues of acculturation, patient-provider communication, and health education classes would help answer Freire’s pedagogical questions and improve health care services for free clinic patients and other underserved populations in the U.S. Keywords: medically uninsured; acculturation; patient-provider communication; health education; US

Doctors’ Opinion Papers in Long-term Care Need Certification in Japan: Comparison between Clinic and Advanced Treatment Hospital Settings

The Doctor’s Opinion Paper (DOP) in long-term care insurance addresses the patient’s chronic conditions of daily life. It is expected to be written by a doctor who knows the patient well. However, DOPs are sometimes written by doctors at advanced treatment hospitals (ATHs) who might not know the patient well. Japanese government is promoting functional differentiation of medical care. We discuss appropriateness that specialists of ATH who have to provide a higher medical care take on a role to write DOP which addresses the patient’s chronic conditions of daily life. The purpose of this study is to compare DOPs completed by clinic doctors with those completed by ATH doctors, in order to examine who should write a DOP. Data: The DOPs which were used at the Care Need Certification Committee meeting held in March 2012 in Tokyo. Subjects: 403 DOPs for patients aged 65 or older. Results indicated that DOPs written by doctors in ATHs included less information than DOPs written by doctors in clinics. We need to discuss who would be appropriate doctors to write DOPs and how to educate older adults to choose the right health care facility and their doctors for their health condition. Keywords: Doctor’s opinion paper, certification of need for long-term care, long-term care insurance, advanced treatment hospital, clinic, family doctor, Japa

Covid-19 Vaccine Perception and Hesitancy Among Uninsured Free Clinic Patients

There are many complexities regarding the acceptance of COVID-19 vaccines, mainly because the COVID-19 vaccine had a fast track of development compared to vaccines developed in the past years. The purpose of this study is to understand COVID-19 vaccine perception and hesitancy among uninsured free clinic patients using the theory of planned behavior. This study had seven focus groups with 37 total participants, including 19 Spanish speakers. Free clinic adult patients (over the age of 18) participated in four focus groups during Summer of 2021. The average age of the participants was 44.7, and the majority of the participants self-identified as female and Hispanic. Social networks are found to be important factors in reducing vaccine hesitancy. Hesitant patients had concerns related to vaccines’ safety, effectiveness, and side effects. The lack of valid and reliable COVID-19 vaccination information was a challenge among this study’s participants. This exploratory study highlights some of the factors contributing to vaccine behavior among free clinic patients. This study concluded that the influence of family and friends are important motivational factors in vaccine behavior. A future study could focus on the multifaceted influences on vaccine hesitancy among free clinic patients, emphasizing the strong motivational role of family and friends while also addressing concerns about vaccine safety, efficacy, and the dissemination of reliable information

Health Services for Refugees in the United States: Policies and Recommendations

Some of refugees, who were forced to move out from a home country due to political or religious conflicts, war or natural or manmade disasters, resettle in another country. Resettlement in another country is challenging as refugees suffer from a number of mental and physical health problems. Under the Refugee Act of 1980, the United State (US) governments provide medical assistance as well as financial and immigration legal assistance. Yet, it is still challenging to ensure health and well-being of refugees who have diverse social and health conditions and needs. This study reviewed federal policies and limitations on refugee health in the US, which accepts the largest number of refugee resettlements in the world. The reviewed policies include health insurance policies, health promotion policies, the Survivors of Torture Program, and medical screening. Some refugees still have limited accessibility to services due to difficulties in understanding the healthcare system even when they are eligible for many of the services. While most policies on refugee health mainly focus on the early stage of resettlement and infectious disease screening, follow-up services for chronic conditions are essential to ensure health and well-being of refugees. Because social factors affect health of refugees, it is necessary to provide services that address social and health issues. There are several recommendations to improve policies and services to better serve refugee populations who resettled in the US. First, more comprehensive health promotion and education programs are necessary for refugees to better understand the US healthcare system and healthcare. Second, long-term follow-ups which include chronic health conditions are important to improve health of refugees. Lastly, social and health issues should be integrated with a bidirectional approach which supports both refugees and existing communities. Keywords: refugees, physical and mental health, resettlement, federal policies, United States

Policy and Social Factors Influencing Diabetes among Pima Indians in Arizona, USA

The Pima Indians have the highest rate of type 2 diabetes in the world. While biomedical studies have identified a genetic variable associated with the high prevalence of diabetes among Pima Indians, genetics is only one factor that encompasses an individual’s risk for developing a disease. Information on the social factors relating to the development of type 2 diabetes amongst this population is necessary. The purpose of this analysis is to review policy, social and historical factors associated with diabetes among Pima Indians. Governmental policies have affected this population’s ability to eat a diet native to their culture. For example, the damming of the Gila River in the early 1920s resulted in diet and lifestyle changes, reducing traditional low fat, high fiber intake and physical activity, among the Pima population. U.S. Department of Agriculture (USDA) policies in place in the 1970s and 1980s did not allow Native Americans, the Pima included, to get farm help such as agricultural loans in times of need. These policies led to many Pima finding sedentary jobs, if they could find work at all, and adopting unhealthy lifestyles. While genetic factors have shown to be important predictors of diabetes incidence, the historical and social factors that changed US Pima Indians’ lifestyles are significant factors which have contributed to the high prevalence of diabetes among this group. In order to address the high rates of diabetes among the Pima Indians, it is vital that emphasis be placed upon culturally appropriate interventions. U.S. government agencies, tribal leaders, and community elders would benefit from working together to establish healthier food sources, encourage physical activity, and utilize existing community networks to spread information on diabetes prevention and management practices. Future studies on diabetes among Pima Indians would include more policy, social and historical factors, develop programs with reflection of these factors, and evaluate the programs. Keywords: Pima Indians, type 2 diabetes, Native American policies, social factors, US

Healthcare Team Members’ Views on Social Determinants of Health Screening and Referral Practices in a Pediatric Emergency Department

We aimed to explore the healthcare team members’ (HTMs) views on social determinants of health (SDH) screening and referral processes in a pediatric emergency department (PED). We conducted a cross-sectional, mixed-methods study to explore PED HTMs’ views on social care practices at a quaternary-level children’s hospital. The survey was created using a goal identification framework. The survey gathered quantitative and qualitative data by assessing SDH screening practices, comfort and personal habits in screening, prioritization of SDH domains, workflows to perform screening, and perceived barriers to screening. Quantitative data were analyzed using descriptive statistics. Qualitative data were analyzed using thematic analysis and multiple reviewers to identify themes in free-text responses. There were 63 HTMs (48% response rate, Table 1), all of whom reported SDH screening efforts should continue in the PED (Fig. 1), yet 36% were unaware of the current SDH screening processes. Participants reported a median comfort level rate of 47.5 out of 100 when asking SDH-related questions (Fig. 1), and the highest reported barriers were “lack of knowledge/skill on resources” (77.3%), “lack of time” (68%), and “patient volume” (59%) (Fig. 2). Regarding the screening process, approximately half of the respondents suggested improvements in “integration of screening” and “variability of screening” (Fig. 4). This explorative analysis demonstrated that HTMs support continuing screening and referring patients for SDH-related needs. In addition, HTM survey respondents suggested improvements in screening and referral processes, opportunities for HTM training, and screening support to address social needs and ultimately improve patient health outcomes

Preoperative Predictors of Ambulation Ability at Different Time Points after Total Hip Arthroplasty in Patients with Osteoarthritis

The aims of this study were to identify the preoperative factors influencing ambulation ability at different postoperative time points after total hip arthroplasty (THA) and to examine the cutoff values of predictive preoperative factors by receiver operating characteristic (ROC) curves. Forty-eight women with unilateral THA were measured for hip extensor, hip abductor, and knee extensor muscle strength in both legs; hip pain (visual analog scale, VAS); and the Timed Up and Go (TUG) test pre- and postoperatively. Multiple regression analysis indicated that preoperative knee extensor strength (β=-0.379,R2=0.409) at 3 weeks, hip abductor strength (β=-0.572,R2=0.570) at 4 months, and age (β=0.758,R2= 0.561) at 7 months were strongly associated with postoperative ambulation, measured using the TUG test. Optimal preoperative cutoff values for ambulation ability were 0.56 Nm/kg for knee extensor strength, 0.24 Nm/kg for hip abductor strength, and 73 years of age. Our results suggest that preoperative factors predicting ambulation ability vary by postoperative time point. Preoperative knee extensor strength, hip abductor strength, and age were useful predictors of ambulation ability at the early, middle, and late time points, respectively, after THA