Search

Objective: To examine the impact of community-level social determinants of health (SDoH) on the onset of occupational therapy (OT) and physical therapy (PT) services among individuals hospitalized for traumatic brain injury (TBI). Setting: 14 acute care hospitals in the state of Colorado. Participants: We studied 5825 adults with TBI. Design: In a secondary analysis of de-identified electronic health record data, we performed multivariable logistic and linear regressions to calculate odds ratios (ORs) and 95% CIs for the likelihood of receiving services and duration to initiation of services among those who received them. Main Measures: Community-level SDoH, receipt of rehabilitation services, and onset of rehabilitation services. Results: Multivariable logistic and linear regressions revealed that those in top quartiles for community income were associated with duration to OT services, ranging from OR = 0.33 [05% CI, 0.07, 0.60] for quartile 2 to 0.76 [0.44, 1.08] for quartile 4 compared with those with the lowest quartile. Only the top quartile differed significantly for duration to PT services (0.63 [0.28, 0.98]). Relative to those with below the median community percentage of high school degree, those with above the median were associated with duration to PT services only (−0.32 [−0.60, −0.04]). Neither community percentage with bachelor's degree nor rural-urban designation was associated with duration to either therapy service. Conclusion: Further research is needed to determine whether our SDoH variables were too diffuse to capture individual experiences and impacts on care or whether community-level education and income, and rurality, truly do not influence time to therapy for patients hospitalized with TBI. Other, individual-level variables, such as age, comorbidity burden, and TBI severity, demonstrated clear relationships with therapy onset. These findings may help therapists evaluate and standardize equitable access to timely rehabilitation services. [ABSTRACT FROM AUTHOR]

Microfinance as a tool for poverty alleviation has attracted much attention especially after Grameen Bank of Bangladesh was awarded the Noble peace prize. Self-help groups (SHGs) in India, which originated during the same time as Grameen Bank, are considered to be an efficient mechanism for delivering microfinance to the poor. Apart from providing economic benefits, participation in SHG also brings for its members social and political empowerment. This paper examines the impact of the level of participation in SHGs on the empowerment (economic, social and political) of women SHG members. The study also investigates the impact of moderating variables, such as socio-economic status, age, and place of residence, on the relationship between the level of participation and empowerment. As we were unable to find suitable scales in the existing literature to measure the level of participation, empowerment (economic, social and political) and socio-economic status, we developed new scales to measure these constructs. Using an interview schedule in a survey method, we interviewed 353 women SHG members from the eastern Indian state of Odisha to collect primary data. Using partial least squares structural equation modeling (PLS-SEM), the study explicates the relationship between level of participation and women empowerment. The findings suggest that an increased level of participation in SHGs results in enhanced economic empowerment of its members by bringing in employment opportunities, higher income, stability in current jobs, and improved entrepreneurial abilities. Besides, higher participation also brings in higher social empowerment of members in the form of decision-making capability in households, access to health care, self-confidence, heightened self-esteem, communication skills, and the ability to transact with banks and NGOs. In addition, increased participation in SHGs leads to higher political empowerment in the form of higher political participation and better community mobilization. Socio-economic status and place of operation significantly moderate the effect of the level of participation on women (SHG member) empowerment. Insights from this study are helpful for the government and non-government agencies working towards empowering women in developing regions. They may take note of the different indicators of participation and role of the significant moderators while implementing similar programs. JEL Classifications: C12, O15, Z13 Keywords: Participation, Self-Help Groups, Women Empowerment, Socio-Economic Status, Microfinance, Microcredit Corresponding Author's Email Address: aknayak@iimidr.ac.in, INTRODUCTION Developing the underdeveloped has remained the focus of welfare states. Government and non-government agencies in India for long have been implementing numerous programs to fulfill this objective. The Self-help [...]

Historically, minority women have had limited access to health care resources. Healthy People 2020 identified the promotion of activity and wellness as a key for eliminating heath disparities in ethnic minorities, as minority women are not significant consumers of exercise programming. This study explored participation of a sample of underserved African American women in an individualized Zumba exercise program. The underserved sample was taken from a postindustrial Midwestern city. Participants (n = 35, [M.sub.age] = 45.75) completed a 4-month aerobic intervention program offered through an accessible gym. At program completion, they responded to a semistructured survey that gauged reasons for participation, perceived enjoyment, and effectiveness. In addition, the survey prompted recommendations and suggestions for future programming. Low cost and entertainment aspects were the most commonly cited reasons for participation. Most participants found the program enjoyable and effective and expressed interest for participating in similar events in the future., Cardiovascular disease is the number one cause of death in the United States, and African American women are particularly at risk for cardiovascular disease, with an age-adjusted rate of cardiovascular [...]

Objective To Investigate the effect of using volunteer screeners in active tuberculosis case-finding in South Kivu, the Democratic Republic of the Congo, especially among groups at high risk of tuberculosis infection. Methods To identify and screen high-risk groups in remote communities, we trained volunteer screeners, mainly those who had themselves received treatment for tuberculosis or had a family history of the disease. A non-profit organization was created and screeners received training on the disease and its transmission at 3-day workshops. Screeners recorded the number of people screened, reporting a prolonged cough and who attended a clinic for testing, as well as test results. Data were evaluated every quarter during the 3-year period of the intervention (2014-2016). Findings Acceptability of the intervention was high. Volunteers screened 650434 individuals in their communities, 73418 of whom reported a prolonged cough; 50 368 subsequently attended a clinic for tuberculosis testing. Tuberculosis was diagnosed in 1 in 151 people screened, costing 0.29 United States dollars (US$) per person screened and US$ 44 per person diagnosed. Although members of high-risk groups with poorer access to health care represented only 5.1% (33 002/650434) of those screened, they contributed 19.7% (845/4300) of tuberculosis diagnoses (1 diagnosis per 39 screened). The intervention resulted in an additional 4300 sputum-smear-positive pulmonary tuberculosis diagnoses, 42% (4 300/10247) of the provincial total for that period. Conclusion Patient-led active tuberculosis case-finding represents a valuable complement to traditional case-finding, and should be used to assist health systems in the elimination of tuberculosis. Objectif ttudier les eftets de I utilisation dexaminateurs volontaires dans le depistage de la tuberculose active au Sud-Kivu, en Republique democratique du Congo, en particulier dans les groupes exposes a un risque eleve d'infection tuberculeuse. Methodes Afin d'identifier et d'examiner des groupes a haut risque dans des communautes isolees, nous avons forme des examinateurs volontaires, qui etaient principalement des individus ayant eux-memes recu un traitement contre la tuberculose ou ayant un antecedent familial de la maladie. Une organisation a but non lucratif a ete creee et les examinateurs ont recu uneformation sur la maladie et sa transmission dans le cadre d'ateliers de 3 jours. Les examinateurs ont enregistre le nombre de personnes examinees, faisant etat d'une toux prolongee et qui se sont rendues dans un centre de consultation pour beneficier d'un depistage, ainsi que les resultats des examens. Les donnees ont ete evaluees tous les trimestres pendant les 3 ans qu'a dure l'intervention (2014-2016). Resultats L'acceptabillte de l'intervention etait elevee. Les volontaires ont examine 650 434 membres de leurs communautes, parmi lesquels 73 418 ont fait etat d'une toux prolongee; 50 368 se sont ensuite rendus dans un centre de consultation pour beneficier d'un depistage de la tuberculose. La tuberculose a ete diagnostiquee chez 1 personne examinee sur 151, pour un cout de 0,29 dollar des Etats-Unis (US$) par personne examinee et 44 US$ par personne diagnostiquee. Bien que les membres des groupes a haut risque qui ont un acces plus restreint aux soins de sante ne representaient que 5,1% (33 002/650434) des personnes examinees, ils representaient 19,7% (845/4300) des cas de tuberculose diagnostiques (1 personne diagnostiquee sur 39 personnes examinees). L'intervention a donne lieu a 4300 autres diagnostics de la tuberculose pulmonale afrottis positif,soit42% (4300/10 247) du total de la province pour la periode consideree. Conclusion Le depistage de la tuberculose active par les patients complete utilement le depistage traditionnel et devrait etre utilise pour aider les systemes de sante a eradiquer la tuberculose. Objetivo Investigar el efecto del uso de examinadores voluntarios para la deteccion de casos de tuberculosis activa en Kivu del Sur (Republica Democratica del Congo), sobre todo entre los grupos de alto riesgo de infeccion por tuberculosis. Metodos Para identificar y examinar los grupos de alto riesgo en comunidades remotas, hemos formado a examinadores voluntarios, principalmente aquellos que habian recibido tratamiento para la tuberculosis o tenian antecedentes familiares de la enfermedad. Se creo una organizacion sin animo de lucroy los examinadores recibieron formacion sobre la enfermedad y su transmision en talleres de tres dias. Los examinadores registraron el numero de personas examinadas que mostraban una tos prolongada y que acudian a una clinica para hacerse la prueba, asi como los resultados de la prueba. Los datos se evaluaron cada trimestre durante el periodo de tres anos de la intervencion (2014-2016). Resultados La aceptacion de la intervencion fue elevada. Los voluntarios examinaron a 650 434 personas en sus comunidades, 73 418 de las cuales presentaron una tos prolongada; posteriormente, 50 368 acudieron a una clinica para someterse a pruebas de tuberculosis. Se diagnostico tuberculosis a 1 de cada 151 personas examinadas, lo que costo 0,29 USD por persona examinada y 44 USD por persona diagnosticada. Aunque los miembros de los grupos de alto riesgo con peor acceso a la atencion de la salud representaban solo el 5,1 % (33 002/650434) de los examinados, supusieron el 19,7% (845/4300) de los diagnosticos de tuberculosis (1 diagnostico por cada 39 examinados). La intervencion dio como resultado 4300 diagnosticos adicionales de tuberculosis pulmonar con frotis de esputo positivo, el 42% (4300/10 247) del total provincial durante el periodo. Conclusion La busqueda de casos de tuberculosis activa dirigida por el paciente representa un complemento valioso a la busqueda de casos tradicional y deberia utilizarse para ayudar a los sistemas sanitarios a eliminar la tuberculosis., Abstracts in [phrase omitted] and Espanol at the end of each article. [phrase omitted] Introduction Of the estimated 10.4 million people worldwide who developed tuberculosis in 2016, one third of [...]

Objectives In 2013, Kenya removed delivery fees at public health facilities in an effort to promote equity in access to health services and address high maternal mortality. This study determines the effect of the policy to remove user fees on institutional delivery in a population-based sample of women from urban Kenya. Methods Longitudinal data were collected from a representative sample of 8500 women from five cities in Kenya in 2010 with a follow-up interview in 2014 (response rate 58.9%). Respondents were asked about their most recent birth since 2008 at baseline and 2012 at endline, including the delivery location. Multinomial logistic regression is used, controlling for the temporal time trend and background characteristics, to determine if births which occurred after the national policy change were more likely to occur at a public facility than at home or a private facility. Results Multivariate findings show that women were significantly more likely to deliver at a public facility as compared to a private facility after the policy. Among the poor, the results show that poor women were significantly more likely to deliver in a public facility compared to home or a private facility after policy change. Conclusions for Practice These findings show Kenya's progress towards achieving universal access to delivery services and meeting its national development targets. The removal of delivery fees in the public sector is leading to increased use of facilities for delivery among the urban poor; this is an important first step in reducing maternal death., Author(s): Lisa M. Calhoun [sup.1] , Ilene S. Speizer [sup.1] [sup.2] , David Guilkey [sup.1] [sup.3] , Elizabeth Bukusi [sup.4] Author Affiliations: (Aff1) 0000000122483208, grid.10698.36, Carolina Population Center, The University [...]

Canada is a huge country with a large rural population. The health of Canadians living in remote, rural and indigenous communities is substantially worse than the general population. In general, [...]