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- Title:
- Understanding Racial Disparities in Low Birth Weight
- Abstract:
- This paper summarizes the research on the epidemiology of low birth weight (LBW) births focusing on the evidence about disparities in low birth weight for Black infants in the US. Studies have continually shown that Black mothers and their infants are at higher risk for pregnancy-related complications such as LBW. LBW, a leading cause of infant death for this racial group, is associated with a multitude of risk factors, with the major two dimensions being health status and health care. Evidence suggests that the accumulation of chronic stress over a lifetime culminates in health problems for Black women, thus leading to the conditions for LBW to occur. There is growing acceptance of the context of societal and systemic racism that creates a toxic and harmful environment for Black mothers and how this results in physiological stress that directly causes infant and maternal mortality. Although racial disparities in low birth weight are widely known in the medical community, prevention requires addressing the harmful social conditions that underlie these inequitable outcomes. This paper focuses on the way in which Black women and infants are disproportionately burdened with the effects of LBW. It concludes by discussing how changes can, with careful consideration and implementation, drive efforts to protect the Black infants and mothers as part of a holistic, patient-centered approach.
- Keyword:
- low birth weight, Black infants, racial disparities, physiological stress
- Subject: MESH:
- Infant, Low Birth Weight, Black People, Health Disparate, Minority and Vulnerable Populations, Psychological Distress
- Subject: Geographic Name:
- United States
- Creator:
- Jones, Kiana A.
- Publisher:
- DigitalHub. Galter Health Sciences Library & Learning Center
- Language:
- English
- Date Created:
- 2021-05-17
- Rights:
- http://creativecommons.org/licenses/by/4.0/
- Resource Type:
- Masters Thesis
- Title:
- Understand success and challenges in adaptation and implementation of Quality Improvement Collaboratives to help End the HIV Epidemic in Namibia and Zimbabwe
- Abstract:
- Background: Improving HIV health care quality remains an unfulfilled goal necessary to both reduce mortality for people living with HIV and reach epidemic control. Although a common strategy, improvement collaboratives (ICs) are variably effective in improving quality and better understanding of their implementation and adaptation to local contexts is needed. We applied implementation science methods to study how Ministry of health-led ICs supported by UCSF-HEALTHQUAL were implemented in Namibia and Zimbabwe to support and accelerate improvement in the HIV care cascade including rapid uptake of ART and viral load suppression. Methods: We applied two implementation research frameworks, EPIS [Exploration, Preparation, Implementation, and Sustainment] and CFIR [Consolidated Framework for Implementation Research] to guide data collection and analysis for a retrospective mixed methods case study of the ICs. We conducted nine key informant interviews, field observations, and document review to identified implementation strategies contextual factors and implementation outcomes. Results were synthesized using content analysis and organized by EPIS stage. Results: Many implementation strategies for both countries were similar across the exploration, preparation and implementation stages, including alignment with national priorities and guidelines, leveraging existing relationships with stakeholders, QI capacity-building, and adaptations of IC components and data collection tools. Important contextual factors of both ICs were: national leadership, donor funding and country resources, baseline national and local QI knowledge, capacity and culture, existing implementation partnerships, data system integrity, and geography. All sites in both countries completed QI projects. Active peer-to-peer learning occurred; and improvement was demonstrated in many of the targeted measures. Implementation challenges encountered included data validity and quality, finite resources and staff turnover. Limited information was available for sustainment improvement, but both countries have scaled ICs, indicating longer term capacity in QI. Conclusions: Successful implementation of ICs involved adaptation to local context and other strategies which leveraged facilitating factors and addressed barriers with strong adoption and fidelity. Other key lessons included early stakeholder engagement, national leadership engagement, alignment with national priorities, and attention to developing QI capacity. These results can inform future efforts to accelerate improvement of HIV care and treatment through ICs in the region and improving quality more broadly.
- Keyword:
- HIV, health care quality, improvement collaboratives, Namibia, Zimbabwe, epidemic
- Subject: MESH:
- HIV, Quality of Health Care, Intersectoral Collaboration, Epidemics
- Subject: Geographic Name:
- Namibia, Zimbabwe
- Creator:
- Jok, Christie, Hirschhorn, Lisa Ruth, Persaud, Udita, Agins, Bruce, Murungu, Joseph, Basenero, Apollo, Neidel, Julie, Khabo, Bobbie, Mabuko, Japhet, Ikeda, Dan, Schaefer, Willemijn
- Publisher:
- DigitalHub. Galter Health Sciences Library & Learning Center
- Language:
- English
- Date Created:
- 2021-05-24
- Rights:
- http://creativecommons.org/licenses/by/4.0/
- Resource Type:
- Masters Thesis
- Title:
- Using Natural Language Processing to Identify and Classify Incidental Findings
- Abstract:
- Over the last few years there has been an explosion of deep learning research leading to quick development of very powerful algorithms that have found their way into every industry. There are a few major reasons why deep learning is particularly attractive for algorithm development. The algorithms can complete complex tasks with surprisingly high accuracy. Deep learning models, unlike machine learning models, automatically extract features that are important for the algorithms task. The deep learning community has established and open-sourced high quality feature extractors and classifier architectures with weights included for most data domains. Lung cancer is a major cause of morbidity and mortality in the US and globally. Lung cancers are conditions that include a silent phase during which intervention is highly effective, but patients are asymptomatic so there is no indication for an exam. It is common that patients with symptoms unrelated to a forming cancer get imaging to work-up their current illness. During these times an incidental nodule in the lungs may be captured and a radiologist may recommend a follow-up, but there are few mechanisms in place to ensure that these patients have their follow-up completed. As a point of quality control, NM would like to maximize the likelihood that a patient with an incidentally noted lung nodule with follow-up recommendations will receive appropriate follow-up. In order to meet this goal, we have developed an EHR ready artificial intelligence pipeline that identifies reports containing text suggesting a lung nodule requiring follow-up. We find that upon retrospective review, we are able to use machine learning to capture reports containing lung nodules requiring follow-up with a sensitivity of 87% and specificity of 87%.
- Keyword:
- deep learning, algorithms, lung cancer, lung nodule
- Subject: MESH:
- Deep Learning, Algorithms, Lung Neoplasms
- Creator:
- Galal, Galal
- Contributor:
- Huang, Jonathan, Mukhin, Vladislav, Soni, Priyanka, Byrd, Thomas, Etemadi, Mozziyar
- Publisher:
- DigitalHub. Galter Health Sciences Library & Learning Center
- Language:
- English
- Date Created:
- 2021-04-16
- Rights:
- http://creativecommons.org/licenses/by/4.0/
- Resource Type:
- Masters Thesis
- Title:
- Identifying Predictors of Long Length of Stay and Mortality for General Surgery Patients in Surgical Intensive Care Units: A Comparative Study
- Abstract:
- Objective: Approximately 5 million patients are admitted to intensive care units (ICUs) annually in the United States, with 500,000 of these patients dying per year during their admission. We aim to provide unadjusted rates of complications and mortality in a cohort of surgical ICU patients and to compare outcomes between a large, urban, academic referral center and community hospitals using a risk-adjusted model. Methods: We constructed a retrospective cohort of patients who underwent general surgery procedures and stayed in the surgical ICUs at Northwestern Memorial Hospital (NMH), Central DuPage Hospital (CDH), and Lake Forest Hospital (LFH) from March 2018-April 2021. Patients at the latter suburban community hospital sites were grouped. Patients treated at NMH versus CDH and LFH were compared using univariate analyses of complications and mortality and multivariable analyses adjusted for patient clinical and sociodemographic characteristics. Results: Univariate analysis demonstrated that an ICU stay at NMH was associated with higher rates of hyperglycemia (45.8% vs. 30.7%, p <0.001), malnutrition (33.3% vs. 20.5%, p<0.001), and wound infections (8.9% vs 4.9%, p = 0.03), but lower mortality rates (4.7% vs 8.8%, p = 0.006). BMI, ASA score, surgery type, and having subsequent procedures were the characteristics most commonly associated with adverse events. Multivariate analysis demonstrated that hospital site was not significantly associated with long length of stay (OR = 1.1 [0.60-2.03]) but being treated at CDH/LFH was associated with higher mortality (OR = 2.34 [1.16-4.73]). Discussion: These data provide baseline rates of adverse outcomes in a large cohort of surgical ICU patients, and show that mortality, but not length of stay, may differ between the surgical ICUs studied. Our results provide a foundation for future study of surgical ICU outcomes within the Northwestern Healthcare network and may be hypothesis-generating for additional research within this population.
- Keyword:
- intensive care unit, hospital, mortality
- Subject: MESH:
- Hospital Mortality, Intensive Care Units, Surgical Procedures, Operative, Length of Stay
- Subject: Geographic Name:
- Illinois--Northern
- Creator:
- Bushara, Omar
- Publisher:
- DigitalHub. Galter Health Sciences Library & Learning Center
- Language:
- English
- Date Created:
- 2021-05-11
- Rights:
- http://creativecommons.org/licenses/by/4.0/
- Resource Type:
- Masters Thesis
- Title:
- The Association Between Timely Access to Pediatric Appendicitis Care and Neighborhood Factors
- Abstract:
- BACKGROUND: Appendicitis is the most common acute pediatric surgical condition, with 30% of patients presenting as complicated. Complicated appendicitis may indicate a delay in seeking care, resulting in higher complication rates, longer lengths of stay and higher readmission rates compared to simple appendicitis and can serve as indicator for access to care. Although patient-level and neighborhood-level factors can affect timely access to care, the effect of neighborhood factors on access to pediatric surgical care remains poorly understood. We examined the association between neighborhood social determinants of health and the odds of presenting with complicated appendicitis and unplanned post-discharge healthcare utilization. METHODS: A retrospective, cohort study of pediatric patients with appendicitis between 2016-2018 were identified using the Pediatric Health Information System (PHIS) database. Neighborhood characteristics were captured using the Child Opportunity Index (COI), a validated, comprehensive measure of 29 neighborhood characteristics known to impact childrens health. Nationally-normalized COI measurements were divided into quintiles from very low to very high opportunity. Hierarchical logistic regression was used to model the odds of presenting with complicated appendicitis as a function of COI. Adjustments included age, sex, race/ethnicity and insurance. A similar model was assessed for unplanned healthcare utilization, including emergency department visits and readmissions. RESULTS: A total of 67,489 patients had appendicitis with 21,728 (32.2%) being complicated. Patients were 43.3% non-Hispanic white, 60.1% male, 47.8% publicly-insured, and predominantly aged 10-14 years (42.7%). Patients living in very low COI neighborhoods were 34% more likely to present with complicated appendicitis (OR 1.34, 95%CI 1.26, 1.42) compared to those in very high COI neighborhoods. There was no significant association between COI level and unplanned post-discharge healthcare utilization. CONCLUSIONS: Children living in lower COI neighborhoods had an increased risk of presenting with complicated appendicitis; however, neighborhood characteristics were not associated with unplanned healthcare utilization post-discharge. Given increased interest among health systems, public health organizations and third-party payers in mitigating the effects of disadvantaged neighborhood characteristics on health outcomes, these findings may inform policies and programs that seek to improve equitable outcomes in pediatric surgical care.
- Keyword:
- Social Determinants of Health, pediatric surgery, appendicitis, neighborhood
- Subject: MESH:
- Pediatrics, Appendicitis, Social Determinants of Health, Neighborhood Characteristics
- Creator:
- Bouchard, Megan E, Kan, Kristin, Tian, Yao, Casale, Mia, Smith, Tracie, DeBoer, Christopher, Linton, Samuel C, Abdullah, Fizan, Ghomrawi, Hassan
- Publisher:
- DigitalHub. Galter Health Sciences Library & Learning Center
- Language:
- English
- Date Created:
- 2021-03-04
- Rights:
- http://creativecommons.org/licenses/by/4.0/
- Resource Type:
- Masters Thesis
- Title:
- Identifying mobile health technology experiences and preferences of low-income pregnant women with diabetes
- Abstract:
- BACKGROUND: Rapid expansion of mobile technology has resulted in the development of many mobile health ("mHealth") platforms for health monitoring and support. However, applicability, desirability, and tailoring of these platforms for pregnant women, particularly in populations who experience the greatest health inequitiessuch as women with diabetes mellitus (DM) and/or those with greater socioeconomic barriersremains unknown. The objective is to understand low-income pregnant women's experiences and preferences for mHealth tools to support pregnancy and improve DM self-management. METHODS: Low-income pregnant and postpartum women were included in individual interviews or focus groups; women with and without type 2 or gestational DM were included. Analysis was performed with the constant comparison method. RESULTS: In this population of 45 (N=37 with DM) low-income, largely minority, pregnant and postpartum women, 100% reported access to smartphones and prior experience with apps. Interest in mHealth to support health and engagement during pregnancy was high. Preferences for general mHealth features included education that reduces uncertainty, support communities, visualizing progress, convenient access to information, and support for better management of pregnancy-related tasks. Preferred design elements included personalization, interactive features, and integrated graphics. Women with DM expressed multiple additional DM-specific needs, including support tools for DM self-management and self-regulation tasks.
- Keyword:
- behavioral intervention, diabetes, mobile health, pregnancy, smartphone
- Subject: MESH:
- Diabetes Mellitus, Psychosocial Intervention, Pregnancy, Smartphone, Telemedicine
- Creator:
- Birch, Eleanor, Leziak, Karolina, Jackson, Jenise, Strohbach, Angelina, Niznik, Charlotte, Yee, Lynn M
- Publisher:
- DigitalHub. Galter Health Sciences Library & Learning Center
- Language:
- English
- Date Created:
- 2021-04-12
- Rights:
- http://creativecommons.org/licenses/by/4.0/
- Resource Type:
- Masters Thesis
- Title:
- Sustainable Agriculture and Natural Resource Management in Sub-Saharan Africa for Climate Change Resilience
- Abstract:
- Climate change repercussions in Sub-Saharan Africa are permeating both natural and human systems in numerous ways. This paper therefore seeks to identify (1) sustainable agricultural policies and (2) natural resource management policies that would improve climate change resilience in Sub-Saharan Africa. It adopts a multi-goal policy analysis approach. The literature review on policy formulation and implementation revealed several themes, such as complex relationships between actors, disjointed policy implementations, and a one-size-fits-all approach. Furthermore, the policy analysis reveals that national policy for alternative agriculture, green economy, and agricultural and environmental schemes have different predicted outcomes in their implementations as climate change resilience strategies in Sub-Saharan Africa. Concerning agricultural policies that would enhance climate change resilience in Sub-Saharan Africa, alternative agricultural practices include dependence on recycled and green practices, animal manure, and localized and friendly land tillage. The green economy entails layered agricultural systems and the cultivation of local plants, while agri-environmental schemes encompass practices such as organic farming and crop rotation. This paper recommends a combination of national policies for alternative agriculture, the green economy, and agri-environmental schemes to build climate change resilience in agriculture and natural resource management in Sub-Saharan Africa.
- Keyword:
- climate change, sustainability, agriculture, natural resources, Sub-Saharan Africa, national policy
- Subject: MESH:
- Climate Change, Natural Resources, Environmental Policy
- Subject: LCSH:
- Sustainable agriculture
- Subject: Geographic Name:
- Africa, Sub-Saharan
- Creator:
- Berbos, Emma
- Publisher:
- DigitalHub. Galter Health Sciences Library & Learning Center
- Language:
- English
- Date Created:
- 2021-04-29
- Rights:
- http://creativecommons.org/licenses/by/4.0/
- Resource Type:
- Masters Thesis
- Title:
- 2021-2022 Series 09 NUCATS Articulating your Mentoring Philosophy and Plan
- Description:
- Presentation discusses the different between a mentoring plan and mentoring philosophy, the "how's" and "why's" of mentoring, and creating a mentoring philosophy that is unique to you. This presentation was highly interactive leaving time for participants to reflect and write on their own throughout.
- Keyword:
- NUCATS, Mentoring, Mentoring Philosophy, Mentoring Plan
- Subject: MESH:
- Mentoring
- Creator:
- Goodman, Adam
- Publisher:
- DigitalHub. Galter Health Sciences Library & Learning Center
- Language:
- English
- Date Created:
- 2022-06-09
- Rights:
- http://creativecommons.org/licenses/by-nc/3.0/us/
- Resource Type:
- Presentation
- Title:
- Quality Improvement for the Global Health Trainee
- Keyword:
- quality improvement , global health education
- Subject: MESH:
- Global Health, Quality of Health Care
- Creator:
- Visek, Caitlin Anne
- Contributor:
- Doobay-Persaud, Ashti
- Publisher:
- DigitalHub. Galter Health Sciences Library & Learning Center
- Language:
- English
- Rights:
- http://creativecommons.org/licenses/by-nc-sa/3.0/us/
- Resource Type:
- Other
- Title:
- Global Health Quality Improvement Educational Resources
- Keyword:
- quality improvement , global health education
- Subject: MESH:
- Global Health, Quality of Health Care, Education, Distance
- Creator:
- Visek, Caitlin Anne
- Contributor:
- Doobay-Persaud, Ashti
- Publisher:
- DigitalHub. Galter Health Sciences Library & Learning Center
- Rights:
- http://creativecommons.org/licenses/by-nc-sa/3.0/us/
- Resource Type:
- Other