Effects of Health Insurance Interruption on Loss of Hypertension Control in Women With and Women Without HIV.

BACKGROUND: Among low-income women with and without HIV, it is a priority to reduce age-related comorbidities, including hypertension and its sequelae. Because consistent health insurance access has been identified as an important factor in controlling many chronic diseases, we estimated the effects of coverage interruption on loss of hypertension control in a cohort of women in the United States. METHODS: We analyzed prospective, longitudinal data from the Women's Interagency HIV Study. HIV-infected and HIV-uninfected women were included between 2005 and 2014 when they reported health insurance at consecutive biannual visits and had controlled hypertension, and were followed for any insurance break and loss of hypertension control. We estimated hazard ratios (HRs) by Cox proportional hazards regression with inverse-probability-of-treatment-and censoring weights (marginal structural models), and plotted the cumulative incidence of hypertension control loss. RESULTS: Among 890 HIV-infected women, the weighted HR for hypertension control loss comparing health insurance interruption to uninterrupted coverage was 1.37 (95% confidence interval [CI], 0.99-1.91). Inclusion of AIDS Drug Assistance Program (ADAP) participation with health insurance modestly increased the HR (1.47; 95% CI, 1.04-2.07). Analysis of 272 HIV-uninfected women yielded a similar HR (1.39; 95% CI, 0.88-2.21). Additionally, there were indications of uninterrupted coverage having a protective effect on hypertension when compared with the natural course in HIV-infected (HR, 0.82; 95% CI, 0.61-1.11) and HIV-uninfected (HR, 0.78; 95% CI, 0.52-1.19) women. CONCLUSIONS: This study provides evidence that health insurance continuity promotes hypertension control in key populations. Interventions that ensure coverage stability and ADAP access should be a policy priority.

Impact of Operator Positioning on Musculoskeletal Disorders and Work Habits Among Mississippi Dental Hygienists.

Purpose: The purpose of this study was to assess impact of operator positioning on the development of musculoskeletal disorders (MSDs) and workforce issues among practicing dental hygienists in the state of Mississippi.Methods: The sample consisted of all dental hygienists (n=1,553) licensed in the state of Mississippi. A modified 47 item, online version of the Standardized Nordic Questionnaire was used to document the following: types of MSDs, practice history, operator positioning, ergonomic work habits and the impact of MSDs on workforce issues. Descriptive statistics were used to analyze practice history and work habits. Chi-square analysis examined the relationship between operator positioning and MSDs as well as the relationship between the onset of MSDs and their impact on patient workload, work hours, time off from work, and ability to practice clinical dental hygiene. Survival analyses were used to test the onset of MSDs in relationship to operator positioning.Results: The survey yielded a 22% (n=338) response rate. There was no significant difference in the prevalence of MSDs between those sitting in front of the patient as compared to those sitting behind the patient (PL) (χ2 (1) = 1.67, p=0.196), although respondents sitting behind the patient reported developing their MSDs earlier (χ2 (1) = 3.92, p=0.048). Of the participants who had practiced 15 or more years, 85% reported developing MSDs. However, only 13% reported ever having to modify their patient load. Sixteen percent reported reducing work hours and 21% reported taking time off from work due to MSDs.Conclusions: Regardless of the operator position used, the majority of practicing dental hygienists surveyed developed MSDs earlier than has been previously reported in the literature. Workforce related issues were not shown to have a negative impact on this study population.

Is It a Trust Issue? Factors That Influence Trust for Persons Living With HIV/AIDS.

Trust in one's health care provider, trust in the health care system in general, and even trust in one's community affects engagement in HIV-related health care. This article examines the issue of trust among a random sample of HIV-infected individuals residing in Mississippi, an area hard-hit by the HIV/AIDS epidemic. Five constructs based on survey responses from these individuals were developed: (1) trust in one's provider to offer the best possible medical care, (2) trust in one's provider to protect patient privacy, (3) willingness to disclose HIV status to one's provider, (4) trust in the health care system, and (5) trust in one's community. Findings suggest that interventions to improve trust in providers to deliver the highest quality of care should be targeted to young people, African Americans, and the more highly educated. Interventions to increase trust in providers to protect privacy should focus on creating and strengthening social support groups or networks that build relationships and foster trust. Interventions aimed to increase community trust also should be targeted to young people. This information is useful to researchers, policy makers, health care providers, and organizations interested in prioritizing interventions and strategies that have the greatest potential to reduce health disparities in HIV diagnosis and treatment in the Deep South.

State Health Mapper: An Interactive, Web-Based Tool for Physician Workforce Planning, Recruitment, and Health Services Research.

OBJECTIVES: Health rankings in Mississippi are abysmal. Mississippi also has fewer physicians to serve its population compared with all other states. Many residents of this predominately rural state do not have access to healthcare providers. To better understand the demographics and distribution of the current health workforce in Mississippi, the main objective of the study was to design a Web-based, spatial, interactive application to visualize and explore the physician workforce. METHODS: A Web application was designed to assist in health workforce planning. Secondary datasets of licensure and population information were obtained, and live feeds from licensure systems are being established. Several technologies were used to develop an intuitive, user-friendly application. Custom programming was completed in JavaScript so the application could run on most platforms, including mobile devices. RESULTS: The application allows users to identify and query geographic locations of individual or aggregated physicians based on attributes included in the licensure data, to perform drive time or buffer analyses, and to explore sociodemographic population data by geographic area of choice. This Web-based application with analytical tools visually represents the physician workforce licensed in Mississippi and its attributes, and provides access to much-needed information for statewide health workforce planning and research. CONCLUSIONS: The success of the application is not only based on the practicality of the tool but also on its ease of use. Feedback has been positive and has come from a wide variety of organizations across the state.

Data Lakes and Data Visualization: An Innovative Approach to Address the Challenges of Access to Health Care in Mississippi.

BACKGROUND: There are a variety of challenges to developing strategies to improve access to health care, but access to data is critical for effective evidence-based decision-making. Many agencies and organizations throughout Mississippi have been collecting quality health data for many years. However, those data have historically resided in data silos and have not been readily shared. A strategy was developed to build and coordinate infrastructure, capacity, tools, and resources to facilitate health workforce and population health planning throughout the state. OBJECTIVE: Realizing data as the foundation upon which to build, the primary objective was to develop the capacity to collect, store, maintain, visualize, and analyze data from a variety of disparate sources -- with the ultimate goal of improving access to health care. Specific aims were to: 1) build a centralized data repository and scalable informatics platform, 2) develop a data management solution for this platform and then, 3) derive value from this platform by facilitating data visualization and analysis. METHODS: A managed data lake was designed and constructed for health data from disparate sources throughout the state of Mississippi. A data management application was developed to log and track all data sources, maps and geographies, and data marts. With this informatics platform as a foundation, a variety of tools are used to visualize and analyze data. To illustrate, a web mapping application was developed to examine the health workforce geographically and attractive data visualizations and dynamic dashboards were created to facilitate health planning and research. RESULTS: Samples of data visualizations that aim to inform health planners and policymakers are presented. Many agencies and organizations throughout the state benefit from this platform. CONCLUSION: The overarching goal is that by providing timely, reliable information to stakeholders, Mississippians in general will experience improved access to quality care.

Using a mandatory reporting database to recruit persons living with HIV/AIDS to study access to care in Mississippi.

Using funds provided by the Ryan White Care Act, we conducted a statewide needs assessment of persons living with HIV/AIDS (PLWHA) in Mississippi as required by provisions of the Act. Most published research addressing access to care for PLWHA is based on convenience samples of persons already accessing care in specified clinic locations. For this study of a single state with a well-established mandatory reporting system, we conducted a cross-sectional study interviewing a random sample of PLWHA across the state of Mississippi. The Mississippi State Department of Health has maintained the Mississippi HIV/AIDS Reporting System since its inception in 1980. The database tracks all reported cases of HIV+ cases and includes name, age, last-known address, and other contact information. The sample was selected from a frame of all recorded PLWHA in Mississippi at that time, regardless of their association with care facilities. The purpose of this article is to describe the design and methodology of this study, difficulties encountered in locating this hard-to-reach population, multimethod recruiting strategies and outcomes, and lessons learned. Locating participants using a truly random sample from a mandatory reporting database was resource intensive. However, data collected as a result of these efforts have provided invaluable information on a number of topics important to PLWHA.

Associations between factors affecting access to care and health-related quality of life: results of a statewide HIV/AIDS cross-sectional study.

The objective of this cross-sectional study was to describe the relationship between access to care and health-related quality of life (HRQOL) for persons living with HIV/AIDS (PLWHA) in Mississippi by administering a statewide survey. A random probability sample of PLWHA was derived from the Mississippi State Department of Health's communicable disease tracking system. Interviews were conducted with 220 PLWHA to collect data on access to care, demographic and social characteristics, and HRQOL. Overall, most participants had access to care and reasonable HRQOL. Multivariate and univariate analyses were performed to measure associations between access to care and HRQOL. Univariate analyses showed that age, income, social networks, severity of disease, having been prescribed medications, and having experienced problems accessing care to be significantly associated with HRQOL scales. Multivariate analysis of variance models further demonstrated low-income level, having experienced problems accessing care, and having been prescribed antiretroviral medications to be significantly associated with HRQOL. Reducing barriers is a major factor in improving quality of life. This study provides needed insight into the relationship between access to care and HRQOL among PLWHA in Mississippi, which could be valuable to public health planners to help them better understand how to make the greatest impact on HRQOL.

Determining unmet, adequately met, and overly met needs for health care and services for persons living with HIV/AIDS in Mississippi.

A statewide needs assessment of persons living with HIV/AIDS (PLWHA) was conducted to determine what is known about access to care, utilization of services, and perceived barriers to receiving care and services. Our objective was to determine which needs were being met or unmet among PLWHA in Mississippi to provide a better understanding of how effectively to allocate funding to provide for the needs of that group. In this cross-sectional study, a true random sample of PLWHA in Mississippi was interviewed in 2005-2006. Questions were asked to identify opinions about respondents' experiences with 23 health care services and 30 public or private assistance services. The kappa statistic was used to measure agreement between level of services needed and level of services provided. Services with the lowest kappa scores revealed which services were being either mostly unmet, or even overly met. Greatest service needs were HIV viral load test, Pap smear, CD4/T-cell count test, and medication for HIV/AIDS, which were reasonably well met. The most significantly unmet needs were dental care and dental exams, eye care and eye exams, help paying for housing, subsidized housing assistance, mental health therapy or counseling, access to emotional support groups, and job placement or employment. Overly met services included medical care at a physician's office or clinic and free condoms. This study identified needs perceived to be significantly unmet by PLWHA, as well as areas that were perceived to be adequately or overly met. This information may be used to target areas with the greatest impact for improvement and provide insight into how to effectively allocate health care resources and public/private assistance.

Overcoming data challenges examining oral health disparities in appalachia.

OBJECTIVE: The objective of our study of oral health disparities in Appalachia was to use existing data sources to geographically analyze suspected disparities in oral health status in the 420 counties of Appalachia, and to make sub-state comparisons within Appalachia and to the rest of the nation. The purpose of this manuscript is to describe the methods used to overcome challenges associated with using limited oral health data to make inferences about oral health status. METHODS: Oral health data were obtained from the Behavioral Risk Factor Surveillance System (BRFSS). Because the BRFSS was designed for state-level analysis, there were inadequate numbers of responses to study Appalachia by county. We set out to determine the smallest possible unit we could use, aggregating data to satisfy CDC minimum requirements for spatially identified responses. For sub-state comparisons, data were first aggregated to Appalachian and non-Appalachian regions within Appalachian states. Next, urban versus rural areas within Appalachian and non-Appalachian regions were examined. Beale codes were used to define metropolitan and non-metropolitan statistical regions for the United States. RESULTS: Aggregating the data as described proved useful for smoothing the data used to analyze oral health disparities, while still revealing important sub-state differences. Using geographic information systems to map data throughout the process was very useful for determining an effective approach for our analysis. DISCUSSION: Studying oral health disparities on a regional or national level is difficult given a lack of appropriate data. The BRFSS can be adapted for this purpose; however, there is a limited number of oral health questions and because they are also optional, they are not routinely asked by all states. Expanding the BRFSS to include a larger sampling frame would be very helpful for studying oral health disparities. CONCLUSIONS: Novel techniques were introduced to use BRFSS data to study oral health disparities in Appalachia, which provided informative sub-state results, useful to health planners for targeting intervention strategies.

Demographics and distribution of dentists in Mississippi: a dental work force study.

BACKGROUND: Many segments of the population experience one or more barriers to accessing quality oral health care, including availability of licensed dentists. The purpose of the authors' study was to analyze the availability of dentists in Mississippi by county over four decades to determine the geographic distribution of dentists, shifts in their distribution over time and how this distribution relates to population demographics. METHODS: Dentist-to-population ratios were determined by county from 1970 through 2000. The authors analyzed these data using standardized z scores and geographic information systems (GIS) technology. Results are presented graphically and geographically. RESULTS: Results showed that 55 counties were designated as dental health professional shortage areas in 1970, 51 counties in 1980, 30 in 1990 and 40 in 2000. Counties that have a more favorable ratio of providers to population were determined, indicating areas in which dentists are more likely to practice. CONCLUSIONS: Many geographic areas in Mississippi remain underserved. Identifying these areas is a critical first step when addressing the current state of Mississippi's dental work force. This type of information is useful for decision making as well as responding to the population's oral health care needs. PRACTICE IMPLICATIONS: Results of this study can assist current and future practicing dentists, dental school administrators and policy-makers in making informed decisions for determining suitable practice locations, dental school admissions criteria and areas to target for public health initiatives. This model also is useful for studying work force disparities in other health care professions.

Maximizing the dental workforce: implications for a rural state.

Geographic areas with low socioeconomic status may experience status may experience less access to oral health promotion and oral health care. Approximately 40% of the licensed dentists in Mississippi practice in two metropolitan areas, Jackson and the Gulf Coast. As a result, 38 of the 82 counties in Mississippi have 4,000 or more persons per dentist. With minimal incentives attracting dentists to underserved areas, and with little public health intervention providing first-rate care, education, and prevention, promotion of case referrals for oral health care should be implemented. Several states have loosened restrictions on the level of dental hygienist supervision required in order to extend care to populations in need. For the predominantly rural state of Mississippi, less restrictive supervision of dental hygienists might help address the acute problems of poor oral health and access to care issues.

The child-centered social worker and the sexually abused child: pathway to healing.

The prosecution of child sexual abuse cases continues to be an area in which there is a strain between the judicial system and the social work profession; the former is predominately interested in the conviction of the accused and the later is primarily interested in the protection of the child's emotional well-being. In an effort to assist the sexually abused child throughout the court process, the authors propose the concept of a child-centered social worker committed to minimizing the potential for system-induced trauma by assisting the sexually abused child through the judicial process and providing clinical treatment as well.