35333 research outputs found
Sort by
Enhancing Disease Surveillance In Conflict Settings: An Ecological Case Study On Cholera In Sudan At The Intersection Of Environmental And Conflict Drivers
Full text linkCholera outbreaks are complex and driven by an interaction of environmental circumstances and conflict-related disruptions, yet few studies have integrated both in the context of conflict regions. This ecological study examines cholera transmission dynamics in Sudan from 2016 to 2025, exploring temporal associations using cross-correlation analysis and applying generalized additive mixed models (GAMMs) to analyze the influence of remotely sensed environmental variables (rainfall, temperature, NDVI, NDWI) and conflict indicators (civilian targeting, political violence, demonstrations) on cholera cases. Weekly cholera surveillance data, combined with satellite-derived environmental variables and conflict event datasets, were modeled across two time periods: pre-conflict (2016-2018) and active conflict (2023-2025). Findings reveal that vegetation density (NDVI) was a consistent environmental driver of cholera across both pre-conflict and conflict periods. Associations between environmental factors and cholera strengthened during conflict, likely due to the collapse of WASH infrastructure increasing population vulnerability to climate shifts. Rainfall showed mixed and modest effects across models and became more pronounced when conflict factors were included. Nighttime temperatures were positively associated with cholera risk, reflecting bacterial survival in warmer conditions, while lower surface water availability (NDWI) was associated with higher cholera cases, potentially due to reliance on other unsafe water sources. Conflict-related variables, particularly civilian targeting and demonstration events during Period 2, were strongly associated with increased cholera risk. Spatial analyses reveal that reporting gaps overlap with conflict-affected regions, suggesting that true cholera burden is significantly underestimated. Together, these findings show the importance of integrating remote sensing and conflict event data into cholera surveillance frameworks. This highlights the critical role of environmental monitoring in strengthening early warning systems when traditional surveillance is disrupted by violence
Under-Five Malaria And Malnutrition Syndemic In Rajasthan
No full textBackground: The syndemic of severe acute malnutrition (SAM) and malaria in under-five children in Rajasthan presents a critical public health challenge. Current SAM and malaria programs are implemented as siloed interventions despite the potential benefits of integrated approaches. A better understanding of the interactions between these factors is important to strengthen the delivery of integrated services.
Objective: This study investigates the relationship between under-five SAM and malaria infections at the block level in Rajasthan to inform targeted, integrated interventions. By running regression analysis, we will identify associations between these co-occurring health threats to guide state-level policy integration. To the best of our knowledge, this is the first study to analyze SAM and malaria data for under-five children spanning 4 years (2017-2020) at the block level for the state of Rajasthan using a repeated cross-sectional design. We hypothesize that blocks with higher under-five SAM cases are more likely to experience higher malaria prevalence.
Methods: Data were retrieved from the Health Management Information System (HMIS) government portal and are used to examine block-level associations between under-five block level SAM cases and under-five block-level malaria cases.
Results: Negative binomial regression analysis revealed a positive and statistically significant association between number of under-five severe acute malnutrition (SAM) cases and malaria case counts at the block level in Rajasthan (β = 0.058, p \u3c 0.001). After adjusting for sociodemographic and temporal variables, each additional SAM case was associated with an approximately 5.8% increase in malaria cases in the under-five population at the block level . However, none of the sociodemographic variables were statistically significant predictors of under-five malaria case counts.Conclusion: Under-five SAM and malaria should be addressed in tandem, especially in high burden blocks in Rajasthan. Given the substantial sociodemographic variability across blocks, nutrition and malaria interventions should be tailored to hyperlocal needs to optimize resource allocation
Ecuador: National Bank Holiday, 1999
Full text linkAfter a series of exogenous shocks hit Ecuador’s economy in 1997 and 1998, foreign creditors reduced external credit lines to the country, draining liquidity. The newly created Deposit Guarantee Agency (Agencia de Garantía de Depósitos, AGD) administered deposit insurance and a new blanket guarantee and had the authority to resolve failing banks. Despite these actions, bank runs continued. After depositors reportedly withdrew USD 400 million from banks over a two-week period, on Monday, March 8, 1999, one hour before banks were supposed to open, the bank superintendent declared a surprise bank holiday effective that day; banks reopened a week later on, March 15, 1999. On Thursday, March 11, the president and finance minister announced a one-year partial freeze on different types of deposits (demand, savings, time), repurchase transactions, and mutual funds. The freeze significantly contracted liquidity and virtually halted all financial activity. Runs and bank failures continued throughout 1999, and the government adopted the US dollar as Ecuador’s official currency in early 2000 to stabilize the system and prevent hyperinflation. The government gradually unfroze many accounts earlier than planned, including savings and checking deposits. In November 1999, the Constitutional Tribunal declared account freezes unconstitutional. In early 2000, the government proposed a schedule for unfreezing time deposits, starting in mid-March. The central bank later said that the holiday and deposit freezes had failed to restore confidence in the banking system
United States: National Bank Holiday, 1933
Full text linkBy mid-February 1933, the United States was in the depths of the Great Depression and the banking system faced sustained depositor runs and currency hoarding. On February 14, the governor of Michigan declared a holiday for all banks and trusts in the state. There followed a wave of declared bank holidays and bank runs across the country. The public withdrew 1.2 billion, or two-thirds of the decline in deposits since the beginning of February, had returned to the banking system
Lessons Learned: Luis Jácome
No full textLuis Jácome was appointed president of the board of Ecuador’s central bank in 1998 by newly elected President Jamil Mahuad. He and other members of the board resigned in 1999 in protest against a number of crisis-intervention measures they saw as threatening the bank’s independence to set monetary policy. Since the 1970s, Ecuador’s economy had experienced a period of growth fueled by oil exports, but by the mid-1990s the economy was reeling from a series of shocks, among them: a sharp drop in the price of oil, the effects of severe flooding on the country’s agricultural production, and the cost of waging a war with neighboring Peru. The shocks destabilized the country’s banking system, leading to bank runs and spiraling depreciation of the currency. Mahuad was deposed by a military coup in January 1999 and replaced by his vice president, Gustabo Noboa. Shortly after the coup, Ecuador replaced the Ecuadorian sucre with the US dollar, which helped to halt bank runs and restored some trust in the financial system
Reducing Structural Barriers In The Pediatric Transplant Selection Process: Assessing And Intervening Using A Standardized Psychosocial Assessment Tool
No full textEvidence shows that implicit bias adversely impacts health outcomes for disenfranchised marginalized patients, and pediatric liver transplant candidates are susceptible to the effects of bias. Existing liver transplant selection processes for pediatric candidates do not include a standardized psychosocial assessment tool which might limit the chances of implicit bias impacting the pre-evaluation. The DNP project piloted the use of a standardized psychosocial assessment protocol, the Pediatric Transplant Rating Instrument (P-TRI), in pediatric patient pre-transplant evaluation and evaluated its effectiveness by comparing to results to the existing psychosocial assessment process in retrospective vs. prospective cohorts. Results using the existing assessment process showed a total of 24 of 40 participants were approved for transplant candidacy, 10 of 20 (50%) from the retrospective cohort compared to 14 of 20 (70%) prospectively evaluated. With implementation of standardized P-TRI assessment and referrals, all 20 participants (100%) in the prospective cohort were approved for transplant candidacy. Referrals were made in 8 of 20 children in the retrospective cohort compared to 19 of 20 in the prospective cohort, with 37 of 48 referrals placed in the prospective cohort. The project findings offer novel information regarding the impact of a standardized assessment protocol on decision-making in pediatric transplantation. Using an objective screening process with intervention and referral for patient and family needs related to clinical, psychosocial, economic, and demographic factors improved the likelihood of children being listed as candidates for liver transplant, and offered the opportunity for life saving treatment once structural barriers to care were addressed
Transgender And Gender Diverse People – Inclusive Healthcare System Access
Full text linkTransgender and Gender Diverse People – Inclusive Healthcare System AccessPurpose: This DNP project implemented a dual strategy to increase system-wide access to care and awareness of the needs of transgender and gender diverse people. Background: The 2015 U.S. Transgender Survey is the most recent and largest survey of its kind in the United States comprising a total of 27,715 responses. (National Center for Transgender Equality, 2015, U.S. Transgender Survey). The results of this survey are as follows: 1) 26% of the total national respondents experienced insurance issues for gender affirming healthcare or being denied coverage for routine care; 2) 32% reported a negative experience in a healthcare setting; 3) 27% reported not seeing a doctor for fear of healthcare mistreatment; 4) 28% did not seek medical help because of financial limitations; and 5) 13% reported a healthcare professional or religious advisor attempted to stop them from being transgender. As evidenced in these findings, almost 60% of the respondents directly reported having a negative experience or fearing mistreatment in healthcare settings. This particular finding, along with the other concerning results of this survey, validate the prevalence of healthcare avoidance within the TGD population. Methods: 16 nurse leaders participated in a 60 minute interactive didactic seminar sessions, focused on understanding the significance of inclusive language (gender, pronouns, and name) and standardized communication. The seminars had a foundation of evidence from WPATH SOC 8, which is the global evidenced based standard for TGD health. Results: Descriptive and bivariate statistics were utilized for the data analysis. The pre / post test surveys were compared via paired t-tests. The program evaluations were analyzed descriptively with the results pooled for a total score for comparative purposes. Conclusion: The need for the sustainability and scalability of this project is exemplified in the data analysis and correlating seminar discussion
Improving Equity In Atherosclerotic Cardiovascular Disease Risk
Full text linkThe current use of racial categorization in Atherosclerotic Cardiovascular Disease (ASCVD) risk, limits assessment of confounders beyond cholesterol. The Life’s Essential Eight (LE8) categories of healthy diet, sleep, physical activity, smoking, body mass index, hypertension, total cholesterol, and blood glucose could reduce two million ASCVD events per year. The documentation of Z codes 55 – 65 describe social drivers of health (SDH) like housing, economics, and social systems which complicate care. Development of the ASCVD risk assessment and management protocol (ASCVD-RAMP) assessed ASCVD risk without race modification in patients aged 45 – 75 and improved health equity by pairing SDH with LE8 interventions. Implementation at a Federally Qualified Health Center (FQHC) involved training 9 providers, 3 case managers and 4 registered nurses on changes to clinical practice. ASCVD-RAMP was evaluated with a pre and post implementation survey, a comparison of ASCVD risk calculation and SDH Z code documentation. Following implementation in 164 patients, the ASCVD-RAMP was scaled across the organization. Integration into the EMR and updates to case manager and registered nursing roles ensured sustainability. Removing race from the ASCVD risk calculator resulted in lower risk categorization (p\u3c0.001), improved opinions of calculation (p = 0.013) and LE8 management. ASCVD-RAMP improved perception of management that emphasized patient’s barriers to achieving better health (p=0.002). Utilization of SDH Z codes increased by 533% (p =0.054). Replacing race with SDH results in a change to dynamic variables in assessment of ASCVD risk and improved equity through a holistic patient centered approach to ASCVD prevention management
Provider Mindfulness: Changing Implicit Bias And Improving Perinatal Health Outcomes For Patients With Adverse Social Determinants Of Health
Full text linkAbstractProvider Mindfulness: Changing Implicit Bias and Improving Perinatal Health Outcomes for Patients with Adverse Social Determinants of Health Purpose: Implicit bias is an unconscious prejudice or preexisting belief developed over time toward another group. It can influence provider judgement, treatment decisions and levels of care. The purpose of this DNP Quality Improvement (QI) project was to improve patient care and provider knowledge on how implicit bias affects perinatal health for those with adverse social determinants of health (SDOH). Methods: A 53-second daily mindfulness intervention was developed and implemented among 8 obstetric providers caring for a population at risk for bias and discrimination. Provider knowledge, attitude and mindfulness practice was evaluated before and after the intervention with a survey. Provider engagement was tracked via number and types of social support referrals generated on patients’ behalf. Patient experience of respectful care was evaluated with a survey before and after care from providers involved in the intervention. Results: Post-implementation survey results indicated 63% of providers were willing to incorporate mindfulness into practice. 64% of patients received one or more social support referrals. There were no statistically significant outcomes, however qualitative analysis of providers pre and posttest indicated some benefit. Patients had a very weak negative Pearson correlation between pre and posttest outcomes. Patients’ paired t-test indicated no statistically significant difference in perceptions of respectful care pre and posttest. viii Conclusion: Although there were no statistically significant outcomes, benefits were seen. Provider posttest results were positive. Patients’ perceptions of respectful care were high throughout. Repeating this project is warranted, as statistical significance was limited by number of participants