bluuebunny/crossref_metadata_2025_split huggingface dataset:
Non-Public Shareholders’ Ownership and Economic Performance in the Urban Public-Transport Companies. Empirical Evidence from European Union
Authors: Corvino Antonio , Rigolini Alessandra 
Published: May 2024

Urban mobility (UM) represents an increasingly important field in European Union policy agenda. The growing complexity of citizens’ needs and the criticalities related to the global economic downturn have reduced the amount of the public expenditure that can be invested to cover the UM systems’ requirements. From this perspective, private funding is unavoidable. Public-private partnerships are more and more widespread. In particular, we look to a more relevant non-public shareholders’ presence in the ownership structure of urban public-transport companies. Many scholars have investigated the relationship between the presence of non-public shareholders and the economic performance generated by these companies. Nevertheless, less attention is paid to the “intensity” of non-public shareholders’ presence on firm performance. Moreover, cross-country comparisons are infrequently explored. In light of these considerations, this paper aims to test whether a lesser or higher presence (i.e. the intensity) of non-public shareholders in the ownership structure of the urban public-transport companies can affect economic performance. This research issue is investigated by statistical methodologies focusing on a sample made up by 333 companies operating in 12 European Union countries. Findings, managerial implications and suggestions for future research are outlined and discussed.
Predicting Hospital Closure Using Popular Financial Indicators: An Exploratory Study of Muhlenberg Hospital
Authors: Crosby Andrew , Knepper Hillary J. , Levine Helisse 
Published: May 2024

The role of government in the U.S. healthcare system is critical and hospitals play fundamental roles in our communities, among them critical healthcare provider and major employer. The federal funding program Medicare, and the federal-state funding source, Medicaid, are the two public health financing mechanisms that comprise significant funding to hospitals. Further, Medicare and Medicaid account for approximately 37 percent of all health expenditures in the U.S. (United States Centers for Medicare and Medicaid Services, 2018), and more than 60 percent of all hospital care (American Hospital Association, 2016). The public administration roles in the $3.4 trillion U.S. healthcare industry span that of provider, purchaser of services, initiatives and research funder, regulator, and policy implementer. In today's precarious political climate, amidst layers of government bureaucracies and an increased focus on better and fairer healthcare outcomes, the integration of public policy, administration, and healthcare has become increasingly important to practitioners and researchers. Indeed, the American Hospital Association tallies 5,564 hospitals in the United States, with 16 million employees and accounting for about one-sixth of the U.S. economy. Recently, of particular importance is the rise in U.S. hospital closures that impact healthcare and the economy in our local communities. This study contributes to the literature by identifying indicators for detecting warning trends in hospital financial condition before closures occur using a parsimonious system that can be replicated by both practitioners and policymakers with minimal data gathering efforts. The findings discussed here suggest that in the case of Muhlenberg Hospital, a clear trend of worsening financial condition could be detected at least four years prior to its closure. Current ratio, total margin, and debt to net asset ratio for Muhlenberg Hospital evidenced very clear indicators of financial instability. Consequently, the question emerges as to why neither the hospital nor the community was able to adequately negotiate these treacherous financial challenges to retain this valuable community asset.
Evaluating the Effectiveness of Community Health Partnerships: A Stakeholder Accountability Approach
Authors: Weech-Maldonado Robert , Benson Keith J. , Gamm Larry D. 
Published: May 2024

Community health partnerships (CHPs) are promoted as effective cooperative interorganizational relationships to improve community health status while conserving resources. However, relatively little is known about the effectiveness of these partnerships in achieving their goals. Using concepts from a network effectiveness framework (Provan and Milward, 2001) and a network accountability framework (Gamm, 1998), the authors propose that successful CHPs are those that are effective in multiple levels (community, network, organization/particpants) and/or accountability dimensions (political, commercial, clinical/patient, and community). The combined frameworks serve to identify a number of community health stakeholders and associated interests that vary according to accountability dimensions to which CHPs respond. Using survey data from over 400 participants in 25 Community Care Networks, the authors assess the usefulness of the conceptual framework in evaluating CHP effectiveness. The results suggest that CHP participants recognize three different levels of analysis in their evaluation of network effectiveness: community, network, and organization/participant. Furthermore, the results show that respondents distinguish between two different organization/participant benefits: enabling and client services. While respondents rated the intangible resources or enabling benefits ( e.g., legitimacy and learning) of partnership participation most highly, client services resulting from CHP participation ( e.g., client services and referrals) received the lowest ratings. Community benefit ( e.g., improving community health status) and network effectiveness ( e.g., ability to provide efficient, high quality health and human services) received ratings that fall between the enabling and client services. Given the relatively good scores (above 60%) received by CHPs on all four effectiveness dimensions considered here, it appears that the majority of respondents find at least some evidence of network effectiveness across all three levels of network effectiveness and all four dimensions of accountability.
An Evaluation of a Medicaid Managed Maternity Program: The Impact of Comprehensive Care Coordination on Utilization and Pregnancy Outcomes
Authors: Nason Carroll S. , Alexander Greg R. , Pass Mary Ann , Bolland John M. 
Published: May 2024

The purpose of this study is to evaluate the effectiveness of the implementation of a Medicaid managed maternity care program in a public health department service population, analyzing race-specific models of WIC participation and risk of small-for-gestational age of term. There were 13,095 singleton deliveries during the period 1987–1990 to women with prenatal care in this managed maternity care program. The research design entailed comparison of the intervention group (those receiving regular prenatal care plus comprehensive care coordination in 1989–90) with an historical comparison group of women who received only regular prenatal care in the two years (1987–88). For the intervention groups, black women were 1.7 times and white women 2.1 times more likely to participate in WIC than their comparison groups. The impact of care coordination on term-SGA births indicates a protective odds ratio of 0.851 for black women. Results for white women were not significant. These findings suggest that care coordination is associated with an increase in WIC participation and with lower risk of term-SGA births for black women but not for white women. The overall results add to growing evidence regarding the efficacy of comprehensive care coordination in improving specific pregnancy outcomes and inform our understanding of the evaluation of a comprehensive approach in preventive, community-based intervention.
Urban/Rural Differences in Access and Barriers to Health Carefor People with Multiple Sclerosis
Authors: Buchanan Robert J. , Stuifbergen Alexa , Chakravorty Bonnie J. , Wang Suojin , Zhu Li , Kim Myungsuk 
Published: May 2024

Context People living in rural areas face barriers when seeking health care, often experiencing difficulties accessing health providers or facilities. Little is known about barriers to the use of health care confronting people with multiple sclerosis (MS) in rural areas. Purpose To identify any rural/urban differences in access and barriers to health services, including MS-focused care, among people with MS. Methods The data were collected in a survey of 1,518 people with MS living in all 50 States. The study included three geographic subgroups: urban areas; adjacent rural areas; and more remote rural areas. Findings We found significant rural/urban differences in access and barriers to care among people with MS, especially for MS-focused care. Significantly smaller proportions of people with MS from adjacent and more remote rural areas reported no difficulty getting MS-related care than their urban counterparts. Conclusions Greater difficulty accessing MS-related care experienced by people with MS in rural areas has negative implications for the quality of the MS care they receive.
Integrating Health and Social Services for Older Adults: A Case Study of Interagency Collaboration
Authors: Vogel Amanda , Ransom Pamela , Wai Sidique , Luisi Daria 
Published: May 2024

As public housing residents age in place, they require health and social services outside of those traditionally offered by housing authorities. A promising response to these emerging needs is for housing authorities to collaborate with local public health departments to deliver coordinated services to older adult residents. Aging residents’ health needs include health promotion activities, preventive health services, health education, and mental health services, among others. From 2001–2004 the New York City Department of Health and Mental Hygiene (DOHMH) and the New York City Housing Authority (NYCHA) collaborated to implement the Senior Wellness Project. This outreach program integrated health and social services provided by DOHMH and NYCHA, and delivered these services to older adult residents on site in 21 New York City public housing developments. Services were rendered at senior centers located in the housing developments and in residents’ apartments. The program also referred residents to community healthcare providers to address special needs such as addiction. This article retroactively applies a formal model for interagency collaboration, the Stages of Collaboration, to describe and analyze the process of collaboration between DOHMH and NYCHA. It identifies the successes and shortcomings of the collaborative process, and explores the theory that successful collaboration leads to inherent challenges for implementation. Recommendations are then made for other public housing and public health agencies that have considered collaborating to address the needs of public housing residents who are aging in place.
Infant Mortality in Southern States: A Bureaucratic Nightmare
Authors: Menifield Charles E. , Dawson Jacob 
Published: May 2024

Despite numerous advances in technology, medicine, and health care, infant mortality continues to reach very high levels in southern states. The purpose of this paper is to examine demographic, economic, and health care factors that are likely to affect infant mortality. In so doing, we first compare infant mortality and other critical factors in southern states to other regions of the country. Second, we use cross tabulation tables to determine if there is a correlation between infant mortality and several independent variables. Third, we use regression analysis to determine how each of these variables affects the change in infant mortality for the 1990–2003 periods. The results of the cross tabulation tables indicate relationships between infant mortality and each of the independent variables. When these variables were placed in a regression model, high school graduation rates, race, geographic region, unemployment rates, uninsured rates, teenage pregnancy rates, single parent families, and the number of doctors and hospitals were significant.
Multi-Criteria Assessment of County Public Health Capability Disparities
Authors: Zuniga Miguel A. , Carrillo-Zuniga Genny , Seol Yoon Ho , Fos Peter J. 
Published: May 2024

Objective This paper proposes an analytical approach to the assessment of geographic population health disparities that are measured as the consolidation of public health related indicators into geographic-specific scores, and are representative of the level of public health capability within counties in the state of Mississippi. Study Design A multi-criteria decision model was employed to develop an additive scoring system that assigns a numerical score of public health capability disparities for a geographical area (county). Methods Routinely collected indicators were used to measure each county's current public health related concerns. These indicators include access, risks, health care quality, and outcomes data. Public health experts rated and ranked indicators to generate indicator weight. Results A county score was developed to rank Mississippi counties based on relative public health capability. This scoring system depicts population health disparities among Mississippi counties. Conclusions The model is useful and ideal for establishing expectations and benchmarks for reduction or equalization of disparities. This information can be used to manage geographic population health disparities by guiding policy formulation and implementation.
Hiv Knowledge, Attitudes and Practices among College Students in the United States
Authors: Inungu Joseph , Mumford Vincent , Younis Mustafa , Langford Sara 
Published: May 2024

BACKGROUND Students enrolled at a Midwestern university in the United States were surveyed between February and April 2008 about their HIV knowledge, sources of information, attitude toward people living with HIV/AIDS, and their sexual behaviors. METHODS An anonymous questionnaire was sent to 1,000 students via Survey Monkey. RESULTS Of the 650 respondents (65%) who provided complete information, 91.2% were white, 70.6% were female, 76.3% were seniors at the university and 94.7% were heterosexuals. Their average age was 22.5 years (SD ± 4) with a range of 18 to 30 years. Although the majority of students (77.3%) reported to be very familiar with HIV/AIDS including its mode of transmission, important misconceptions still exist regarding HIV/AIDS. Several students either thought that mosquitoes transmit HIV/AIDS (14.2%) or did not know one way or the other (19.9%). About 43.1% were unsure about the existence of drugs that can prevent maternal to child transmission of HIV and 12% actually believed that these drugs do not exist. Moreover, despite the high prevalence of risky sexual behaviors among students, the majority of participants (86.8%) did not perceive themselves to be at risk for contracting HIV. As a result only 29.4% had ever been tested for HIV. CONCLUSION Coexistence among college students of both misconceptions about the mode of HIV/AIDS transmission and denial about their vulnerability to contract this disease underscores the need for a proactive approach to address these challenges facing our youths.
Factors Associated with the Uptake of Sodium Dichloroisocyanurate (NADCC) Tablets as Household Water-Treatment Product among Caregivers of Children under Five in Benin, West Africa
Authors: Inungu Joseph N. , Zinsou Cyprien E. , Mustafa Younis , Singbo Narcisse 
Published: May 2024

Improving access to safe drinking water is a critical step in mitigating diarrheal diseases that affect millions of children under 5 years throughout the developing world each year. While the delivery of safe water is out of the reach of many countries, the utilization of Sodium dichloroisocyanurate (NaDCC) is a proven cost-effective alternative to prevent diarrhea caused by waterborne pathogens. However, its uptake remains low in many developing countries, such as the Republic of Benin. This study examines the trends and the determinants of NaDCC uptake in Benin. Population Services International and its affiliate conducted two multistage household surveys among caregivers of children under five in Benin to examine the practices towards diarrheal disease in children under five and identify the factors associated with the use of NaDCC in this population. 2912 respondents/caregivers of children under five were interviewed in 2009 versus 3196 in 2011. The proportion of caregivers who reported ever treating water with NaDCC increased from 5.8% in 2009 to 11.5% in 2011, p<0.001. The logistic regression model showed that caregivers who knew places that sell NaDCC in the community; those who felt capable of utilizing NADCC correctly to treat drinking water as well as caregivers who reported to be Muslim were more likely than their counterparts to use NaDCC as water treatment product. In order to increase the use of NADCC among caregivers, the Government of Benin and its development partners should focus not only on making NADCC available in the community and informing the community members about the different points of sale, but also in building up the capacity and confidence of caregivers in utilizing it.
The Prevalence of Community Benefit Participation in the Hospital Region and Its Relationship to Community Health Outcomes
Authors: Cronin Cory E. 
Published: May 2024

The structure of the U.S. health care industry has long emphasized individual outcomes, but there is a growing recognition that hospitals may be able to provide more cost-effective care through community-focused initiatives. Few assessments have been established to measure outcomes of these increasing community benefit efforts. This study uses the rate of ambulatory care sensitive condition admissions in the Medicare population as a mechanism for understanding the effectiveness of a range of hospital community benefit practices. This study is based on national data collected through the American Hospital Association Annual Survey for the years 2004, 2006, 2008, and 2010 and supplemented by demographic, region, and policy information collected from other sources. The outcome measure and the region definition are established through the Dartmouth Atlas of Health Care. Multilevel mixed-effects linear regression modeling is used to analyze the relationship between community benefit participation levels within a region and the region's ambulatory care sensitive condition prevalence. Community health education was found to be associated with a reduced prevalence of ambulatory care sensitive conditions (ACSCs). ACSC rates were also connected to several other factors, including health needs and demographic characteristics in a region. The finding that community education appears to have the greatest link to limiting ACSC admissions is in line with other studies showing community education initiatives to be effective in improving health outcomes. This may be particularly important for hospitals seeking to best direct their resources in a way that addresses broader community health outcomes.
Educating Paramedics for the Future: A Holistic Approach
Authors: O'Meara Peter F. , Furness Susan , Gleeson Ray 
Published: May 2024

The education and training of paramedics largely remains focused on an emergency medicine dominated curricula with limited attempts made to expand paramedic education to include primary care and public health topics that might better address the contemporary needs of practicing paramedics. In developed countries, paramedic roles and scopes of practice are changing in response to aging populations and the attendant prevalence of chronic conditions, advances in technology, changes in community expectations and broader health system challenges. The emergence of paramedic practitioner roles in a number of countries illustrates the impact of these social, technological and economic factors, and how paramedics are being integrated into the health systems of their respective countries. Countries such as the United Kingdom, Australia and New Zealand, have moved toward near-mandatory higher education models for paramedics. While three-year Baccalaureate degrees generally provide the scope and flexibility to introduce a wider range of studies in primary care and public health, they face the challenge of adding these topics to an already crowded curriculum. In countries without widespread access to Baccalaureate degrees in paramedicine the challenge of broadening the education of paramedics would appear to be near impossible within the constraints of relatively short entry-level programs. This paper describes how an Australian university is responding to this challenge through the development of a four-year Bachelor of Paramedic Practice with (Clinical) Honours program. The paramedic program was initially encompassed within a suite of allied health courses in 2009 and provided students with the qualification of Bachelor of Health Science / Master of Paramedic Practice. Shortly after its inception, the course was reviewed against the future needs of students, industry and the community. Practice trends and the educational requirements of future entry-level paramedics were critically examined in Australia and internationally through literature reviews, conference attendances, direct feedback from the field, and overseas visits. As a result, the program was modified, and after further review, a new four-year paramedic program will be offered to commencing students in 2018. The structure of the program will provide opportunities for students to gain skills and knowledge beyond that delivered in traditional paramedicine programs, including knowledge specific to primary health care and extended community paramedicine. These components of the program will allow for enhanced and flexible roles within communities and professional settings, and are responsive to calls for a holistic model of education to meet future paramedic role demands.
Musculoskeletal Knowledge on the in-Training Examination Improves in Family Medicine Residents Participating in a Longitudinal Sports Medicine Clinical Track
Authors: Furr Micah , Tumin Dmitry , Ferderber Megan L 
Published: May 2024

Objectives The study aims to assess the impacts of a sports medicine (SM) track on musculoskeletal (MSK) knowledge of family medicine (FM) residents. In-training examination (ITE) results were used to compare the MSK knowledge of FM residents with and without SM track participation. Methods A single-center, retrospective study was completed on 85 FM residents from the 2018 to 2024 graduating classes who completed the ITE from 2017 to 2021. Residents were categorized by participation in the SM track, where half a day of FM continuity clinic per week is replaced with an SM clinic, supervised by a fellowship-trained SM physician. ITE scores throughout training were compared between the 2 groups using mixed-effects regression. Results The ITE MSK scores increased among both SM track participants (+77 points/year, p = .001) and nonparticipants (+39 points/year, p = .001) throughout their training. By postgraduate year 3, SM track participants performed significantly better on the MSK portion of the ITE (+87 points compared to non-participants, p = .045). No significant difference in total ITE scores was seen between groups. Conclusions Our data demonstrates that participation in an SM track is associated with an increase in MSK knowledge of ITE, suggesting that an SM track may provide FM residents with a better understanding of MSK conditions.