Conceptualizing Vulnerable Populations Health-Related Research

Flaskerud, Jacquelyn H.; Winslow, Betty

doi:10.1097/00006199-199803000-00005

Cited by 426 publications

(477 citation statements)

References 38 publications

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“…Both urban and rural poor experience unique access to care difficulties, including geographic barriers or financial limitations, that may influence health outcomes even when integrated behavioral medicine and specialty care are successfully implemented to others [29]. A number of frameworks, such as the Andersen behavioral model (ABM) and its revisions, have been developed to organize thinking and research on patient factors hypothesized to influence healthcare access in underserved populations [30][31][32].…”

Section: Introductionmentioning

confidence: 99%

Access to care for vulnerable veterans with hepatitis C: a hybrid conceptual framework and a case study to guide translation

Rongey

Asch

Knight

2011

Behav. Med. Pract. Policy Res.

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The Veterans Health Administration (VHA) is the largest single provider of medical care to people with hepatitis C (HCV) in the USA. Given the advent of promising new HCV therapies, the VHA is now faced with a large number of chronically HCV-infected veterans with concomitant psychiatric or substance use comorbid conditions who will need to either be retreated or newly treated for HCV or will require management for chronic liver disease. There is a critical need in the VHA for behavioral medicine and hepatology specialists, along with infectious disease and primary care providers with an interest in hepatitis C, to provide coordinated care for these complex patients. The VHA Health Services Research and Development Service has advocated for the application of strong implementation science theories and methods to translate new models of healthcare delivery in clinical practice. To inform the delivery and evaluation of integrated behavioral medicine and specialty care for vulnerable patient populations, we sought to develop an enriched framework which incorporates implementation science theory and strong conceptual models for access to care. In this paper, we present a hybrid conceptual framework that accomplishes this goal. To illustrate how this hybrid model could inform the translation of a novel method of healthcare delivery, we provide a case study of a VHA initiative to improve access to integrated behavioral medicine and specialty care among veterans with HCV.

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Section: Introductionmentioning

confidence: 99%

Access to care for vulnerable veterans with hepatitis C: a hybrid conceptual framework and a case study to guide translation

Rongey

Asch

Knight

2011

Behav. Med. Pract. Policy Res.

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“…In general, sex workers are seen as a vulnerable population, defined as a social group with an increased susceptibility to adverse physical and mental health outcomes. 8 Street-based sex workers (i.e., prostitutes), for example, are exposed to multiple health risks, including physical and sexual abuse, substance abuse, mental health problems, and HIV-risk behaviors. [9][10][11][12] It is unknown to what degree adult film performers, as part of a large and legal industry of sex workers, are exposed to similar risks and when, where, and to whom these risks are likely to occur during their careers.…”

Section: Introductionmentioning

confidence: 99%

Pathways to Health Risk Exposure in Adult Film Performers

Grudzen

Ryan

Margold³

et al. 2008

J Urban Health

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Despite being part of a large and legal industry in Los Angeles, little is known about adult film performers' exposure to health risks and when and how these risks might occur. The objective was to identify exposure to physical, mental, and social health risks and the pathways to such risks among adult film performers and to determine how risks differ between different types of performers, such as men and women. Semi-structured in-depth interviews were conducted with 18 female and ten male performers as well as two key informants from the industry. Performers and key informants were recruited through Protecting Adult Welfare, adult film venues, and snowball sampling. Performers engaged in risky health behaviors that included highrisk sexual acts that are unprotected, substance abuse, and body enhancement. They are exposed to physical trauma on the film set. Many entered and left the industry with financial insecurity and suffered from mental health problems. Women were more likely than men to be exposed to health risks. Adult film performers, especially women, are exposed to health risks that accumulate over time and that are not limited to sexually transmitted diseases.

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“…A premature infant's health status, supportive care, and environmental exposures, before and after birth, can, in combination or alone, alter the fetus'/infant's neurodevelopmental subsystems such as communication, motor, and social skills (Als, 1986). The Vulnerable Populations Model (Flaskerud & Winslow, 1998) defined a vulnerable population as a social group that is at increased susceptibility to adverse health outcomes as evidenced by increased comparative morbidity and premature mortality. Although PNS aid lung maturity, higher doses may be harmful to the long-term developmental health of the vulnerable premature infant whose susceptibility can be multidimensional (e.g., neurosensory, immune, neuromuscular, etc.)…”

Section: Theoretical Frameworkmentioning

confidence: 99%

“…The theoretical framework for this research was formulated from a combination of three models that evolved into the Preterm Infant Vulnerability to Neuromorbidity Model ( Figure 1) that focused on health status, relative risks, and resource availability (Als, 1986;Flaskerud & Winslow, 1998;Matthews, 2000Matthews, ,2001. This theoretical framework highlights corticosteriods as one of many perinatal risk factors that can positively or negatively influence preterm infant development and long-term health status.…”

Section: Theoretical Frameworkmentioning

confidence: 99%

Cumulative Perinatal Steroids: Child Development of Preterm Infants

Purdy

Wiley

Smith

et al. 2008

Journal of Pediatric Nursing

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The development of premature infants may be altered due to exposure to high cumulative doses of the perinatal corticosteroid dexamethasone during critical growth periods. To compare child behavioral development of prematurely born infants who were exposed to higher perinatal steroids (PNS; N0.2 mg/kg) with that of infants exposed to lower PNS (≤0.2 mg/kg), we used the Vineland Adaptive Behavioral Scales to assess school-age behavioral outcomes of a historical cohort of 45 prematurely born infants. Children who had received higher PNS treatment were more likely to have lower overall behavioral developmental scores, especially lower social skills (p < .05). Higher PNS plus higher severity of illness during the first day of life based on the Clinical Risk Index for Babies (p = .016) and lower birth head size (p = .015) were linked with poorer behavioral outcomes among participants. Nursing practice includes promotion of quality care and should include closer evaluation of cumulative steroid therapy, severity of illness, and promotion of long-term follow-up support for premature infants. KeywordsPerinatal steroids; Dexamethasone; Preterm infants; Neurodevelopment PRETERM DELIVERY, ESTIMATED to occur in 7-11% of all North American births, is responsible for 75% of neonatal deaths (National Institutes of Health [NIH] Consensus Development Conference Statement, 1994). The outcomes of preterm infant survival are often dependent upon the provision of high-quality perinatal care, prior to 40 weeks' postconceptual age, as this is a vulnerable time in development. Over the past 30 years, synthetic or exogenous steroids have increasingly been prescribed before and after birth with the intent to improve infant lung maturity and outcomes. The 1994 NIH consensus panel recommendation for antenatal steroids (before birth) consisted of two doses of 12 mg of betamethasone given intramuscularly at 24-hour intervals or four doses of 6 mg of dexamethasone given intramuscularly at 12-hour intervals. In 2000, the panel revisited this recommendation and discouraged the use of multiple-course antenatal steroids because studies identified associations between steroids and impaired infant head growth and neurodevelop-mental outcomes (National Institutes of Health, 2000 Although commonly given for a variety of therapeutic reasons in perinatal care, the risks may not outweigh the benefits of either higher antenatal or postnatal steroid exposure. Perinatal steroids (PNS) are primarily administered for the promotion of infant lung maturation and reduction of respiratory distress syndrome and mortality (Huang, Dunlop, & Harper, 1999). Many premature infants have received multiple doses of therapeutic steroid drugs while in utero as well as in the postnatal period.Studies have retrospectively examined either antenatal or postnatal steroid effects . This study was the first to retrospectively identify the precise milligram amount of cumulative PNS dosed prior to 40 weeks and prospectively examine relationships with neurodevelopment of pre...

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Conceptualizing Vulnerable Populations Health-Related Research

Cited by 426 publications

References 38 publications

Access to care for vulnerable veterans with hepatitis C: a hybrid conceptual framework and a case study to guide translation

Access to care for vulnerable veterans with hepatitis C: a hybrid conceptual framework and a case study to guide translation

Pathways to Health Risk Exposure in Adult Film Performers

Cumulative Perinatal Steroids: Child Development of Preterm Infants

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