Digital Commons Network^™

Angioedema: Is Icu Admission Warranted? A Single Institution Assessment, Madeleine Brill-Edwards, W. Chase Hamilton, Erika J. Yoo, Jennifer Costello, George J. Koenig, Murray J. Cohen, Joshua A. Marks

Department of Surgery Faculty Papers

INTRODUCTION: Angioedema has potential for rapid airway decompensation requiring intervention. Patients are often admitted to an ICU for "airway watch." There is a lack of evidence to support which patients require this.

AIM: We aimed to characterize admission patterns and outcomes of angioedema patients at our institution to assess resource utilization and necessity of ICU use. We hypothesized that patients not requiring intubation upon presentation are safe to manage outside the ICU.

MATERIALS AND METHODS: Retrospective chart review of patients admitted to our urban academic quaternary referral institution with angioedema ICD-10 codes between 2017 and 2020. Charts reviewed for demographics, …

Shifting From Crisis To Prevention: Community-Generated Materials From The Core Sipp Listening Sessions (Version 1), Camille Velarde, Mahtab Soleimani, Yvonnie Baik, Theresa Cruz

Reports & Documents

The Core State Injury Prevention Program (CORE SIPP) in New Mexico sought to understand how communities can prevent injury and violence before crisis occurs. In 2025, the University of New Mexico Prevention Research Center, in partnership with the New Mexico Department of Health, listened to service providers, advocates, and community leaders working with youth and families across the state. Participants described overlapping challenges, including poverty, unsafe housing, limited mental health care, transportation gaps, and a lack of safe spaces for young people, and emphasized that real prevention must start early and address families’ basic needs. From these sessions, community members …

Assessment Of Covid-19 Risks Related To Behaviour And Body Resistance In The Remote Area: Case Study In Jeneponto, Basri Basri, Andi Tilka Muftiah Ridjal, Lukman Setiawan, Renaldi M

Journal of Environmental Science and Sustainable Development

COVID-19 has posed significant global health threats, with responses varying across populations due to differences in risk perception, behaviour, and biological vulnerability. In Indonesia, most research has focused on urban settings, with limited attention paid to rural or remote communities. This study assesses COVID-19- risks related—specifically behavioural and immunity-related-factors—in the remote area of both Bontoramba Subdistrict, Jeneponto Regency. A cross-sectional study was conducted using cluster random sampling across eight villages, with 183 participants selected from a total of 12,242 households. Data were collected between November to December 2020 using a validated structured questionnaire, administered both online and face-to-face interviews. The …

Analyzing High-Risk Fertility Behavior For Sustainable Maternal-Child Health: A 2017 Sociodemographic Study In Urban And Rural Indonesia, Asti Annisa Utami, Fadhaa Aditya Kautsar Murti, Popy Yuniar, Milla Herdayati

Kesmas

Indonesia's goal of achieving Indonesia Emas 2045 hinges on improving Maternal-Child Health (MCH), essential for building a healthy and competitive population. Despite some advancements, the Maternal Mortality Rate (MMR) and Under-five Mortality Rate (U5MR) remain high, particularly because of High-Risk Fertility Behavior (HRFB). The HRFB poses significant risks to MCH, affecting both urban and rural women. This study aimed to identify the factors associated with HRFB in these areas to enhance MCH outcomes and support Indonesia's sustainable health goals. This cross-sectional study used a secondary dataset from the 2017 Indonesian Demographic Health Survey. A total of 20,530 women of reproductive …

The Effectiveness Of Remote Patient Monitoring In Reducing The Risk Of Rehospitalizations In Covid-19 Patients: A Meta-Analysis, Dela Riadi, Indang Trihandini, Dewi Nirmala Sari, Fikri Wijaya

Kesmas

An integrated analysis of various Remote Patient Monitoring (RPM) studies is needed to evaluate the reduction rate of the risk of rehospitalization in COVID-19 patients. This meta-analysis aimed to provide an overview of the effectiveness of RPM. A literature search through online databases (PubMed, Science Direct, Scopus, ProQuest, and Embase) was conducted from 2019 to 2022. After using the Cochrane Collaboration's risk of bias tool, five studies on COVID-19 were selected. Based on the data collected from 2,685 participants (intervention = 1,060, control = 1,625), the use of RPM was found to reduce rehospitalization by 0.56 times compared to not …

Direct Medical Costs Of Diabetes Mellitus Treatment For Patients With Cardiovascular And Renal Complications, Rizki Fadila, Ayu Tyas Purnamasari, A.A. Istri Citra Dewiyani

Kesmas

Type 2 Diabetes Mellitus (T2DM) represents a growing global health challenge with significant clinical and economic implications, notably in Indonesia. The burden is intensified by renal and cardiovascular complications, especially among National Health Insurance beneficiaries. This retrospective study evaluated the direct medical costs of hospitalized T2DM patients with such complications at a type B hospital from 2019 to 2022. Costs were analyzed from both healthcare provider and payer perspectives, covering medical services, medical support services, pharmaceuticals, and other support services. Of the 192 patients reviewed, most were male (57.8%), aged 45–64 years (72.4%), with hospital stays of 1–5 days (90,1%) …

Cross-Cultural Adaptation And Validation Of Ranas-Based Instrument For Measuring Latrine Use Behavior In Indonesia, Vera Yulyani, Fatwa Sari Tetra Dewi, Iswanto Iswanto

Kesmas

Using toilets is a simple way to prevent diarrhea, yet no validated tool exists to measure this habit. This study aimed to develop and validate instruments for measuring latrine use consistency. This questionnaire was adapted from the risk, attitude, norm, ability, and self-regulation (RANAS) framework developed in India and modified for Indonesia. It was evaluated by three experts using the content validity index (CVI). The face validity index (FVI) was pilot-tested on 40 community respondents. Variables measured included behavior, habits, intentions to use toilets, knowledge, attitudes, norms, abilities, and self-regulation. Question items with relevance and clarity scores of item CVI …

Contribution Of National Health Insurance Patient Revenue To Financial Performance Of Private-Profit Hospitals From 2017 To 2022, Fadlul Imansyah, Amal Chalik Sjaaf, Mardiati Nadjib, Rina Hartini

Kesmas

This study investigated the relationship between National Health Insurance (NHI) patient revenue and profit-private hospital financial performance in Indonesia. As the NHI provider, Badan Penyelenggara Jaminan Sosial (BPJS) Healthcare Security’s influence on hospital revenues has raised concerns about its impact on financial sustainability. This study used financial performance indicators to develop a financial performance index—Return on Assets (ROA), Return on Equity (ROE), Earnings Before Interest, Taxes, Depreciation, and Amortization (EBITDA) Margin, Current Ratio, and Net Profit Margin (NPM)—to assess the financial impact of BPJS Healthcare Security revenue. A partial model approach of multiple linear regression was employed using secondary data …

Associated Factors In Willingness To Shift Tobacco Expenditure Into National Health Insurance Premium Among Subsidized Members, Mugi Wahidin, Muhammad Agus Mikrajab, Rozana Ika Agustiya, Veza Azteria

Kesmas

In Indonesia, subsidized members are the largest group in the National Health Insurance program. Hence, it is essential to understand their ability to pay (ATP) based on tobacco expenditure. This study aimed to determine the ATP of subsidized members based on tobacco expenditure and factors associated with their willingness to pay (WTP). This cross-sectional study used secondary data from the National Institute of Health Research and Development. The population included all subsidized members; 19,918 were sampled for ATP, and 14,560 were WTP. The independent t-test, ANOVA, and logistic regression were performed. Results showed that ATP from tobacco expenditure ranged from …

Supporting And Hindering Factors Associated With Covid-19 Health Protocol Adherence Among Online Motorcycle Taxi Riders In Samarinda City, Indonesia, Dina Lusiana Setyowati, Tanti Asrianti, Ismail Kamba, Rina Tri Agustini

Kesmas

The COVID-19 pandemic has underscored the importance of preventive health protocols, especially for high-contact occupations, such as online motorcycle taxi riders. However, adherence among these riders is inconsistent, particularly in economically constrained regions, such as Samarinda, a buffer zone for Indonesia's new capital. This study examined the influence of supporting and hindering factors on COVID-19 protocol compliance. A cross-sectional design was employed with 87 riders selected through quota sampling. Data were collected using structured questionnaires and analyzed using Spearman's rank correlation to assess the relationships between influencing factors and compliance levels. Economic barriers, especially high personal protective equipment (PPE) costs …

Health Economics Perspective On Indonesian Telemedicine Platform Practices: A Qualitative Study, Yossico Ria Wibowo, Rina Djunita Pasaribu

Kesmas

Telemedicine in Indonesia has experienced significant growth since its introduction in 2014. The financing system is regulated independently by each platform, leading to disparities in teleconsultation fees and medical incentives. This qualitative study, which involved a literature review and interviews with 33 participants, offered a health economics perspective on the implementation of telemedicine. The recommended teleconsultation fee ranges from USD 0.05 to USD 2.54, with medical incentives set at USD 1,59-3.18 for general practitioners and USD 4.77-6.36 for specialists, using telephone or video calls as the preferred means of teleconsultation. Although most patients and Indonesian Medical Association administrators generally agreed …

Google Review Analysis Of “Duta We Care” Excellent Service As A Featured Service At A Central General Hospital In Padang, Alfitri Alfitri, Ricvan Dana Nindrea, Adek Setiawan, Elsa Yuniarti

Kesmas

Improving healthcare service quality required both technical and interpersonal enhancements through a personalized approach, as demonstrated by the “Duta We Care” program at a Central General Hospital in Padang. This study aimed to evaluate the program’s effectiveness by analyzing patient feedback from Google Reviews. A descriptive quantitative design examined 2,035 patient reviews from March 2013 to June 2024. Using NVivo 12 software, the data analysis generated word clouds. The results showed that 68.20% of reviews received a 5-star rating, 9.48% a 4-star rating, 4.35% a 3-star rating, 2.27% a 2-star rating, and 15.70% a 1-star rating. Words like “friendly,” “professional,” …

Socioeconomic Status, Environmental Health Knowledge, And Housewives’ Behavior In Maintaining Healthy Housing At Subsidized Flats In East Jakarta, Indonesia, Alfitra Firizkia Luthfiana Dewi, Laila Fitria

Kesmas

Healthy behavior among housewives is a crucial aspect of efforts to maintain healthy housing. This study aimed to analyze the relationship of socioeconomic status (e.g., household income, level of education of family head and housewives, and family head’s occupation) and environmental health knowledge with housewives’ behavior (e.g., vector control, waste management, home ventilation, cigarette smoking, and hand sanitation hygiene) in maintaining healthy housing in the subsidized flats in East Jakarta, Indonesia. This cross-sectional study employed the two-proportion hypothesis test formula and a simple random sampling method, recruiting 137 housewives for interviews. Data were analyzed via logistic regression to determine factors …

Factors Of Anxiety Symptoms Due To Large-Scale Social Restriction Policy During The Covid-19 Pandemic In Indonesia, Indri Hapsari Susilowati, Sudibyo Alimoeso, Susiana Nugraha, Bonardo Prayogo Hasiholan, Magda Sabrina Theofany Simanjuntak, Nur Rachmat Satria

Kesmas

The Indonesian Government took some preventive measures to slow the spread of the COVID-19 virus, including social restrictions and encouraging individuals to stay at home and avoid needless gatherings. This study aimed to identify factors related to anxiety symptoms during large-scale social restrictions. This study employed a cross-sectional design using the snowball technique in an online survey. A total of 788 respondents comprised the target population to detect the smallest effect size (Cohen's dz = .2), with the level of power of 0.8 using G*Power 3.1, specifically targeting adults aged over 18 years. Out of 1,194 people who took part …

Single-Cell Transcriptomics Reveals Biomarker Heterogeneity Linked To Cdk4/6 Inhibitor Resistance In Breast Cancer Cell Lines, Ilenia Migliaccio, Martina Bonechi, Dario Romagnoli, Giulia Boccalini, Francesca Galardi, Cristina Guarducci, Agostina Nardone, Rachel Schiff, Laura Biganzoli, Luca Malorni, Matteo Benelli

Faculty, Staff and Students Publications

Cyclin dependent kinases 4 and 6 inhibitors have brought great improvements in the treatment of luminal breast cancer, but resistance is a major clinical hurdle. Multiple biomarkers of resistance have been proposed, but none is currently utilized in clinical practice. By performing single-cell RNA sequencing of seven palbociclib-naïve luminal breast cancer cell lines and palbociclib-resistant derivatives, we show that established biomarkers and pathways related to CDK4/6i resistance present marked intra- and inter- cell-line heterogeneity. Transcriptional features of resistance could be already observed in naïve cells correlating with levels of sensitivity (IC50) to palbociclib. Resistant derivatives showed transcriptional clusters that significantly …

Role And Use Of Race In Artificial Intelligence And Machine Learning Models Related To Health, Martin C Were, Ang Li, Bradley A Malin, Zhijun Yin, Joseph R Coco, Benjamin X Collins, Ellen Wright Clayton, Laurie L Novak, Rachele Hendricks-Sturrup, Abiodun O Oluyomi, Shilo Anders, Chao Yan

Faculty, Staff and Students Publications

The role and use of race within health-related artificial intelligence (AI) and machine learning (ML) models have sparked increasing attention and controversy. Despite the complexity and breadth of related issues, a robust and holistic framework to guide stakeholders in their examination and resolution remains lacking. This perspective provides a broad-based, systematic, and crosscutting landscape analysis of race-related challenges, structured around the AI and ML life cycle and framed through "points to consider" to support inquiry and decision-making.

Global, Regional, And National Time Trends In Falls And Their Predictions: An Age-Period-Cohort Analysis Of The Global Burden Of Disease Study 2021, Huan Jiang, Ning Sun, Huiqi Yang, Ye Li, Lihong Jiang, Huicui Zhao, Yi Zeng, Chengyang Sun, Chun Xu, Yongqiang Lai, Jia Meng

Health & Biomedical Sciences Faculty Publications

Background: Falls are a global public health issue with a heavy disease and socioeconomic burden, with an increasing number of risky people. The aim of this study is to explore the global disease burden of falls and to provide a scientific basis for the prevention and management of falls.

Methods: This study used data from the Global Burden of Disease Study 2021 (GBD 2021) to analyse global, regional, and national temporal trends in falls. An age-period-cohort (APC) model was applied to analyse data from 1990 to 2021, with global predictions made through 2046.

Findings: Although the falls mortality of all …

A Workplace Posture Initiative To Reduce Work-Related Musculoskeletal Disorders, Carrie Isaac

All Doctor of Nursing Practice (DNP) Scholarly Projects

Problem: Work-related musculoskeletal disorders (WRMSDs) are a leading cause of occupational injury and discomfort in industrial workplaces. Although an ergonomic program existed at the project site, a formalized process to detect postural misalignments early had not been established. Relying on employee self-reporting, delayed intervention, and limited opportunities to prevent injuries before they progress.

Aim of the Project: A proactive posture screening program using PostureScreen® was implemented to identify postural deviations that could contribute to WRMSDs. Emphasis was placed on supporting employees through early awareness of posture-related issues and evaluation of alignment improvements following individualized intervention.

Review of the Evidence: Evidence …

In Pursuit Of A Better Hospital Quality Metric For Medicare, Brad Wright Ph.D.

Faculty Publications

No abstract provided.

Assessment Of Total Cardiovascular Risk Using Who/Ish Risk Prediction Chart Among Adults In Rural Areas Of Mysuru: A Cross-Sectional Study, Anchu R Nath, Amogha Shree, Rashmi S, Shweta N K, Deepshika R, Sunil Kumar D

Digital Journal of Clinical Medicine

Background:

Cardiovascular diseases (CVDs) are a leading cause of morbidity and mortality in rural India, where preventive healthcare infrastructure remains underdeveloped. Myocardial infarction and stroke are among the deadly events that are caused by a combination of risk factors that are present in the majority of cardiovascular diseases (CVD). This study aimed to estimate the 10-year CVD risk among adults in rural Mysuru using the WHO/ISH risk prediction charts, a practical tool designed for low-resource settings.

Methodology:

This community-based cross-sectional study was conducted over three months (January 2025- March 2025), involving 172 study participants from the rural field practice area …

Integrating Circulating Tumor Dna Into Clinical Management Of Colorectal Cancer: Practical Implications And Therapeutic Challenges, Nikhil Vojjala, Viktoriya Gibatova, Raj N Shah, Sakshi Singal, Rishab Prabhu, Geetha Krishnamoorthy, Karen Riggins, Nagaishwarya Moka

Faculty, Staff and Students Publications

The American Cancer Society estimates that over 152,000 new cases of colorectal cancer (CRC) were diagnosed in 2024, with more than 105,000 cases affecting the colon and 46,000 involving the rectum. CRC remains the second leading cause of cancer-related deaths in the United States, with an estimated 53,010 deaths in 2024. In the era of precision medicine, which incorporates molecular and environmental information into clinical decision-making, identifying patients harboring a deficiency in Deoxyribonucleic acid (DNA) repair allowed for targeted immunotherapies and significantly reduced CRC-related mortality. A significant advancement in this domain is the application of liquid biopsy, which has emerged …

Resilience Mediates The Association Between Discrimination And Psychological Distress Among Rural, Black Women In South Carolina: A Structural Equation Model, Camryn Garrett, Abhisheak Aggrawal, Huiyi Xia, Cheuk Chi Tam, Bankole Olatosi Ph.D., Sarah Wilcox Phd, Xiaoming Li Ph.D., Shan Qiao Ph.D.

Faculty Publications

Introduction

The marginalization of intersecting racial, gender, and rural identities compounds the structural vulnerabilities (e.g., discrimination, stigma, health disparities) experienced by Black women in South Carolina’s rural areas. Discriminatory experiences can deteriorate mental health; however, resilience can potentially reduce the ill effects of discrimination by decreasing associated psychological distress. This study examines the mediating role of resilience in the association between discrimination and psychological distress among rural, Black women in South Carolina in the post-pandemic era.

Methods

Black women (n = 300, mean age = 48.6) living in rural South Carolina were recruited from January to February 2024 using …

Refinement Of Hyams Grading Criteria For Olfactory Neuroblastoma In An Endoscopic Sinus Surgery Predominant Cohort With Extended Follow-Up: Worth The Effort?, Stacey Gargano, Vincent Cracolici, Carl Snyderman, Eric Wang, Garret Choby, Aron Pollack, Paul Gardner, Diana Bell, Raja Seethala

Computational Medicine Center Faculty Papers

BACKGROUND: Hyams grading is considered prognostic in olfactory neuroblastoma (ONB), but grading criteria are subjective and predate modern classification and surgical approach. We evaluate the application of granular grading criteria to an endoscopic surgery predominant cohort with extended follow-up.

METHODS: 78 ONB patients were identified (1994-2019) with original diagnoses dating to 1979. Original Hyams grade, Modified Hyams grade incorporating more detailed criteria and other histologic features (i.e. divergent differentiation, clear cell/oncocytic change, and spindling) were assessed if feasible, evaluated for distribution by grade and correlated with outcomes.

RESULTS: Original Hyams grade (n = 43) distribution was: I: 4 (9%), II: …

Inequality And Covid Risk At School: Racial Disparities In Indoor Density, Vaccination Rates, And Consequences For Absenteeism, Michael C. Quinn, Michah W. Rothbart, Amy Ellen Schwartz, Brian Elbel

Center for Policy Research

During the COVID pandemic, schools were widely believed to be a venue that facilitated disease transmission. While some worried Black and Hispanic students would disproportionately face greater risk of COVID exposure at school (school COVID risk) – given well-documented racially disparate school environments and resources – little empirical evidence exists documenting or refuting potential disparities in school COVID risk. This paper begins to fill this gap by examining racial disparities in the school environments that contribute to COVID risk at school—specifically, vaccination rates and classroom space per pupil (indoor density) - in New York City elementary schools. We then document …

Understanding Black American Pastors' Leadership Role And Interaction With Public Health During Covid-19, Stacy L. Tolbert

Walden Dissertations and Doctoral Studies

The COVID-19 pandemic tested the leadership, response, and resilience of Black American pastors and their communities. These pastors played a crucial role in supporting their communities to lessen the impact the virus had on underlying health conditions and socioeconomic hardships that were exacerbated by the pandemic. Despite their efforts, Black American pastors frequently encountered challenges helping their community. The current research sought to understand the lived experiences of Black American pastors during the pandemic and their interactions with public health institutions to secure resources for their communities through Interpretative Phenomenological Analysis (IPA). The study was guided by the research question, …

Barriers And Facilitators To Occupational Therapy For The Frail Older Person Within Primary Care In Belgium, Anne Ledoux, Stijn De Baets, Thérèse Van Durme, Patricia De Vriendt, Dominique Van De Velde, Sophie Thunus

Internet Journal of Allied Health Sciences and Practice

Introduction: The population is quickly aging in Belgium and there is an increasing number of older frail adults. Occupational therapy (OT) in primary care (PC) favors the stay-at-home of frail older persons through its preventive action on the person, the environment, and/or the task. However, OT is not well implemented in Belgian PC. We aimed to investigate the implementation of OT, to support the frail older person living at home, within primary care in Belgium. Methods: We performed a secondary thematic analysis, based on data collected during an implementation study of an OT guideline for this population. Data were collected …

A Model For Teaching Social Determinants Of Health In Doctor Of Physical Therapy Programs, Elise N. Bjork, Rupal M. Patel Pt, Phd, Rebecca Operacz, Deandrea B. Melvey, Luciano Garcia Iii

Internet Journal of Allied Health Sciences and Practice

Purpose: The purpose of this study was to 1) describe the development and implementation of a novel educational module on social determinants of health (SDOH) for Doctor of Physical Therapy (DPT) students, and 2) to assess the effectiveness of the module on altering DPT students’ knowledge, attitudes, beliefs, and barriers in addressing SDOH. Methods: Drawing on current literature, content expert feedback, identity theory, and experiential learning theory, a two-hour module on SDOH was created and delivered at two universities. The Physical Therapy Social Determinants of Health Scale (PT-SDHS) was used to assess change in students’ knowledge, attitudes, beliefs, and barriers …

Association Between Sociocultural Factors, Obesity, And Depression In The Hispanic/Latino Population, Maia Junco

Walden Dissertations and Doctoral Studies

The increasing prevalence of obesity and mental health disparities among Hispanic/Latino populations in the United States underscores the need to understand how sociocultural factors shape physical and psychological health. The purpose of this study was to examine how acculturation, diet quality, and fiber intake affect BMI and depressive symptoms over time. The study was guided by acculturation theory and the biopsychosocial model. The study used longitudinal secondary data from the Hispanic Community Health Study/Study of Latinos (HCHS/SOL) with a sample of N=8,816, including adults who completed examination visits, 1 (2008–2011) and 2 (2014–2017). Path analysis was conducted to assess direct …

Explore Toolkit, Kimberly Page, Janet Page Reeves, Ivan De La Rosa, Marie Alice Scott, Christina Phillips, Maria Sanchez, Andrew Gorvetzian, Joe Albright, Cynthia Killough, Randall Benalli

Epidemiology, Biostatistics, and Preventive Medicine

Welcome to the Exploring Health Beliefs for Community Engagement and Diversity in Clinical Trials (EXPLORE) Toolkit, a resource designed to support researchers and frontline workers addressing substance use in the Borderlands. The EXPLORE Toolkit was designed by an interdisciplinary team of epidemiologists, social workers, anthropologists, and public health professionals to enhance the engagement of underrepresented communities in substance use clinical trials. Utilizing a strength-based approach, the toolkit addresses equity, stigma, and participation barriers, promoting culturally sensitive and community-centered research practices. This toolkit is an ideal tool for clinical trials researchers and community health workers who are interested in learning more …

Phosphoglycerate Mutase Regulates Treg Differentiation Through Control Of Serine Synthesis And One-Carbon Metabolism, Wesley H Godfrey, Judy J Lee, Shruthi Shanmukha, Kaho Cho, Xiaojing Deng, Chandra Shekar R Ambati, Vasanta Putluri, Abu Hena Mostafa Kamal, Paul M Kim, Nagireddy Putluri, Michael D Kornberg

Faculty, Staff and Students Publications

The differentiation and suppressive functions of regulatory CD4 T cells (Tregs) are supported by a broad array of metabolic changes, providing potential therapeutic targets for immune modulation. In this study, we focused on the regulatory role of glycolytic enzymes in Tregs and identified phosphoglycerate mutase (PGAM) as being differentially overexpressed in Tregs and associated with a highly suppressive phenotype. Pharmacologic or genetic inhibition of PGAM reduced Treg differentiation and suppressive function while reciprocally inducing markers of a pro-inflammatory, T helper 17 (Th17)-like state. The regulatory role of PGAM was dependent on the contribution of 3-phosphoglycerate (3 PG), the PGAM substrate, …