Digital Commons Network^™

Medicaid Eligibility Loss Among Dual-Eligible Beneficiaries Before And During Covid-19 Public Health Emergency, Yanlei Ma, Eric T Roberts, Kenton J Johnston, E John Orav, Jose F Figueroa

2020-Current year OA Pubs

IMPORTANCE: Medicaid coverage loss can substantially compromise access to and affordability of health care for dual-eligible beneficiaries. The extent to which this population lost Medicaid coverage before and during the COVID-19 public health emergency (PHE) and the characteristics of beneficiaries more at risk for coverage loss are currently not well known.

OBJECTIVE: To assess the loss of Medicaid coverage among dual-eligible beneficiaries before and during the first year of the PHE, and to examine beneficiary-level and plan-level factors associated with heightened likelihood of losing Medicaid.

DESIGN, SETTING, AND PARTICIPANTS: This repeated cross-sectional study used national Medicare data to estimate annual …

A Culturally Sensitive And Intersectional Approach To Healthcare Among Latinx Communities, Gabriela Meza

Nursing | Senior Theses

Various factors, including immigration status, language barriers, age, and socioeconomic status, influence healthcare service utilization among the Latinx population. This study seeks to assess whether culturally sensitive care addressing intersectional factors enhances health access and outcomes in low-income Latinx communities (Purpose). The research proposes a longitudinal quasi-experimental study involving 400 Latinx participants aged 18 and above in low-income urban Los Angeles neighborhoods. A control group of 200 participants and an intervention group of 200 will be established, with the latter receiving culturally sensitive interventions when seeking care during the study. A pre-study survey will collect demographic information, health history, healthcare …

The Association Of Skin Cancer Prevention Knowledge, Sun-Protective Attitudes, And Sun-Protective Behaviors In A Navy Population, Rachel Newnam, Uyen Le-Jenkins, Carolyn Rutledge, Craig Cunningham

Nursing Faculty Publications

Introduction: U.S. Navy service members are primarily between the ages of 18 and 30 years and often required to be outside for extended periods of time in geographical locations with increased and often unfamiliar ultraviolet indexes that collectively increase their risk for skin cancer. Skin cancer is the country's most common form of cancer, yet there is a paucity of skin cancer prevention literature, especially within the U.S. Navy. The purpose of this study was to describe skin cancer risk and skin cancer prevention "cues-to-action" and to determine if skin cancer prevention knowledge was associated with sun-protective attitudes (e.g., prevention …

Harm Reduction In Undergraduate And Graduate Medical Education: A Systematic Scoping Review, Kelsey R. Smith, Nina K. Shah, Abby L. Adamczyk, Lara C. Weinstein, Erin L. Kelly

Department of Family & Community Medicine Faculty Papers

BACKGROUND: Substance use increasingly contributes to early morbidity and mortality, which necessitates greater preparation of the healthcare workforce to mitigate its harm. The purpose of this systematic scoping review is to: 1) review published curricula on harm reduction for substance use implemented by undergraduate (UME) and graduate medical education (GME) in the United States and Canada, 2) develop a framework to describe a comprehensive approach to harm reduction medical education, and 3) propose additional content topics for future consideration.

METHODS: PubMed, Scopus, ERIC: Education Resources Information Center (Ovid), and MedEdPORTAL were searched. Studies included any English language curricula about harm …

State Public Assistance Spending And Survival Among Adults With Cancer, Justin M Barnes, Kenton J Johnston, Kimberly J Johnson, Fumiko Chino, Nosayaba Osazuwa-Peters

2020-Current year OA Pubs

IMPORTANCE: Social determinants of health contribute to disparities in cancer outcomes. State public assistance spending, including Medicaid and cash assistance programs for socioeconomically disadvantaged individuals, may improve access to care; address barriers, such as food and housing insecurity; and lead to improved cancer outcomes for marginalized populations.

OBJECTIVE: To determine whether state-level public assistance spending is associated with overall survival (OS) among individuals with cancer, overall and by race and ethnicity.

DESIGN, SETTING, AND PARTICIPANTS: This cohort study included US adults aged at least 18 years with a new cancer diagnosis from 2007 to 2013, with follow-up through 2019. Data …

Development Of A Covid-19 Vulnerability Index (Cvi) For The Counties And Residents Of New Jersey, Usa., Remo Disalvatore, Sarah K Bauer, Jeong Eun Ahn, Kauser Jahan

Henry M. Rowan College of Engineering Faculty Scholarship

The coronavirus disease 2019, or COVID-19, has impacted countless aspects of everyday life since it was declared a global pandemic by the World Health Organization in March of 2020. From societal to economic impacts, COVID-19 and its variants will leave a lasting impact on our society and the world. During the height of the pandemic, it became increasingly evident that indices, such as the Center for Disease Control's (CDC) Social Vulnerability Index (SVI), were instrumental in predicting vulnerabilities within a community. The CDC's SVI provides important estimates on which communities will be more susceptible to 'hazard events' by compiling a …

Exploring Inmate Health In Prisons: Health Issues, Interventions, And Suggestions To Improve Care, Jenna Healy

Honors Program Theses and Projects

The United States has the highest number of prisoners per capita at 639 people per 100,0008. There has been a fivefold increase in the number of inmates in the United States prison systems since 197044, and this may be a major contributor to the corrections healthcare system having trouble keeping up with this growth compared to the general population of the United States. According to the World Health Organization, the United States has documented higher mortality rates than many other developed countries. Rates of conditions such as cardiovascular disease have decreased everywhere, but much less in the United States. In …

Plasma Metabolites Associated With Cognitive Function Across Race/Ethnicities Affirming The Importance Of Healthy Nutrition., Einat Granot-Hershkovitz, Shan He, Jan Bressler, Bing Yu, Wassim Tarraf, Casey M Rebholz, Jianwen Cai, Queenie Chan, Tanya P Garcia, Thomas Mosley, Bruce S Kristal, Charles Decarli, Myriam Fornage, Guo-Chong Chen, Qibin Qi, Robert Kaplan, Hector M González, Tamar Sofer

Journal Articles

INTRODUCTION: We studied the replication and generalization of previously identified metabolites potentially associated with global cognitive function in multiple race/ethnicities and assessed the contribution of diet to these associations.

METHODS: We tested metabolite-cognitive function associations in U.S.A. Hispanic/Latino adults (n = 2222) from the Community Health Study/ Study of Latinos (HCHS/SOL) and in European (n = 1365) and African (n = 478) Americans from the Atherosclerosis Risk In Communities (ARIC) Study. We applied Mendelian Randomization (MR) analyses to assess causal associations between the metabolites and cognitive function and between Mediterranean diet and cognitive function.

RESULTS: Six metabolites were consistently associated …

Dear Pandemic: A Topic Modeling Analysis Of Covid-19 Information Needs Among Readers Of An Online Science Communication Campaign., Aleksandra M Golos, Sharath Chandra Guntuku, Rachael Piltch-Loeb, Lindsey J Leininger, Amanda M Simanek, Aparna Kumar, Sandra S Albrecht, Jennifer Beam Dowd, Malia Jones, Alison M Buttenheim

College of Nursing Faculty Papers & Presentations

BACKGROUND: The COVID-19 pandemic was accompanied by an "infodemic"-an overwhelming excess of accurate, inaccurate, and uncertain information. The social media-based science communication campaign Dear Pandemic was established to address the COVID-19 infodemic, in part by soliciting submissions from readers to an online question box. Our study characterized the information needs of Dear Pandemic's readers by identifying themes and longitudinal trends among question box submissions.

METHODS: We conducted a retrospective analysis of questions submitted from August 24, 2020, to August 24, 2021. We used Latent Dirichlet Allocation topic modeling to identify 25 topics among the submissions, then used thematic analysis to …

Assessment Of Ethno-Racial And Insurance-Based Disparities In Pediatric Forearm And Tibial Fracture Care In The United States, Andrew J Landau, Afolayan K Oladeji, Pooya Hosseinzadeh

2020-Current year OA Pubs

INTRODUCTION: Despite growing attention to healthcare disparities and interventions to improve inequalities, additional identification of disparities is needed, particularly in the pediatric population. We used state and nationwide databases to identify factors associated with the surgical treatment of pediatric forearm and tibial fractures.

METHODS: The Healthcare Cost and Utilization Project State Inpatient, Emergency Department, and Ambulatory Surgery and Services Databases from four US states and the Nationwide Emergency Department Sample database were quarried using International Classification of Diseases codes to identify patients from 2006 to 2015. Multivariable regression models were used to determine factors associated with surgical treatment.

RESULTS: State …

Association Of State Medicaid Expansion Status With Rates Of Suicide Among Us Adults, Hetal Patel, Justin Barnes, Nosayaba Osazuwa-Peters, Laura Jean Bierut

2020-Current year OA Pubs

Importance: In the US, suicide is the 10th leading cause of death and a serious mental health emergency. National programs that address suicide list access to mental health care as key in prevention, and more large-scale policies are needed to improve access to mental health care and address this crisis. The Patient Protection and Affordable Care Act (ACA) Medicaid Expansion Program was implemented in several states with the goal of increasing access to the health care system.

Objective: To compare changes in suicide rates in states that expanded Medicaid under the ACA vs states that did not.

Design, Setting, and …

Physician-Scientists In The United States At 2020: Trends And Concerns, Howard H Garrison, Timothy J Ley

2020-Current year OA Pubs

Physician-scientists comprise a unique and valuable part of the biomedical workforce, but for decades there has been concern about the number of physicians actively engaged in research. Reports have outlined the challenges facing physician-scientists, and programs have been initiated to encourage and facilitate research careers for medically trained scientists. Many of these initiatives have demonstrated successful outcomes, but there has not been a recent summary of the impact of the past decade of effort. This report compiles available data from surveys of medical education and physician research participation to assess changes in the physician-scientist workforce from 2011-2020. Several trends are …

Implicit Bias Against Bipoc Patients In Clinical Settings: A Qualitative Review, Raisa Kabir, Sayeda Tazim Zaidi

Spectra Undergraduate Research Journal

Black, Indigenous, and People of Color (BIPOC) from stigmatized and marginalized communities face implicit bias in medicine. Implicit biases are unconscious attitudes and internalized discrimination developed through repeated practices based on stereotypes from a foundation of systematic racism. In clinical settings, it impacts individuals’ healthcare experience and treatment outcomes. This study aimed to characterize and address implicit bias among healthcare providers toward BIPOC patients in clinical settings. A literature search in MEDLINE/PubMed, CINAHL, PsyArticles, PsycINFO from EBSCO databases was conducted to include all peer-reviewed studies (2012-2021) about implicit bias toward BIPOC. Most healthcare providers have some form of implicit bias-positive …

Risk Of Opioid Overdose Associated With Concomitant Use Of Oxycodone And Selective Serotonin Reuptake Inhibitors, Ismaeel Yunusa, Joshua J. Gagne, Kazuki Yoshida, Katsiaryna Bykov

Faculty Publications

Importance Some selective serotonin reuptake inhibitors (SSRIs) inhibit the enzymes responsible for the metabolism of oxycodone, a potent prescription opioid. The clinical consequences of this interaction on the risk of opioid overdose have not been elucidated.

Objective To compare opioid overdose rates in patients initiating oxycodone while taking SSRIs that are potent inhibitors of the cytochrome-P450 2D6 enzyme (CYP2D6) vs SSRIs that are not.

Design, Setting, and Participants This cohort study included adults who initiated oxycodone while receiving SSRI therapy between 2000 and 2020 whose data were included in 3 US health insurance databases.

Exposures Use of SSRIs that strongly …

Prenatal And Pediatric Oral Health Education Among Dental Hygiene Programs In The United States, Denise M. Claiborne, Shillpa Naavaal

Dental Hygiene Faculty Publications

Purpose: Health care and dental providers must be prepared to address the oral health needs of mothers and children in order to reduce the burden of dental disease in these populations. The purpose of this study was to describe the curriculum and clinical experiences related to prenatal and pediatric oral health in the university and community college dental hygiene programs in the United States (US).

Methods: Dental hygiene program directors (PDs) from across the US were invited to participate in a cross-sectional electronic survey regarding the prenatal and pediatric oral health curriculum at their institution. In addition to program characteristics, …

Characterization Of Gut Microbiome And Metabolome In Helicobacter Pylori Patients In An Underprivileged Community In The United States, Brian White, John D Sterrett, Zoya Grigoryan, Lauren Lally, Jared D Heinze, Hyder Alikhan, Christopher A Lowry, Lark Perez, Joshua Desipio, Sangita Phadtare

Faculty Scholarship for the College of Science & Mathematics

Background: Helicobacter pylori (H. pylori), a bacterium that infects approximately half of the world's population, is associated with various gastrointestinal diseases, including peptic ulcers, non-ulcer dyspepsia, gastric adenocarcinoma, and gastric lymphoma. As the burden of antibiotic resistance increases, the need for new adjunct therapies designed to facilitate H. pylori eradication and reduce negative distal outcomes associated with infection has become more pressing. Characterization of the interactions between H. pylori, the fecal microbiome, and fecal fatty acid metabolism, as well as the mechanisms underlying these interactions, may offer new therapeutic approaches. Aim: To characterize the gut microbiome and metabolome in H. …

The Impacts Of Health Insurance On The Uninsured And Underinsured, Isabela Camayd

Student Research Poster Presentations 2021

In the United States the American healthcare is constantly up for debate, it seems to only be aimed towards individuals who can afford insurance. Those individuals who can afford insurance must have a full-time or part time job to obtain the benefits from the employer. For those individuals who are underinsured and uninsured there could be endless reasons holding them from obtaining their own insurance, private insurance, company insurance and many others. There are a few organizations in place to help those who are in need of insurance such as, the Affordable Care Act, Medicare and, Medicaid.

Association Of Patient-Centered Medical Home Designation And Quality Indicators Within Hrsa-Funded Community Health Center Delivery Sites, Nathaniel Bell, Rebecca Wilkerson, Kathy Mayfield-Smith, Ana Lòpez-De Fede

Faculty Publications

BACKGROUND: Patient-Centered Medical Home (PCMH) adoption is an important strategy to help improve primary care quality within Health Resources and Service Administration (HRSA) community health centers (CHC), but evidence of its effect thus far remains mixed. A limitation of previous evaluations has been the inability to account for the proportion of CHC delivery sites that are designated medical homes.

METHODS: Retrospective cross-sectional study using HRSA Uniform Data System (UDS) and certification files from the National Committee for Quality Assurance (NCQA) and the Joint Commission (JC). Datasets were linked through geocoding and an approximate string-matching algorithm. Predicted probability scores were …

Oral Health-Related Quality Of Life In Us Adults With Type 2 Diabetes., Giang Truong Vu

Electronic Theses and Dissertations

This dissertation focused on the relationship between type 2 diabetes (T2DM) and oral health-related quality of life (OHRQoL) and the factors associated with this relationship in the US. The objectives of the dissertation research were a three-part process: (1) to understand the relationships of T2DM with poor OHRQoL, clarify risk and preventive factors that affect this association, and identify research gaps in the literature, (2) to analyze risk factors associated with poor OHRQoL in US adults with T2DM using a nationally representative random probability cluster sample, and (3) to apply structural equation modeling (SEM) to a simplified Andersen’s Behavioral Model …

The Emerging Spectrum Of Cardiopulmonary Pathology Of The Coronavirus Disease 2019 (Covid-19): Report Of 3 Autopsies From Houston, Texas, And Review Of Autopsy Findings From Other United States Cities, Louis Maximilian Buja, Dwayne A Wolf, Bihong Zhao, Bindu Akkanti, Michelle Mcdonald, Laura Lelenwa, Noah Reilly, Giulia Ottaviani, M Tarek Elghetany, Daniel Ocazionez Trujillo, Gabriel M Aisenberg, Mohammad Madjid, Biswajit Kar

Journal Articles

This paper collates the pathological findings from initial published autopsy reports on 23 patients with coronavirus disease 2019 (COVID-19) from 5 centers in the United States of America, including 3 cases from Houston, Texas. Findings confirm that COVID-19 is a systemic disease with major involvement of the lungs and heart. Acute COVID-19 pneumonia has features of a distinctive acute interstitial pneumonia with a diffuse alveolar damage component, coupled with microvascular involvement with intra- and extravascular fibrin deposition and intravascular trapping of neutrophils, and, frequently, with formation of microthombi in arterioles. Major pulmonary thromboemboli with pulmonary infarcts and/or hemorrhage occurred in …

How Does Access To Healthcare Affect Life Expectancy?, Yara Mahmoud

Senior Honors Projects, 2010-2019

Access to health care is a pressing issue in the United States, whether it be the cost of care or not having enough of it. To emphasize the importance of this topic, this paper assesses the impact of access to health services on life expectancy. A comparison is made between the universal health systems in France and Spain and the mixed system in the United States. Even though the United States spends the most on health care in the world, its statistics fall below those of other developed countries. After addressing other risk factors, it was found that individuals under …

Prevalence Of Molar-Incisor Hypomineralization In Milwaukee, Wisconsin, Usa: A Pilot Study, Megan Davenport, Andrew D. Welles, Matina V. Angelopoulou, Cesar D. Gonzalez, Christopher Okunseri, Lori Barbeau, Naveen K. Bansal, Rodney Vergotine, Brian D. Hodgson

School of Dentistry Faculty Research and Publications

Purpose: This pilot study investigated the prevalence of Molar-Incisor Hypomineralization (MIH) in third-grade school children in Milwaukee Wisconsin, USA.

Methods: A convenience sample of third-grade school children in the Milwaukee Public School System (MPS) participated in the study. Calibrated examiners trained on the European Academy of Paediatric Dentistry (EAPD) MIH recommendations examined the children between December 1, 2014 and June 30, 2015. Children were examined at their schools using a flashlight and mirror after receiving consent from parents/caregivers and assent from each child. Findings were recorded onto a standardized form by one of five trained examiners. Summary statistics were calculated, …

Food Insecurity And Violence In A Prospective Cohort Of Women At Risk For Or Living With Hiv In The U.S., Amy A. Conroy, Mardge H. Cohen, Edward A. Frongillo Jr., Alexander C. Tsai, Tracey E. Wilson, Eryka L. Wentz, Adaora A. Adimora, Daniel Merenstein, Ighovwerha Ofotokun, Lisa Metsch, Mirjam-Colette Kempf, Adebola Adedimeji, Janet M. Turan, Phyllis C. Tien, Sheri D. Weiser

Faculty Publications

Background Food insecurity and violence are two major public health issues facing U.S. women. The link between food insecurity and violence has received little attention, particularly regarding the temporal ordering of events. The present study used data from the Women’s Interagency Human Immunodeficiency Virus Study to investigate the longitudinal association of food insecurity and violence in a cohort of women at risk for or living with HIV.

Methods Study participants completed six assessments from 2013–16 on food insecurity (operationalized as marginal, low, and very low food security) and violence (sexual or physical, and psychological). We used multi-level logistic regression, controlling …

Depressive Symptoms And Untreated Coronal Dental Caries Among Adults Ages 21-64 Years, Nhanes 2013-2014, R. Constance Wiener, Chan Shen, Patricia A. Findley, Nilanjana Dwibedi, Usha Sambamoorthi

Clinical and Translational Science Institute

Background: Depression has been linked to poor oral health among patients seeking dental care. However, systematic research on the relationship between depressive symptoms and oral health is limited. Objective: To examine the association of depressive symptoms with untreated dental caries among adults aged 21-64 years. Basic Research Design: Cross-sectional secondary analysis. Setting: The data were extracted national data collected in the United States (2013-2014 National Health Nutrition and Examination Survey). Participants: The sample consisted of 3,127 non-institutionalized civilians. Main outcome measure: Untreated coronal dental caries (yes, no) was the key outcome variable. Depressive symptom categories (none, moderate, and severe) were …

The Impacts Of Medicaid Expansion On Rural Low-Income Adults: Lessons From The Oregon Health Insurance Experiment., Heidi Allen, Bill J. Wright, Lauren Broffman

Articles, Abstracts, and Reports

Medicaid expansions through the Affordable Care Act began in January 2014, but we have little information about what is happening in rural areas where provider access and patient resources might be more limited. In 2008, Oregon held a lottery for restricted access to its Medicaid program for uninsured low-income adults not otherwise eligible for public coverage. The Oregon Health Insurance Experiment used this opportunity to conduct the first randomized controlled study of a public insurance expansion. This analysis builds off of previous work by comparing rural and urban survey outcomes and adds qualitative interviews with 86 rural study participants for …

Hours Lost To Planned And Unplanned Dental Visits Among Us Adults, Uma Kelekar, Shillpa Naavaal

Dental Public Health and Policy Publications

Introduction

Poor oral health is associated with lost hours at work or school, which may affect a person’s productivity. The objective of our study was to estimate work or school hours lost to dental visits among adults aged 18 and older by the types of visits (emergency or unplanned; routine, planned, or orthodontic; or cosmetic) and to determine the factors associated with hours lost.

Methods

We used the most recent Oral Health Supplement data, from the 2008 National Health Interview Survey (NHIS), to estimate the total hours lost at work or school for dental visits among adults in the United …

Healthcare And Its Impact On Nurses: The United States Vs. The United Kingdom, Alexandria Colovos

Mahurin Honors College Capstone Experience/Thesis Projects

Currently, in the United States, the topic of healthcare reform is in the back of everyone’s mind. What will come of our healthcare system? Will the cost of healthcare decrease? Will patients have better access to care? With this Capstone Experience/Thesis, I wanted to explore the differences between the current healthcare system that we have in the United States, to the nearly seventy-year-old National Health Service (NHS) in the United Kingdom, which provides healthcare to all. The NHS is free at the point of care and is funded by taxation. To understand if such a system would work in the …

Hospice Utilization Of Medicare Beneficiaries In Hawai‘I Compared To Other States, Deborah Taira, Merle Kataoka-Yahiro, Angela Sy

Asian/Pacific Island Nursing Journal

The objective is to examine hospice utilization among Medicare beneficiaries in Hawai‘i compared to other states. Data were from the 2014 Medicare Hospice Utilization and Payment Public Use File, which included information on 4,025 hospice providers, more than 1.3 million hospice beneficiaries, and over $15 billion in Medicare payments. Multivariable linear regression models were estimated to compare hospice utilization in Hawai‘i to that of other states. Control variables included age, gender, and type of Medicare coverage. Medicare beneficiaries using hospice in Hawai‘i differed significantly from beneficiaries in other states in several ways. Hawai‘i beneficiaries were more likely to be Asian …

Clinician-Investigator Training And The Need To Pilot New Approaches To Recruiting And Retaining This Workforce., Alison K Hall, Sherry L Mills, P Kay Lund

Neurology Faculty Publications

Clinician–investigators, also called physician–scientists, offer critical knowledge and perspectives that benefit research on basic science mechanisms, improved diagnostic and therapeutic approaches, population and outcomes medicine, health policy, and health services, yet few clinically trained health professionals pursue a research career. Sustaining this workforce requires attention to the unique challenges faced by investigators who must achieve clinical and research competence during training and their careers. These challenges include the duration of required clinical training, limited or discontinuous research opportunities, high levels of educational debt, balancing the dual obligations and rewards of clinical care and research, competition for research funding, and the …

Disability: Becoming An Advocate For Persons With Disabilities And Understanding The History Of The Disability Movement In The United States, Frances Mason Ramsay

Senior Theses

The purpose of this thesis is to look at the different facets that make up disability in the United States, with a specific focus on the children with disabilities. These facets include related legislation, the education system, activism, services, and what it means to care for a child with disabilities. Throughout the research process, each of these facets were analyzed to include the most significant events for the section, an overview of each section to provide insight and a small amount of background and history for someone relatively unfamiliar with the history of disability in the United States. Beyond research …