Medicine and Health Sciences Commons^™

Has Regional Hospital Autonomy Achieved Its Goals? Lessons Learned From Indonesia: A Systematic Review, Masyitoh Basabih, Indriaswari Widhakuswara

Kesmas

This study examined the impact of hospital autonomy implementation on the performance of regional public hospitals in Indonesia, particularly in terms of efficiency, effectiveness, and governance. A systematic review of 32 peer-reviewed studies published between June 12 and September 6, 2023, was conducted using Garba Rujukan Digital and Google Scholar, following PRISMA guidelines. Studies addressing financial performance, service outcomes, and challenges related to implementing autonomy were included. The findings indicated that while autonomy led to improvements in infrastructure, service types, visit volumes, and hospital revenues, it had only a marginal impact on improving key health performance outcomes, such as service …

Understanding User Needs In Health Crisis Risk Monitoring Information System Development: A Lesson From Tasikmalaya District, Indonesia, Arief Tarmansyah Iman, Hari Kusnanto, Ariani Arista Putri Pertiwi

Kesmas

A health crisis risk monitoring information system needs to be developed, especially during the pre-disaster phase; therefore, understanding the needs of prospective users is crucial. This study aimed to investigate the needs of potential users regarding the development of this system. This study employed a qualitative, exploratory approach to gather user needs from stakeholders through interviews (n = 7) and one focus group discussion (n = 12). The data were audio-recorded, transcribed verbatim, and then thematically analyzed using qualitative content analysis. The need for information was related to disaster preparedness and its preferred format. The system should be targeted, multiplatform, …

Barriers To Implementing Comprehensive Sexuality Education As A Strategy To Prevent Adolescent Pregnancy In Indramayu District, Indonesia, Een Kurnaesih, Chahya Kharin Herbawani, Nelly Febriani

Kesmas

The implementation of comprehensive sexuality education (CSE) is not optimal. This qualitative study aimed to identify and contextualize barriers to CSE implementation, specifically in Indramayu District, Indonesia. Conventional content analysis procedures were used. Seven participants, consisting of relevant authorities, were interviewed. A purposive sampling technique was employed to select participants. Data were collected through in-depth, semi-structured interviews. All interviews were recorded and transcribed verbatim. Data were analyzed using conventional qualitative content analysis. The barriers to CSE implementation in Indramayu District were identified across five themes: advocacy, technical considerations, coordination and collaboration, integration with other sexual and reproductive health projects, and …

Experiences Of Elderly Living With Noncommunicable Diseases In Utilizing Health Services In Myanmar During The Covid-19 Pandemic, Nway Eint Chei, Kwanjai Amnatsatsue, Natkamol Chansatitporn, Ariya Bunngamchairat

Kesmas

The COVID-19 pandemic and armed conflicts in Myanmar have intensified the challenges in accessing and utilizing health services, particularly for noncommunicable diseases (NCDs) among older adults. This qualitative study explored the experiences of the elderly with NCDs regarding health service accessibility and utilization in secure areas with fully operational health facilities by conducting in-depth interviews with 20 eligible older adults in Myanmar; data were analyzed using content analysis. Four key themes emerged: NCD service utilization patterns; unmet needs; preferences and hesitancy toward NCD services; and disparities, barriers, and opportunities. The findings revealed widespread underutilization of NCD services due to several …

Low Economic Level And The Risk Of Overweight Among Indonesian Junior And Senior High School Students, Ariyanto Nugroho, Purwo Setiyo Nugroho, Amarin Yudhana, Sri Sunarti

Kesmas

Overweight and obesity among Indonesian adolescents have emerged as a pressing public health issue, reflecting global trends. This study examines the relationship between economic status and overweight prevalence among junior and senior high school students in Indonesia, using secondary data from the Global School-based Health Survey (GSHS). This study analyzed data from 9,977 students aged 11–18 years through a cross-sectional design and binary logistic regression, adjusting for dietary habits, physical activity, and sedentary behavior. Overall, 14.7% of students were overweight; the prevalence was notably higher among low-income students (27.4%) compared to high-income groups (14.2%). Students from lower economic backgrounds were …

Government Health Spending And Life Expectancy: Evidence From Cities And Districts In Indonesia, Kurnia Sari, Budi Hidayat, Amal Chalik Sjaaf, Mardiati Nadjib

Kesmas

Life expectancy is widely recognized as a fundamental indicator of population health, and its improvement is often linked to government health spending, particularly in decentralized health systems. This study aimed to investigate the relationship between local government health expenditures and life expectancy in decentralized Indonesia. Data from 492 cities and districts, spanning from 2015 to 2019, were analyzed using a two-way fixed effects regression model to control for time-invariant district characteristics and common temporal shocks. The findings indicated that a 10% increase per capita in government health expenditure was associated with a 0.01% increase in life expectancy. This association was …

Social Media And Mental Health According To Generation Z: A Health Belief Model-Based Cross-Sectional Evaluation Of Generation Z Adults’ Attitudes And Perceptions Of Problematic Social Media Use And Its Relationship With Depression And Anxiety, Michael Chad Gann

Doctoral Dissertations and Projects

Purpose: This study aimed to examine Generation Z adults’ attitudes and perceptions of problematic social media use (PSMU) as they relate to mental health problems (depression and anxiety) through the lens of the Mental Health Belief Model.

Methods: A cross-sectional, web-based survey gathered data from a convenience sample (N = 353) of Generation Z adults (age 18-30) after receiving approval from the LU IRB. The previously validated instrument battery included the Bergen Social Media Addiction Scale (BSMAS), the Patient Health Questionaire – 9 (PHQ-9), the Generalized Anxiety Disorder – 7 (GAD-7), and the Greene (2012) MHBM subscales for perceived susceptibility …

Evaluating Inclusion Rates Of Oral-Systemic Health Connection Coursework In Dental And Medical Professional Programs' Admissions Requirements, Wendy Marie Carry

Doctoral Dissertations and Projects

Oral systemic health connections (OSHC) are bidirectional, life-threatening, and a significant public health concern. Studies have identified over 200 OSHCs; however, the prevalence of foundational OSHC education in dental and medical professional programs remains unknown. This quantitative descriptive comparative pilot study aimed to explore the prevalence of predictor variables, dental and medical professional programs in the United States, and the criterion variable, including an OSHC admissions requirement for the 2025 academic year. The point-in-time count methodology served as the theoretical framework guiding this study and the development of the PiT-PARCI instrument. The proposed testing was replaced with alternative testing based …

Associations Between Factors Of Unhealthy Lifestyle, Mental Health Issues, Chronic Illnesses, Environmental Health Risks, And Infertility In Females: A Cross-Sectional Study, Richard L. Huang

Doctoral Dissertations and Projects

Infertility has risen rapidly in recent decades and has become the third-largest public health concern in the world. It has significantly threatened individuals’ psychological, physical, and social well-being, and it could be an early sign of severe health problems in the future. Furthermore, it also threatens the continuation of life and human civilization. The purpose of this study was to examine the relationship between individuals’ daily lifestyle behaviors, mental health status, chronic conditions, environmental health factors, and infertility by using cross-sectional quantitative methods. It benefits the public as the study raised awareness of potential risks and provided guidance to avoid …

Mortality And Heart Failure Exacerbations With Incretin-Mimetic Drugs For Weight Loss In Patients With Obesity-Related Heart Failure With Preserved Ejection Fraction, Leila Humphreys, Salvatore Carbone, Syed Imran Ahmed

Cardiovascular Research Symposium

Research has shown that incretin-mimetic agents approved and used for weight loss may help treat heart failure by improving their quality of life and functional capacity. Whether differences exist between these agents in the HFpEF population has not been tested before. Our study set out to see if these agents affected risk of all-cause mortality and further heart failure related hospitalizations in patients with obesity-related HFpEF and whether differences exist among them.

Predicting Cardiovascular Mortality In Hampton Roads Using Social Determinants Of Health, Mohan D. Pant, Aditya Chakraborty, Prachi P. Chavan, George Mcleod, Brett J. Sierra, Glenn A. Yap, Brian C. Martin, Ebbie Kalan, Gregory T. Scott

Cardiovascular Research Symposium

Background: In Virginia’s Hampton Roads (HR) region, minority populations experience notably higher mortality rates than white populations. Despite abundant research on the association between social determinants of health (SDOH) and cardiovascular mortality rates at the state and national levels, there is a lack of research examining this association in the HR region.

Objective: The main objective of this study is to train and validate a geospatial-temporal predictive model to examine the association between SDOH and cardiovascular mortality, in the HR region.

Methods: Utilizing a longitudinal dataset (2010–2021) from the Virginia Department of Health and the U.S. Census Bureau, we trained …

A Modern Analytical Method To Forecast Cerebrovascular Diseases (Cd), And Heart Diseases (Hd) Using Multivariate Time Series Model Utilizing The Cdc Provisional Mortality Data, Aditya Chakraborty, Mohan Pant

Cardiovascular Research Symposium

Background: In this study, a new analytical approach was introduced to answer specific questions related to mortalities due to cerebrovascular diseases, heart diseases, and the association of these mortalities with twelve other causes of death (COD).

Methods: A multivariate time series forecasting model was developed utilizing each of the CODs by taking the weekly and yearly seasonality into account, and the mortality counts were forecasted using the most recent CDC weekly mortality count data. A new COD data matrix was structured for all CODs as a function of weeks by combining the observed and predicted values of the mortality counts. …

Student Nurse-Led Hypertension Management In A Rural Free Clinic, Leslie Okhirkhian

Cardiovascular Research Symposium

This pilot project seeks to evaluate the effect of nurse-led assessments and education on blood pressure control among adult patients with prehypertension and hypertension who attend a free health clinic located inside of a rural community in Southeastern Virginia. A leading, modifiable risk factor for cardiovascular disease is hypertension, yet disparities in consistent healthcare access and education disproportionately affect rural populations. Nurse-led interventions are a promising strategy for improving hypertension control through personalized education, blood pressure monitoring, and follow-up.

Methods: Participants with a diagnosis of prehypertension or hypertension were recruited from a free rural health clinic (n=20). Over a 7-week …

Socioeconomic, Behavioral, And Health Profiles Of Women With Eclampsia: Findings From The 2020–2022 National Pregnancy Risk Assessment Monitoring System Data, Jessi Bates, Gurgen Grigoryants, Hongyun Fu

Cardiovascular Research Symposium

Background: Eclampsia is a severe obstetric complication with significant maternal health implications, disproportionately affects women with certain sociodemographic and health risk factors. This study investigates the characteristics and outcomes of women who experienced eclampsia using data from the national Pregnancy Risk Assessment Monitoring System (PRAMS).

Methods: This analysis included a sample of 729 women with eclampsia from the 2020–2022 PRAMS (N = 238,575). Descriptive statistics, chi-square tests, and multivariate logistic regression were conducted to examine patterns and factors associated with preterm-birth, low birth weight (LBW), and cesarean delivery.

Results: Over half of the women were aged ≥35 years (50.6%), unmarried …

Time Ticks Slowly For Kidney Transplant Reform: Eskd Patient Challenges And Opportunities, Gregory P. Hess

College of Population Health Faculty Papers

No abstract provided.

Low-Level Pm2.5 Exposure And Mortality In The Medicare Cohort: The Role Of Native American Beneficiaries, Judy Wendt Hess, Wenyaw Chan

Faculty, Staff and Student Publications

Fine particulate matter (PM2.5) has been associated with mortality at low concentrations, with higher per-unit risk at lower exposure levels, and no threshold of effect. We examined characteristics of Medicare decedents living in zip codes at the lowest end of the U.S. PM2.5 exposure distribution to determine whether there is a demographic, health or exposure profile of beneficiaries for whom even low PM2.5 exposure is associated with increased mortality. The study included 2,773,647 decedent cases and 27,736,470 non-decedent controls, matched on decile of long-term PM2.5 exposure from among 36 million Medicare fee-for-service beneficiaries enrolled 2015–2016. Outcomes of the study included …

Exploring Lingering Covid-19 Vaccine Hesitancy In Three Diverse U.S. States: Alabama, Illinois, And Texas, Sinan Almukhtar, Noah Mcwhirter, Anaïs Mendiola, Shekwonya Samuel, Olivia Dominguez, Danielle Pester Boyd, Stephen Flores, Pooja Gandhi, Francis Kazungu, Manorama Khare, Paula Cuccaro, Maria E Fernández, Ronald C Hershow, Sage Kim, Emily Stiehl

Faculty, Staff and Student Publications

During the COVID-19 pandemic, vaccine uptake was slower than expected, with some people experiencing concern about the safety and effectiveness of the COVID-19 vaccine even after being vaccinated. This manuscript explores a phenomenon called lingering hesitancy, or the concern that people experience even after receiving an initial dose of a vaccine. Leveraging survey findings from three individual Prevention Research Centers (PRCs) in Alabama, Illinois, and Texas, we compare the attitudes of individuals across three vaccine status groups: those who received their complete COVID-19 vaccine series, those who received an initial dose but no subsequent doses (lingering hesitancy), and those who …

External Validation Of Calculator For Cesarean Delivery During Induction Of Labor, Claudia J. Ibarra, Rachel L. Wiley, Han-Yang Chen, Estefania Guthrie, Ipsita Ghose, Hector Mendez-Figueroa, Suneet P. Chauhan

School of Medicine Faculty Publications

OBJECTIVE: To validate a published risk calculator to predict cesarean delivery (CD) among singletons undergoing induction of labor. METHODS: Our retrospective cohort study included singletons undergoing induction of labor. A predicted CD score was calculated for each individual based on a previously developed calculator. External validation of the calculator was assessed by the discriminative power of the model by using the area under the receiver operating characteristic curve, and by a calibration curve. The score was categorized as less than 10%, 10% to less than 30%, and 30% or greater. The primary outcome was CD. The secondary outcomes were a …

Impact Of Mental Illness On Colon Cancer Screening Participation, Stephanie Tejada

Walden Dissertations and Doctoral Studies

This study analyzed the impact of mental illness on colon cancer screening participation. The research problem centers on the under-screening of colorectal cancer (CRC) in psychiatric patients, leading to delayed diagnoses and poorer treatment outcomes. This quantitative retrospective cohort study examined how demographic factors (age, gender, ethnicity), healthcare access, and support group participation influenced CRC screening among individuals with mental illness. The research used data from 571 adults aged 50 and older from the National Health Interview Survey (NHIS). The Social Ecological Model served as the guiding theoretical framework for this study. Statistical analyses included t-tests, chi-square, logistic regression, and …

Opioid Overdose Bystander Assistance And Harm Reduction In Pennsylvania, Walkirya Peralta

Walden Dissertations and Doctoral Studies

Bystanders play a vital role in reducing opioid overdose deaths by administering naloxone, a medication that can reverse the effects of opioids when used promptly. With opioid-related fatalities considered a public health emergency in the United States, increasing public access to naloxone and education on overdose prevention has become a key strategy in harm reduction. Research shows that these efforts effectively lower overdose deaths in affected communities. As part of this public health approach, many states allow individuals to obtain naloxone without a prescription through standing orders at pharmacies and community programs. Additionally, legal protections such as Good Samaritan laws …

Partner Collective Impact Survey Final Evaluation Report, Courtney A. Fitzgerald, Theresa H. Cruz, Havana Maisano

Reports & Documents

The Healthy Here coalition, based in Bernalillo and Santa Fe Counties, brings together over 30 organizations working across four key areas: healthy eating, active living, family healthy weight, and vaccinations. In summer 2025, the coalition conducted a PARTNER Collective Impact Survey to evaluate its network structure, contributions, and effectiveness. The survey, completed by 29 organizations (87.9% response rate), provided insights into how member organizations collaborate, the resources they contribute, and how trust and value are perceived across the network.

Findings show that coalition members most frequently contributed community connections, content expertise, and information sharing, with Presbyterian Community Health and the …

Birth Outcomes In The Hispanic Population In The United States: Trends, Variation, And Determinants (2011–2021), Yanchao Yang, Sota Fuji '27, Thinh Nguyen '26

Business Analytics Faculty Publications

Infants born to mothers who self-identify as Hispanic account for a substantial and growing share of births in the United States, yet limited research has examined disparities in birth outcomes across Hispanic origin subgroups. This study aims to document trends and identify important factors associated with Cesarean section (C-section), low birth-weight, and prematurity within the Hispanic population. We use data from the National Vital Statistics System (2011–2021), covering nearly all U.S. births. We compare outcomes across Hispanic, non-Hispanic White, and non-Hispanic Black mothers and further disaggregate by Hispanic origin (Mexican, Puerto Rican, Cuban, Central/South American, and Other/Unknown). We use logistic …

Segmental Atrophy Of The Liver: Review Of A Rare Pseudotumor, Ayesha Younus, Yu Liu, Ellen E. Connor, Zeng-Ying Wu, Hwajeong Lee, Zhi-Yan Fu

School of Medicine Faculty Publications

Segmental atrophy (SA) of the liver is a rare, often underrecognized, benign condition that presents as a mass lesion, mimicking a neoplasm, which poses a significant diagnostic challenge. Given its rarity, only a limited number of case reports and series have been published, resulting in sparse literature on the entity. This review aims to summarize the clinicopathologic and diagnostic features of SA and thus improve its recognition.

Outcomes Of Brexucabtagene Autoleucel In Patients With Relapsed/Refractory Acute Lymphoblastic Leukemia With Cns Involvement, Ibrahim N Muhsen, Gregory W Roloff, Rawan Faramand, Tamer Othman, Yannis Valtis, Noam E Kopmar, Simone E Dekker, Matthew Connor, Santiago Mercadal, Timothy E O'Connor, Kaitlyn C Dykes, Mohamed Ahmed, Nikeshan Jeyakumar, Amy Zhang, Katharine Miller, Katherine C Sutherland, Caitlin Guzowski, Vishal K Gupta, Navneet Majhail, Minoo Battiwalla, Melhem M Solh, Shahbaz A Malik, John Mathews, Caspian H Oliai, Paul Shaughnessy, Luke Mountjoy, Catherine J Lee, Aaron C Logan, Stephanie B Tsai, Jessica T Leonard, Marc Schwartz, Joshua P Sasine, Muthu Kumaran, Noelle Frey, Jae H Park, Divya Koura, Ryan D Cassaday, Bijal D Shah, Ibrahim Aldoss, Lori S Muffly, Laquisa C Hill

Faculty, Staff and Students Publications

Patients with relapsed/refractory (R/R) B-cell acute lymphoblastic leukemia (B-ALL) with central nervous system (CNS) involvement (CNS B-ALL) have poor outcomes and were frequently excluded from CD19-targeting chimeric antigen receptor (CAR) T-cell clinical trials. The efficacy and safety of brexucabtagene autoleucel (brexu-cel) in adults with R/R B-ALL was established by the ZUMA-3 trial, which excluded patients with advanced or symptomatic CNS involvement. In this retrospective multicenter analysis, we investigated the safety and efficacy of brexu-cel in patients with CNS B-ALL using data from the ROCCA (Real-World Outcomes Collaborative for CAR T in ALL) consortium. Of 189 patients who received infusion, 31 …

Cathartocytosis: Jettisoning Of Cellular Material During Reprogramming Of Differentiated Cells, Jeffrey W Brown, Xiaobo Lin, Gabriel Anthony Nicolazzi, Xuemei Liu, Thanh Nguyen, Megan D Radyk, Joseph Burclaff, Jason C Mills

Faculty, Staff and Students Publications

Injury causes differentiated cells to undergo massive reprogramming to become proliferative and repair tissue via paligenosis. Gastric chief cells use paligenosis to reprogram into progenitor-like spasmolytic-polypeptide-expressing metaplasia (SPEM) cells. Stage 1 of paligenosis is the downscaling of mature cell architecture via a process involving lysosomes. Here, we notice that sulfated glycoproteins are not only digested during paligenosis but also excreted into the gland. Various genetic and pharmacological approaches show that endoplasmic reticulum membranes and secretory granule cargo are also excreted and that the process proceeds in parallel with but is mechanistically independent of autophagy. Three-dimensional light and electron microscopy demonstrated …

The Association Between Malnutrition And Gingivitis Among Residents In St. Louis, Missouri, Alyssa Detrick

Walden Dissertations and Doctoral Studies

Malnutrition and gingivitis are common diagnoses in primary medical and dental care. The purpose of this quantitative study was to understand the association between malnutrition and gingivitis among residents in St. Louis, Missouri. The study was based on the social ecological model (SEM). The cross-sectional design involved secondary data (N = 2,553) from a Federally Qualified Health Center in St. Louis, Missouri that included de-identified patient demographic and diagnosis information of St. Louis City residents with a medical and dental visit in 2024. This study examined the relationship between malnutrition and gingivitis while controlling for ethnicity, preferred language, race, and …

Earth Care Trusted Messengers Vaccine Access Project, Camille Velarde, Theresa H. Cruz

Reports & Documents

The Earth Care Trusted Messengers Vaccine Access Project was a two-month intervention implemented in Santa Fe, New Mexico in spring 2025 to address persistent barriers to COVID-19 and routine vaccine access among Spanish-speaking communities. Using a peer-to-peer “Trusted Messenger” model, respected community members received training in vaccine knowledge, communication strategies, and community organizing before hosting small house meetings to share accurate information, address concerns, and build trust.

A mixed-methods evaluation included pre/post/follow-up surveys, weekly house meeting questionnaires, and a final focus group. Quantitative results demonstrated substantial increases in participants’ confidence across all domains, including vaccine knowledge, communication skills, and ability …

Hepcidin, Incident Heart Failure, And Cardiac Dysfunction In Older Adults: The Aric Study, Iman A F Aboelsaad, Brian L Claggett, Victoria Lamberson, Pranav Dorbala, Kunihiro Matsushita, Pamela Lutsey, Bing Yu, Brandon W Lennep, Youssef M K Farag, Amil M Shah, Leo F Buckley

Faculty, Staff and Student Publications

Aims: Hepcidin regulates plasma and tissue iron levels. We studied the association of hepcidin levels with the risk of incident heart failure (HF) and cardiac dysfunction in older adults.

Methods and results: We included adults from the ongoing, longitudinal Atherosclerosis Risk in Communities (ARIC) study, who were free from prevalent anaemia and HF at Visit 5 (2011-13) and had available hepcidin and covariate data. Associations of plasma hepcidin levels with overall adjudicated incident HF, HF with reduced ejection fraction (HFrEF), and HF with preserved ejection fraction (HFpEF) were assessed using multivariable Cox proportional hazards regression models. Cross-sectional associations of hepcidin …

Bridging Diagnostic Safety And Mental Health: A Systematic Review Highlighting Inequities In Autism Spectrum Disorder Diagnosis, Abirami Srivarathan, Andrea Bradford, Sara Shearkhani, Layla Heimlich, Sheryl Jefferson, Kristen E Miller, Kelly Smith, Helen Haskell, Traber D Giardina

Faculty, Staff and Students Publications

Introduction: There is increased recognition that diagnostic errors disproportionately affect marginalised and underserved patient populations in the USA. However, evidence on diagnostic inequities in mental disorders is sparse and not well integrated into the overall diagnostic safety literature.

Objective: We systematically reviewed and narratively synthesised evidence on inequities in diagnosis of mental disorders, guided by the Diagnostic Process Framework developed by The National Academies of Sciences, Engineering, and Medicine.

Methods: We conducted a systematic review and a narrative synthesis. Medline, Embase, PsycInfo and CINAHL were searched for studies published between 2015 and 2024. Studies were eligible if they reported on …

Family Healthy Weight Program: Smart Movestm Pilot Project Evaluation Report, Camille Velarde, Theresa H. Cruz Dr., Elena Martinez

Reports & Documents

The Smart Moves™ Family Healthy Weight Program is an evidence-based, family-centered intervention designed to address childhood overweight and obesity through nutrition education, physical activity, social-emotional learning, and caregiver engagement. In spring 2025, Presbyterian Community Health piloted Smart Moves™ in a South Valley community health clinic as part of the Healthy Here initiative, with evaluation conducted by the University of New Mexico Prevention Research Center.

The pilot, adapted from a 12-lesson curriculum to 8 core lessons plus orientation and celebration, included bilingual instruction, cooking in a teaching kitchen, and family-based incentives. Evaluation methods combined quantitative and qualitative data, including pre/post BMI …