Medicine and Health Sciences Commons^™

Comparing Guillain-Barré Syndrome Outcomes Between Rural And Urban Hospitals In The United States: A Retrospective Cohort Study, Anudeep Surendranath, Rahul Damani, Anushareddy Muddasani, Anupam Kumar Gupta

Faculty, Staff and Students Publications

Background and purpose: Rural-urban disparities in neurological care have been well documented, but limited data exist regarding Guillain-Barré Syndrome (GBS). This study examines differences in patient demographics, hospital characteristics, and outcomes among GBS admissions to rural versus urban hospitals in the United States.

Methods: Using the 2021 National Inpatient Sample, we conducted a retrospective cohort study of adult hospitalizations with a principal diagnosis of GBS. Hospitals were classified as rural or urban based on U.S. census designations. Multivariate logistic and linear regression models were used to assess associations between hospital location and outcomes, adjusting for demographic, clinical, and hospital-level factors. …

Long-Term Mortality Following Sars-Cov-2 Infection In Rural Versus Urban Dwellers With Autoimmune Or Inflammatory Rheumatic Disease: A Retrospective Cohort Analysis From The National Covid Cohort Collaborative, A Jerrod Anzalone, Lesley E Jackson, Namrata Singh, Maria I Danila, Elizabeth Reisher, Rena C Patel, Jasvinder A Singh

Faculty, Staff and Students Publications

Objective: Autoimmune or inflammatory rheumatic diseases (AIRDs) increase the risk for poor COVID-19 outcomes. Although rurality is associated with higher post-COVID-19 mortality in the general population, whether rurality elevates this risk among people with AIRD is unknown. We assessed associations between rurality and post-COVID-19 all-cause mortality, up to two years post infection, among people with AIRD using a large nationally sampled US cohort.

Methods: This retrospective study used the National COVID Cohort Collaborative, a medical records repository containing COVID-19 patient data. We included adults with two or more AIRD diagnostic codes and a COVID-19 diagnosis documented between April 2020 and …

Advancing Medical Applications Of Cancer Nanotechnology: Highlighting Two Decades Of The Nci's Nanotechnology Characterization Laboratory Service To The Research Community, Rachael M Crist, Yechezkel Barenholz, Ahuva Cern, Kate N Clark, Pieter R Cullis, Cheryl Dean, Neil Desai, Mauro Ferrari, Matthieu Germain, Carmen A Giacomantonio, Emma Grabarnik, Piotr Grodzinski, Atara Hod, Barry E Kennedy, Ruvanthi N Kularatne, Glen S Kwon, Emmanuel Loeb, Erin B Noftall, Len Pagliaro, Morteza Rasoulianboroujeni, Alexander Roth, Darren Rowles, Kulbir Singh, Nicole F Steinmetz, Zhanna Yehtina, Yao Zhang, Daniel Zilbersheid, Jeffrey D Clogston, Stephan T Stern, Marina A Dobrovolskaia

Center for Medical Ethics and Health Policy Staff Publications

The Nanotechnology Characterization Laboratory (NCL) is a US federally funded resource providing characterization and expertise to the cancer nanomedicine research community. Founded as a formal partnership among the US National Cancer Institute (NCI), the US Food and Drug Administration (FDA), and the US National Institute of Standards and Technology (NIST), the NCL has spent two decades developing a one-of-a-kind service with broad multidisciplinary expertise to meet the needs of a rapidly evolving drug development field. To mark the 20th anniversary of the lab's founding, the NCL hosted a symposium to highlight the achievements of the cancer nanomedicine field, showcase novel, …

Informal Caregivers Connecting On The Web: Content Analysis Of Posts On Discussion Forums, Michelle L. Foster, Chinenye Egwuonwu, Erin Vernon, Mohammad Alarifi, M. Courtney Hughes

Faculty Articles, Papers, and Other Scholarship

Background: About 53 million adults in the United States offer informal care to family and friends with disease or disability. Such care has an estimated economic value of US $600 million. Most informal caregivers are not paid nor trained in caregiving, with many experiencing higher-than-average levels of stress and depression and lower levels of physical health. Some informal caregivers participate in web-based forums related to their caregiving role.

Objective: This study aimed to explore how informal caregivers use easy-to-access caregiving web-based forums, including the types of information they share and seek from others. It also aimed to gain insights into …

Aestheticizing And Engendering Disease: The Case Of Tuberculosis, Abigail Dollries

Dartmouth College Master’s Theses

This thesis examines how tuberculosis, known in the nineteenth century as “consumption,” was aestheticized in American cultural and medical discourse, particularly in industrial cities of the North between 1830 and 1850. It addresses the paradox at the heart of the disease’s representation: while tuberculosis was medically pathologized, it was simultaneously romanticized, especially when afflicting elite white women. The central problem explored is how this aestheticization of illness functioned to reinforce gender, class, and racial hierarchies by transforming suffering into a symbol of virtue, refinement, and social status. Using a cultural-historical methodology, this project analyzes a range of sources, including medical …

Investigative Genetic Genealogy Practices Warranting Policy Attention: Results Of A Modified Policy Delphi, Christi J Guerrini, Louiza Kalokairinou, Jill O Robinson, Whitney Bash Brooks, Stephanie M Fullerton, Sara Huston, Jacklyn Dahlquist, Diana Madden, Norah Crossnohere, Nicola Campoamor, John F P Bridges, Amy L Mcguire

Center for Medical Ethics and Health Policy Staff Publications

A technique known as investigative genetic genealogy (IGG) was first introduced to criminal investigations in 2018, and it has since been used by U.S. law enforcement to help identify hundreds of criminal perpetrators and unidentified human remains. As expertise in IGG grows, policymakers have shown interest in regulating it. To help inform these efforts and to promote coherence in IGG governance as it expands, we recruited experts representing a spectrum of IGG-relevant professions and perspectives to identify and prioritize IGG practices for policy attention and to develop policy options for addressing them. In two rounds of a modified policy Delphi, …

Dental Care Trajectories Among Formerly Incarcerated Older Adults In The United States, Alexander Testa, Luis Mijares, Mateus Renno Santos, Vahed Maroufy, Dylan B Jackson, Rafael Samper-Ternent, Rahma Mungia, Ana C Neumann

Faculty, Staff and Student Publications

A growing body of research has documented an association between prior incarceration and lower dental care use, yet the longitudinal impact of prior incarceration on dental care patterns over time among older adults remains unexplored. This study aims to investigate whether prior incarceration is associated with differing trajectories of dental care use among older adults in the United States. Data were drawn from the 2012-2020 waves of the Health and Retirement Study (HRS), a nationally representative longitudinal survey of older adults in the United States (n =  5,893). Group-based trajectory modeling was used to estimate dental care use patterns over …

Risk Of Post-Acute Symptoms Among Adults: A Comparison Study Of Severe Covid-19, Pneumonia, And Influenza, Caroline M Schaefer, Trudy Millard Krause, George L Delclos, Raymond S Greenberg

Faculty, Staff and Student Publications

Background: A retrospective cohort study was undertaken to assess the relationship between initial disease severity of COVID-19 and the risk of post-acute symptoms. The COVID-19 cohort was compared against influenza and pneumonia cohorts to assess whether risk of post-acute symptoms differed.

Methods: Administrative health claims data were obtained for commercially insured and Medicare Advantage covered adults (≥ 18 years) with symptomatic laboratory-confirmed COVID-19 diagnosed in 2020 (n=121,205), and similar cohorts of influenza (n=20,844) and pneumonia (n=29,052) patients diagnosed prior to the pandemic. Post-acute symptoms were assessed at four weeks, three and six months following initial diagnosis.

Results: Among the patients …

Protective Effects Of Psychiatric Medications Against Covid-19 Mortality Before Vaccines, Rodrigo Machado-Vieira, Trudy M Krause, Gregory Jones, Antonio L Teixeira, Lokesh R Shahani, Scott D Lane, Jair C Soares, Chau N Truong

Faculty, Staff and Student Publications

The coronavirus disease pandemic caused by the coronavirus SARS-CoV-2, which emerged in the United States in late 2019 to early 2020 and quickly escalated into a national public health crisis. Research has identified psychiatric conditions as possible risk factors associated with COVID-19 infection and symptom severity. This study aims to determine whether specific classes of psychiatric medications could reduce the likelihood of infection and alleviate the severity of the disease. The objective of this study is to investigate the relationship between neuropsychiatric medication usage and COVID-19 outcomes before the widespread utilization of COVID-19 vaccines. This cross-sectional study used Optum's de-identified …

Cardiovascular Risk Factors And Genetic Risk In Transthyretin V142i Carriers, Naman S Shetty, Mokshad Gaonkar, Akhil Pampana, Nirav Patel, Alanna C Morrison, Alexander P Reiner, April P Carson, Bing Yu, Bruce M Psaty, Charles Kooperberg, Diane Fatkin, Eric Boerwinkle, Jerome I Rotter, Kent D Taylor, Lifang Hou, Marguerite R Irvin, Michael E Hall, Mathew Maurer, Myriam Fornage, Nicole D Armstrong, Nicole Bart, Parag Goyal, Stephen S Rich, Ramachandran S Vasan, Peng Li, Garima Arora, Pankaj Arora

Faculty, Staff and Student Publications

Background: Nearly 3% to 4% of Black individuals in the United States carry the transthyretin V142I variant, which increases their risk of heart failure. However, the role of cardiovascular (CV) risk factors (RFs) in influencing the risk of clinical outcomes among V142I variant carriers is unknown.

Objectives: This study aimed to assess the impact of CV RFs on the risk of heart failure in V142I carriers.

Methods: This study included self-identified Black individuals without prevalent heart failure from 6 TOPMed (Trans-Omics for Precision Medicine) cohorts, the REGARDS (Reasons for Geographic And Racial Differences in Stroke) study, and the All of …

Heat Stress Prevention And Management In The Construction Industry: A Gap Analysis, Muinat Abolore Idris, Kristina D Mena, Christine Markham, William B Perkison

Faculty, Staff and Student Publications

Background: Despite decades of efforts to prevent heat stress, it remains a major health risk to workers in the construction industry. This health risk has been exacerbated by the rising ambient temperatures from climate change, as well as the increased susceptibility to heat stress in an aging workforce.

Objective: To develop a tailored occupational safety management framework for heat stress prevention in construction, advancing workers’ health, safety, and well-being.

Methods: We built on the findings of a systematic review and analyzed a large industrial company’s current heat stress prevention program through stakeholder engagement, evidence-based practices, and gap analysis. We reviewed …

What We Know About The Peer Workforce And Economic Evaluation For Peer Recovery Support Services: A Systematic Review, Sierra Castedo De Martell, J Michael Wilkerson, Nalini Ranjit, Lori Holleran Steiker, Sheryl A Mccurdy, H Shelton Brown

Faculty, Staff and Student Publications

Background: Peer recovery support services (PRSS) for substance use disorder (SUD) have expanded in the past 2 decades to be formally certified and reimbursed under Medicaid in almost every US state. This rapid expansion has been followed by a growth in research, but 2 persistent gaps remain: a lack of research on the peer workforce, and a lack of economic evaluation research. This systematic review examines the current literature on PRSS to summarize what is currently known about the SUD peer workforce and collect potential PRSS economic evaluation parameters, and clearly identify the current gaps in each category.

Methods: PRISMA …

Diversity In United States Dementia Prevention Trials: An Updated Systematic Review Of Eligibility Criteria And Recruitment Strategies, Najoua Lazaar, Sabine E Van Beek, Awaale F Rirash, Janne M Papma, Jaime Perales-Puchalt, Ashley R Shaw, Eric D Vidoni, Sanne Franzen

Faculty, Staff and Student Publications

Introduction: Given the elevated dementia risk in underrepresented demographic groups in the USA - particularly in Latino and Non-Latino Black individuals compared to Non-Latino White individuals - it is vital that these groups are well-represented in dementia prevention research. Eligibility criteria and recruitment strategies may play a key role in promoting participant diversity. The aim of this review was to examine eligibility criteria and recruitment strategies in US dementia prevention trials in light of participant diversity.

Methods: A systematic review was conducted using Medline (including PubMed), Embase, Cochrane Library, and CINAHL. We explored the percent White participants for trials using …

Use Of Digital Health Interventions For Cancer Prevention Among People Living With Disabilities In The United States: A Scoping Review, Chinenye Lynette Ejezie, Lea Sacca, Sylvia Ayieko, Sara Burgoa, Yasmine Zerrouki, Diana Lobaina, Goodness Okwaraji, Christine Markham

Faculty, Staff and Student Publications

BACKGROUND: The use of digital health strategies for cancer care increased dramatically in the United States over the past 4 years. However, a dearth of knowledge remains about the use of digital health for cancer prevention for some populations with heath disparities. Therefore, the purpose of the present scoping review was to identify digital health interventions for cancer prevention designed for people with disabilities.

METHODS: This scoping review was guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews and the Arksey and O'Malley methodological framework. The Embase, PubMed, Ovid MEDLINE, and CINAHL/EBSCO databases were …

Disposition Outcomes Following Prehospital Use Of Naloxone In A Large Metropolitan City In The United States, James R Langabeer, Christine Bakos-Block, A Sarah Cohen, Ishmam Alam, Bhanumathi Gopal, Marylou Cardenas-Turanzas, Arlo F Weltge, David Persse, Tiffany Champagne-Langabeer

Faculty, Staff and Student Publications

Objectives: During a drug overdose, research suggests individuals may not call 9-1-1 out of fear of criminal justice concerns. Of those that call, research is inconclusive about the disposition of the emergency transport. We evaluated transport outcomes for adults with opioid-related overdose in the Emergency Medical Services (EMS) of a large metropolitan city in the United States.

Methods: We reviewed the EMS incident report database from the patient care record system for years 2018 to 2022. We queried all records, searching for relevant terms, and two reviewers cross-checked the database to identify cases that did not result in death at …

Shifting Patterns In Primary Care Telehealth Utilization Among Medicare Beneficiaries And Providers, Yunxi Zhang, Lincy S Lal, Saurabh Chandra, John Michael Swint

Faculty, Staff and Student Publications

Introduction: The COVID-19 pandemic accelerated telehealth adoption, but disparities in its utilization persist. This study examines primary care patient sociodemographic characteristics, telehealth utilization patterns, and provider adoptions before and during the pandemic.

Methods: A retrospective cohort study analyzed data from Mississippi Medicare beneficiaries continuously enrolled in Parts A, B, and D who accessed primary care services from 2019 to 2021.

Results: Among 201 677 Medicare beneficiaries accessing primary care, 1364 used telehealth before the pandemic, compared to 73 994 during the pandemic. Telehealth utilization shifted during the pandemic to younger, female, White beneficiaries, and those enrolled in Medicare due to …

A Systematic Review And Narrative Synthesis Of Factors Affecting Pre-Exposure Prophylaxis Willingness Among Black Women For Hiv Prevention, Alexis Sims Haynes, Christine Markham, Vanessa Schick, Robert Suchting, Nivedhitha Parthasarathy, Sumaita Choudhury, Mandy J Hill

Faculty, Staff and Student Publications

Pre-exposure prophylaxis (PrEP) can significantly reduce human immunodeficiency virus (HIV) transmission among Black women in the United States (U.S.), a group disproportionately affected by HIV. However, PrEP uptake in this HIV-vulnerable population is low. This review analyzes the factors influencing Black women's PrEP willingness using the Behavioral Model for Vulnerable Populations (BMVP). Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and the Population, Intervention, Comparison, Outcome, Study Design (PICOS) framework, we conducted a systematic literature search and selected 24 peer-reviewed studies on PrEP willingness. Narrative synthesis revealed a heterogeneous landscape of the determinants affecting PrEP willingness …

Exploring Gaps In Hiv Prevention: Hiv Pre-Exposure Prophylaxis Awareness, Attitudes, Utilization, Coverage, Hiv Testing And Risk Perception Among Sub-Saharan African College Students In The United States, Ikenna Obasi Odii

All ETDs from UAB

This dissertation focuses on increasing HIV awareness and contributing to efforts at reducing new HIV infections among Sub-Saharan African (SSA) college students. It begins with an introductory chapter one and ends in the concluding chapter five. Chapter two presents a systematic review identifying key gaps in HIV Pre-Exposure Prophylaxis (PrEP) knowledge, attitudes, and utilization among Black college students in the United States (U.S). The review synthesizes findings from four studies, revealing that a third of participants demonstrated adequate PrEP knowledge, while PrEP utilization remained under-utilized at three percent. Key barriers to PrEP uptake included fear, low self-perceived HIV risk, infrequent …

Family Stress Processes Underlying Covid-19-Related Economic Insecurity For Mothers And Fathers And Children's Internalizing Behavior Problems, Joyce Y. Lee, Shawna J. Lee, Sehun Oh, Amy Xu, Angelise Radney, Christina M. Rodriguez

Psychology Faculty Publications

COVID‐19 and its economic fallout have resulted in unprecedented financial insecurity and material hardship for many American families, with a disproportionately negative impact on children and families from socioeconomically disadvantaged contexts. The current study applied the family stress model to examine the family processes underlying pandemic‐related economic insecurity and children's internalizing behaviours. Online survey data from an economically diverse sample of mothers and fathers, who experienced at least one type of pandemic‐related economic insecurity in the United States (N = 259), were collected across two longitudinal time points in the early weeks of COVID‐19: (1) 14 April and (2) 30 …

Willingness To Use Long-Acting Injectable Pre-Exposure Prophylaxis (Lai-Prep) Among Black Cisgender Women In The Southern United States, Sylvia Shangani, Jaquetta M. Reeves, Kristin Heron, Jessica M. Sales, Kenneth K. Mugwanya

Psychology Faculty Publications

Background

Long-acting injectable pre-exposure prophylaxis (LAI-PrEP) for HIV prevention may improve adherence for those with concerns with daily pills. Limited data exist on LAI-PrEP acceptability among Black women in the U.S., a population vulnerable to HIV. We assessed willingness to use LAI-PrEP among Black women eligible for PrEP in the Southern U.S.

Methods

We conducted a cross-sectional online survey of HIV-negative Black women from March to June 2022 in the U.S. South. Participants provided information on sociodemographic characteristics, HIV knowledge, PrEP awareness, and use, stigma, risk perception, medical mistrust, and healthcare access. Multivariate logistic regression models determined factors associated with …

Changes In Cardiovascular Risk Factors And Health Care Expenditures Among Patients Prescribed Semaglutide, Yuan Lu, Yuntian Lu, Tedi Totojani, Chungsoo Kim, Rohan Khera, Hua Xu, John E. Brush Jr., Harlan M. Krumholtz, Jason Abaluck

Department of Medicine Faculty Publications

Importance Semaglutide, a glucagon-like peptide-1 receptor agonist, has demonstrated substantial weight reduction and cardiovascular benefits in clinical trials. However, its association with clinical outcomes and health care expenditures remains underexplored.

Objective To evaluate changes in cardiovascular risk factors and health care expenditures among patients prescribed semaglutide across multicenter cohorts.

Design, Setting, and Participants This retrospective cohort study included 23 522 adults (≥18 years) who received an initial semaglutide prescription between January 1, 2018, and January 1, 2025, at Sentara Healthcare and between January 1, 2018, and May 1, 2025, at Yale New Haven Health System.

Exposure The first prescription of …

Lipoprotein(A) Levels In A Population With Clinical Atherosclerotic Cardiovascular Disease In The United States: A Subanalysis From The Lp(A)Heritage Study, Michael D Shapiro, Tariq M Haddad, Howard S Weintraub, Seth J Baum, Khaled Abdul-Nour, Samiha Sarwat, Vadim Paluy, Wess Boatwright, Auris Browne, Imran Ayaz, Cheryl A Abbas, Christie M Ballantyne

Faculty, Staff and Students Publications

Background: Elevated lipoprotein(a) (Lp[a]) is the most common inherited dyslipidemia that is independently and causally associated with increased atherosclerotic cardiovascular disease (ASCVD) risk. However, data from diverse populations with ASCVD are lacking.

Objective: To evaluate Lp(a) levels in a diverse, contemporary United States (US) population with ASCVD, stratified by race, ethnicity, and sex.

Methods: Lp(a)HERITAGE (NCT03887520) was a multicenter study that estimated the prevalence of elevated Lp(a) in adults (18-80 years) with ASCVD. US participants with Lp(a) measured in nmol/L pre- or post-enrollment were included in this subanalysis. This study was descriptive; therefore, no statistical comparisons were made. …

Invasive Fungal Disease In Solid Organ And Hematopoietic Cell Transplant Recipients, United States, Jeremy A W Gold, Kaitlin Benedict, Elizabeth Sajewski, Tom Chiller, Meghan Lyman, Mitsuru Toda, Jessica S Little, Luis Ostrosky-Zeichner

Faculty, Staff and Student Publications

Background: Updated benchmark data on invasive fungal disease (IFD) in solid organ transplantation (SOT) and hematopoietic cell transplantation (HCT) recipients are necessary to increase clinical recognition and inform treatment and prevention strategies. We estimated IFD incidence and potential risk factors in transplant recipients in a large US commercial health insurance database.

Methods: We observed patients who received SOT or HCT during 2018-2022 until IFD development, disenrollment, or database end date (July 31, 2023). We calculated incidence (per 1000 person-years) and time to IFD development, comparing demographic features and underlying conditions for IFD versus non-IFD patients.

Results: Overall, 9143 patients received …

Comparison Of Primary Care Experiences And Outpatient Health Service Utilization Among Black And Latino Homeless-Experienced Veterans: An Analysis Of Patient-Centered Medical Homes, Melissa Chinchilla, Audrey L Jones, Aerin Derussy, Michael F Green, Lillian Gelberg, Alexander S Young, Jack Tsai, Sonya E Gabrielian, Stefan G Kertesz

Faculty, Staff and Student Publications

Objectives: To examine whether, among persons with recent homeless experience, minoritized clients rate primary care differently from non-minoritized clients in Veterans Affairs (VA) mainstream and homeless tailored clinics, through the largest survey of homeless-experienced Black, White, and Latino Veterans to date.

Methods: Surveys were collected from HEVs in Homeless-tailored Patient-Aligned Care Teams (HPACTs) and mainstream Patient Aligned Care Teams (PACTs; n = 4894). We tested multivariable associations between race/ethnicity, clinic (HPACT vs mainstream-PACT), and their interaction, on care experience ratings and service utilization.

Results: There were no major differences in care ratings by race/ethnicity; medical and social vulnerability factors were …

Racial And Ethnic Disparities In Longitudinal Trajectories Of Cardiovascular Risk Factors In Us Middle-Aged And Older Adults, Matthew E Dupre, Radha Dhingra, Hanzhang Xu, Scott M Lynch, Qing Yang, Cassie Ford, Michael D Green, Ying Xian, Ann Marie Navar, Eric D Peterson

Faculty, Staff and Student Publications

Background: Racial and ethnic disparities in cardiovascular disease (CVD) risk factors are well-documented. However, racial and ethnic differences in the longitudinal changes among multiple CVD risk factors are unknown.

Methods: We used prospective cohort data of U.S. adults aged ≥50 in the 2006-2016 Health and Retirement Study. Group-based multi-trajectory models characterized age-related trajectories of systolic blood pressure ([BP] mmHg), non-HDL cholesterol (mg/dL), diabetes mellitus (DM), and smoking. Racial and ethnic differences in the multi-trajectory profiles were examined using multinomial logistic regression. Karlson-Holm-Breen methods were used to assess factors contributing to these associations.

Results: Among 10,292 participants (median age: 61), approximately …

Eradication Rates Of Empiric Helicobacter Pylori Treatment Regimens By Race/Ethnicity In A Predominantly Immigrant Us Population, Min J Kim, Isiah Gonzalez, Nia M Choi, David Y Graham, Hashem B El-Serag, Mimi C Tan

Faculty, Staff and Students Publications

Background: Helicobacter pylori infections are mostly treated empirically (without antibiotic susceptibility testing). Determining eradication rates of different treatment regimens can inform antibiotic resistance. Our aim was to examine eradication rates of empiric H. pylori treatments based on treatment regimen, race/ethnicity and previous treatment status in a multiethnic U.S.

Materials and methods: This was a retrospective cross-sectional study of patients with a positive H. pylori test from 7/2021 to 4/2022 at Harris Health (Houston, Texas) who had received treatment and eradication testing within 1 year. We compared eradication rates based on treatment regimen, race/ethnicity, and prior treatment and examined other possible …

Decline In Attrition Rates In United States Pediatric Residency And Fellowship Programs, 2007–2020: A Repeated Cross-Sectional Study, Emma Omoruyi, Greg Russell, Kimberly Montez

Faculty, Staff and Student Publications

Purpose: Declining fill rates in US pediatric residency and subspecialty programs requires trainee retention. Attrition, defined as transfers, withdrawals, dismissals, unsuccessful completions, or deaths, disrupts program function and impacts the pediatric workforce pipeline. It aims to evaluate attrition trends among pediatric residents and fellows in Accreditation Council for Graduate Medical Education (ACGME)-accredited programs from 2007 to 2020.

Methods: This repeated cross-sectional study analyzed publicly available ACGME Data Resource Book records. Attrition rates and 95% confidence intervals (CIs) were calculated overall and by subspecialty. Logistic regression assessed temporal changes; odds ratios (ORs) compared 2020 to 2007.

Results: From 2007-2020, pediatric residents …

National Landscape Of Underrepresented In Medicine Visiting Medical Student Programs In Pediatrics, Tyler K Smith, Rebecca Blankenburg, Ann E Burke, Emma A Omoruyi, Wendla Sensing, Tiffany Ruan, David D Williams, Onyi Oligbo, Lahia Yemane

Faculty, Staff and Student Publications

Objective: Underrepresented in medicine visiting medical student programs (UIM-VMSPs) have gained popularity across specialties as an intervention to diversify residency programs; however, no study has explored the national landscape of these programs in pediatrics. This study aimed to characterize program components, residency rank and match outcomes, benefits, challenges, and lessons learned about UIM-VMSPs in pediatrics nationally.

Methods: From September to December 2023, the authors conducted a national, cross-sectional, mixed methods study surveying program leaders of UIM-VMSPs identified on the Association of Pediatric Program Directors website. The authors used descriptive statistics to analyze the data and conventional content analysis for free-text …

Peer Support During In Vivo Exposure Homework Increases Likelihood Of Prolonged Exposure Therapy Completion, Melba A Hernandez-Tejada, Madeline J Bruce, Wendy Muzzy, Anna Birks, Giovanni Macedo E Cordeiro, Stephanie M Hart, Stephanie Hamski, Ron Acierno

Faculty, Staff and Student Publications

Exposure-based treatments such as prolonged exposure therapy (PE) are effective for veterans with PTSD. However, dropout rates as high as 50% are common. The Department of Veterans Affairs employs peers to increase mental health treatment engagement, however peers are not routinely used to help patients complete PE homework assignments. The present study included 109 veterans who decided to drop out from exposure-based treatment after completing seven or fewer sessions and used a randomized controlled design to compare PE treatment completion rates in response to 2 forms of peer support: (1) standard weekly telephone-based peer support vs. (2) peer-assisted in vivo …

Improved Survival And Decreased Cancer Deaths In Young Adults With Cancer After Passage Of The Affordable Care Act Dependent Coverage Expansion, Michael Roth, Clark R Andersen, Amy Berkman, Stuart Siegel, Branko Cuglievan, J Andrew Livingston, Michelle Hildebrandt, Jaime Estrada, Archie Bleyer

Faculty, Staff and Student Publications

Background: The Patient Protection and Affordable Care Act (ACA) allowed Americans aged 19-25 years to remain on their parents' health insurance plans until age 26 years (the Dependent Care Expansion [DCE]). Have those with cancer diagnoses benefited?

Methods: The ACE DCE 7-year age range of 19-25 years was compared for changes in cancer survival and mortality before and after enactment of the ACA with groups that were younger and older (in 7-year age spans: ages 12-18 and 26-32 years, respectively). Cancer death data for the entire United States were obtained from the Centers for Disease Control and Prevention, and relative …