Population Health Commons^™

Impact Of Gender-Affirming Hormone Therapy On Dry Eye, Keith E. Arnold, Michael J. Foster, Tomasz A. Tabernacki, Chase A. Turner, Peter A. Netland, Kirtishri Mishra

Department of Ophthalmology Faculty Publications

Purpose

To determine whether gender-affirming hormone therapy (GAHT) influences tear system health in transgender individuals.

Methods

This retrospective cohort observational study analyzed data from transgender men and women ages ≥18-years between 2004 and 2024 via electronic medical record (EMR) data. Following propensity score matching, subjects on hormone therapy included 23,623 transgender men, 15,933 transgender women, and an equal number in each matched control group.

Results

Among transgender men and women, respectively, tear system disorders occurred in 0.90% and 0.94% of those using GAHT and 0.90% and 1.17% of those not using GAHT (p = 0.211, p = 0.072). There was …

Exploring The Impact Of Adverse Childhood Experiences On Preventive Healthcare Utilization In Rural Georgia, Ryan R. Traylor

College of Graduate Studies: Theses & Dissertations

This study examines the relationship between Adverse Childhood Experiences (ACEs) and preventive healthcare use among adults in Georgia, specifically within rural populations facing structural barriers. Using 2023 Georgia Behavioral Risk Factor Surveillance System (BRFSS) data, the research analyzes associations between ACE exposure, rural residence, and preventive care outcomes, including physical exams and flu vaccinations. Guided by an intersectionally adapted version of Andersen’s Behavioral Model of Health Services Use, the study evaluates how predisposing factors, enabling resources, and perceived barriers relate to healthcare engagement. Logistic regression analyses assess the correlation of ACE exposure, cost barriers, provider access, and sociodemographics with preventive …

Variation In Lung Cancer Risk Distribution By Race Across Modified Plcom2012 Risk Models Among Lung Cancer Screening Participants, Haley M. Evans, Rebecca Landy, Christine S. Shusted, Brooke Ruane, Eboni Anderson, Teresa Giamboy, Mary Mcmullen, Gregory C. Kane, Hee-Soon Juon, Julie Barta

Division of Pulmonary, Allergy, and Critical Care Medicine Faculty Papers

No abstract provided.

Clinical Challenges Associated With Enhancing Hypertension Among The Underserved African American Population, Ashley Richardson

Doctor of Nursing Practice (DNP) Scholarly Projects

Background 

African Americans face a significantly higher prevalence of hypertension, tend to develop complications at younger ages, and have disproportionately higher mortality rates. Key social determinants of health (SDoH)—including food deserts, unequal access to healthcare, and geographic disparities in healthcare resources—contribute to these ongoing inequities. Addressing both systemic and individual barriers is crucial for effective hypertension management.

Objective

This study aims to assess the effectiveness of a culturally relevant, community-based intervention designed to reduce both systolic and diastolic blood pressure among Black adults with uncontrolled hypertension.

Methods 

Quality improvement (QI) initiatives typically employ multicomponent, equity-focused models. The primary components of …

The Association Between Social Vulnerability And Racial Disparities In Preterm Birth, Anita Pershad, Gabby Adams, Lindsay Robbins, George Saade, Tetsuya Kawakita

Department of Obstetrics & Gynecology Faculty Publications

Objective

To evaluate the association between county-level social vulnerability and preterm birth and assess whether racial disparities vary across levels of vulnerability.

Methods

This cross-sectional study utilized restricted Centers for Disease Control and Prevention natality data from 2023. We included Black or White births with singleton pregnancies across 3123 US counties from 50 US states and the District of Columbia. Participants were grouped into quartiles based on the county-level Social Vulnerability Index (SVI), with quartile 4 representing the most socially vulnerable populations. The primary outcome was preterm birth, defined as delivery before 37 weeks. Secondary outcomes included small for gestational …

Una Nueva Herramienta Para Estimar El Volumen Muscular Independientemente De La Edad, El Sexo Y El Nivel De Actividad Física, José J. Rivera-Sánchez, Laura P. Burgos-Morelos, Daniel Castillo-Castillo, Gerardo Méndez-Suárez, Juan C. Lopez-Alvarenga, Damián Carrillo-Ruíz

School of Medicine Publications

Antecedentes: Actualmente, la evaluación del volumen muscular requiere técnicas invasivas o de imagen, lo que aumenta los costos y retrasa la evaluación, y las mediciones antropométricas con frecuencia son inexactas.

Objetivo: Desarrollar una fórmula matemática para estimar el volumen del cuádriceps.

Material y métodos: Se evaluaron 127 sujetos: 40 adultos sedentarios de 20 a 35 años, 47 atletas adultos de 20 a 45 años y 40 adultos sedentarios de 70 a 94 años. Se dividieron en grupos de desarrollo y de validación. Se realizaron mediciones de variables antropométricas y fuerza de agarre, y se desarrolló la fórmula de predicción del …

Assessment Of Major Adverse Cardiovascular Event Across Diverse Racial Groups Of Psoriasis Patients On Biologic Therapy: A Retrospective Cohort Study, Chunghwan Ro, Ana Ormaza Vera, Waleed Adawi, Clinton W. Enos

Department Dermatology Faculty Publications

Psoriasis is associated with an increased risk of major adverse cardiovascular events (MACE), and biologic therapy may reduce this risk by targeting systemic inflammation. However, limited data exist on whether long term MACE risk differs by biologic class or across racial groups. We conducted a retrospective cohort study to assess the risk of primary MACE in psoriasis patients receiving biological therapies, stratified by biological class, compared with biologic-naïve psoriasis patients. Whether MACE risk among biologic-treated patients varied by race was further examined. After 1:1 propensity score matching, 36 330 biologic-treated patients were compared with 36 330 non-biologic-treated patients. Incident MACE …

Net Effects Of Correlated Determinants Of Health Among U.S. Older Adults, Haomiao Jia, E I. Lubetkin

Publications and Research

Background

The health effect produced by a contributing factor alone may be different from the effect when other interacting factors are present. The effects of a set of contributors, estimated by regression coefficients, may be invalid or inappropriate if some of the predictors are correlated or the model has interaction and nonlinear terms. The net effect (NE) of a given contributing factor is the effect produced by the factor alone, not by other factors due to their correlations with the factor of interest. This study estimated NE of selected determinants of health for U.S. older adults.

Methods

Participants, aged ≥ …

Determining Factors For Long Term Use Of Gadget By Preschool Children, Wardatus Sholihah, Allenidekania Allenidekania, Nur Agustini, Rukmini Rukmini, Dwi Yuniar Ramadhani

Jurnal Keperawatan Indonesia

In the digital era, preschoolers spent more time playing on their gadgets than with their peers. The excessive use of gadgets (including laptops, cellphones, tablets, and similar electronic devices) can have negative impacts on preschool-age children. This study analyzes the determining factors that influence the duration of gadget use in preschool children. The study used a correlational design with a cross-sectional approach involving 318 parents who were selected using cluster sampling. The results showed that there was a significant relationship between the duration of gadget use and the gender of the parents (p = 0.001), parental education (p = 0.035), …

Enhancing Patient Satisfaction Among Coronary Heart Disease Patients Through Islamic Spiritual Care With Murottal In Nursing Practice, Aris Citra Wisuda, Citra Suraya, Suzanna Suzanna, Muhamad Andika Sasmita Saputra, Manisha Manisha, Hesly Devitasari, Dian Emiliasari, Tukimin Bin Sansuwito

Jurnal Keperawatan Indonesia

Spiritual care is essential in nursing, especially for patients with chronic or palliative conditions such as coronary heart disease. Although medical intervention is crucial, Islamic spiritual therapy using murottal has a significant impact on patient satisfaction. This study aims to evaluate the effectiveness of murottal in enhancing patient satisfaction among individuals with coronary heart disease. A quasi-experimental pretest-posttest design was used with 52 participants at Siti Khadijah Islamic Hospital, Palembang, Indonesia. Total sampling was applied, and data were analyzed using the paired sample t-test. Patient satisfaction was measured using a Likert-scale questionnaire to assess the impact of murottal spiritual care. …

Psychological Distress And Quality Of Life Among Infertility Couples Undergoing Infertility Treatment In Malaysia, Farrahdilla Hamzah, Zamzaliza Abdul Mulud, Malini Mat Napes, Sarah Abdul Mubarak, Rosliza Shafie

Jurnal Keperawatan Indonesia

Infertility often leads to stress, anxiety, and depression, significantly affecting the quality of life of affected couples. This study explored the sociodemographic and psychological factors influencing the quality of life among infertile couples undergoing in vitro fertilization (IVF) treatment in Malaysia, using a cross-sectional design. A total of 126 infertile couples were purposively sampled from three public hospitals offering IVF treatment. The Depression, Anxiety, and Stress Scale (DASS-21) measured psychological distress levels, while the Fertility Quality of Life (Ferti-QoL) scale assessed fertility-related quality of life. Data collection adhered to strict ethical standards, with confidentiality ensured. Participants provided informed consent and …

Assessing Community Readiness And Benefits Of A Nursing Program: Implications For Healthcare And Education, Mary Anne Frances D. Reyes, Aaron A. Funa, Robert Jamisola, Ma. Joahna D. Perdigon, Jerica D. Latonero

Jurnal Keperawatan Indonesia

In response to recent policy shifts allowing the establishment of new nursing programs in the Philippines, this study assesses the perceived readiness of Sorsogon, a geographically underserved province, to implement a bachelor of science in nursing program. It also explores the anticipated benefits that such a program may offer to students and the local community. A cross-sectional survey of 375 stakeholders, selected through purposive sampling, was conducted using a validated instrument developed through expert consultation. Quantitative data were analyzed using descriptive statistics, while qualitative responses were examined through thematic analysis. The findings reveal widespread support for the proposed program, emphasizing …

Development Of A Telenursing-Based Self-Assessment Questionnaire For Diabetic Foot Ulcer Risk, Ratna Wirawati Rosyida, Sugiyarto Sugiyarto

Jurnal Keperawatan Indonesia

Development of a Telenursing-Based Self-Assessment Questionnaire for Diabetic Foot Ulcer Risk. Early identification of the risk of diabetic foot ulcers (DFU) is crucial in preventing ulcers. Caring for diabetic patients, including early detection of the risk of DFU with telenursing, will improve accessibility to health facilities and also help the work of nurses. Currently, there are many instruments or tools to detect the risk of DFU, but instruments that apply telenursing and can be used independently and easily by patients are still limited. This study aimed to develop a digital self-assessment questionnaire for DFU risk in type 2 Diabetes Mellitus …

Effectiveness Of Intradialytic Resistance Training On Muscle Mass And Strength In Patients On Hemodialysis, Sandra Vasquien, I Ketut Swarjana, A.A.A. Yuliati Darmini, I Nyoman Arya Maha Putra

Jurnal Keperawatan Indonesia

Hemodialysis (HD) patients with chronic kidney disease (CKD) lose muscle mass and strength due to protein energy wasting (PEW). The purpose of this study was to test the effectiveness of intradialytic resistance training (IRT) in increasing muscle mass and strength. It used a pre-experimental, one-group pretest-posttest design. Based on a sample size estimate using G*power software, 33 CKD patients undergoing HD at a private hospital in Bali were included. The patients were selected using purposive sampling. Muscle mass was measured using Bioelectrical Impedance Analysis (BIA), while muscle strength was measured using the Medical Research Council Muscle Scale. The Wilcoxon test …

Promoting Competence And Confidence: Simulation-Based Basic Life Support Training For Jordanian Nurses, Yousef Shukry Abu-Wardeh, Wan Muhamad Amir W Ahmad, Mohd Shaharudin Shah Che Hamzah, Intan Idiana Hassan

Jurnal Keperawatan Indonesia

Cardiopulmonary arrest is a major health issue that affects healthcare providers. The COVID-19 pandemic has added a new risk to rescuers who may be attempting to resuscitate victims. It is essential to strike a balance between resuscitation and the need to protect oneself from infection. The study aims to evaluate the effectiveness of simulation training in enhancing the Basic Life Support (BLS) knowledge, skills, and confidence levels of newly employed nurses. The study employed a single-masked, prospective, randomized controlled trial design, which consisted of three phases: a pre-test, an immediate post-test, and a post-test conducted three months later. The American …

Design And Implementation Of Data Quality Controls In The Eq-Daphnie Study: Insights From The Pilot Phase And 15-Country Analysis, Fatima Al Sayah, Hilary Short, Juan M. Ramos-Goñi, Rosalie Viney, Erica I. Lubetkin, Mathieu F. Janssen, Jeffrey A. Johnson

Publications and Research

Objective

The EQ-DAPHNIE (EuroQol Data for Assessment of Population Health Needs and Instrument Evaluation) project is a large, multi-country survey initiative designed to generate population norms and enable comparative research using self-reported health measures. This paper describes the quality control processes and summarizes data quality metrics from the United Kingdom (UK) pilot and full implementation across 15 countries.

Methods

Representative samples were recruited via Dynata, an online survey panel provider, using quota sampling by age, sex, income, community setting, and language (where applicable). The UK pilot (n = 3012) informed survey refinements ahead of full rollout (n = 68,411). Quality …

The Home Visiting Referral Quality Improvement Initiative (Thrive) Change Package, Elizabeth Yakes Jimenez, Theresa Cruz, Rebecca Craig, Ivan De La Rosa

Population Health Research and Scholarship

Early childhood home visiting programs improve maternal and child health outcomes but remain underutilized. Healthcare providers are well-positioned to connect families to home visiting services; however, structural barriers in clinical settings limit consistent and effective referral practices. The Home Visiting Referral Quality Improvement Initiative (THRIVE) change package was developed to provide a starting point for addressing these challenges. The THRIVE change package outlines actionable improvement strategies to test, such as standardizing referral workflows, training clinical teams, and establishing relationships and feedback loops with home visiting programs. It offers a scalable approach to strengthening clinical–community linkages and improving family engagement with …

Health-Related Quality Of Life In Covid-19 Patients: A Systematic Review And Meta-Analysis Of Eq-5d Studies, Kidu Gidey, Yirga Legesse Niriayo, Solomon Weldegebreal Asgedom, Erica I. Lubetkin

Publications and Research

Background

COVID-19 has affected millions globally, with a significant proportion experiencing long-COVID and impaired health-related quality of life (HRQoL). This systematic review and meta-analysis aimed to synthesize the existing literature on HRQoL in COVID-19 patients.

Methods

We conducted a systematic search of PubMed, Embase, Web of Science, Scopus, and the Cochrane Library for studies published between December 2019 and March 2025. Eligible studies were peer-reviewed and assessed HRQoL in COVID-19 patients using the EQ-5D instrument. Study quality and risk of bias were evaluated using the Newcastle-Ottawa Scale. Pooled health utility values were estimated using a random-effects model, and heterogeneity was …

Distribution Of Block Grant Funding: Considerations For Rural Communities, Kate E. Beatty, Casey P. Balio, Margaret M. Francisco, Michael B. Meit, Stephanie M. Mathis

ETSU/NORC Rural Health Research Center Policy Briefs

No abstract provided.

A Rural Lens On Federal Block Grant Distribution, Casey P. Balio, Stephanie M. Mathis, Margaret M. Francisco, Michael Meit, Kate E. Beatty

ETSU/NORC Rural Health Research Center Policy Briefs

No abstract provided.

Determinants Influencing The Readiness Of Non-Medical Hospital Personnel To Perform Basic Life Support, Elin Hidayat, Suaib Suaib, I Made Rio Dwijayanto, Nur Aviva Pemasi, Ilne Ai Purana Adel

Jurnal Keperawatan Indonesia

All healthcare personnel, including both medical and non-medical staff within hospitals, are expected to possess the capability to administer Basic Life Support (BLS) in order to provide immediate assistance during emergencies. However, many non-medical hospital staff remain unprepared to perform BLS due to a lack of knowledge, willingness, and confidence. This study aims to identify the factors affecting the preparedness of non-medical hospital staff in carrying out BLS at Undata Hospital, a healthcare facility in Central Sulawesi. This research employed quantitative design with a cross-sectional approach. The sample comprised 103 non-medical respondents selected through total sampling. Data were collected through …

Cholinesterase Enzyme Association With Quality Of Life Among Farmers In Khong Chai District, Kalasin Province, Thailand, Supasin Deeraksa, Mayuree Suuwunnakhot, Khanittha Madngammuang

Jurnal Keperawatan Indonesia

The agricultural sector in Thailand faces challenges that impact farmers' health and quality of life. This study examines the quality of life, cholinesterase enzyme levels, and factors associated with quality of life among farmers in Khong Chai District, Kalasin Province, Thailand. This cross-sectional analytical study was conducted using systematic random sampling. The respondents had a mean age of 54.97 ± 10.50 years (range 25–75 years) and comprised 75.56% females (n = 204), 24.44% males(n = 66). Data collection included demographic information, blood samples to assess cholinesterase enzyme safety levels, and responses to the World Health Organization Quality of Life Brief-Thai …

Correlation Between Family Support And Depression Among Pre-Elderly Individuals With Hiv In Jakarta, Gracella Tanjaya, Surilena Surilena, Nicholas Hardi, Eva Suryani

Jurnal Keperawatan Indonesia

Depression among pre-elderly with human immunodeficiency virus (HIV) can significantly impact their quality of life. Family is often the primary source of support for this demographic and is recognized as a protective factor against depression. Therefore, identifying protective factors against depression is essential for promoting healthy aging among pre-elderly with HIV. This study aimed to determine the correlation between family support and depression among pre- elderly with HIV in Jakarta. A total of 120 pre-elderly with HIV from the Indonesia AIDS Coalition who were receiving HIV care at health centers across Jakarta participated in this cross-sectional study. The participants were …

Effects Of An Integrated Nutritional Health Intervention On Energy And Protein Intake In Under Five-Year Malnourished Children, Yani Maidelwita, Tukimin Bin Sansuwito, Faridah Mohd Said

Jurnal Keperawatan Indonesia

Malnutrition is thought to be the cause of more than one third of all child deaths, despite being rarely cited as a cause. In Indonesia, 19.9% of the population is malnourished, which is a very high prevalence. To prevent and treat malnutrition in children, numerous strategies have been developed, including an integrated nutritional health intervention. This research aimed to determine the effectiveness of an integrated nutritional health intervention for the energy and protein intake of malnourished children under the age of five. This study had a quasi-experimental design with a pre- and post- test control group. The research took place …

Effects Of Incremental Shuttle Walk Test On Maximal Oxygen Consumption And Comfort In Patients With Coronary Artery Disease Undergoing Phase 3 Cardiac Rehabilitation, Mutarobin Mutarobin, Tutiany Tutiany

Jurnal Keperawatan Indonesia

Coronary artery disease (CAD) is a condition characterized by impaired cardiac function due to a reduced blood supply to the myocardial tissue, resulting from narrowing or obstructing of the coronary arteries. This condition can negatively impact the physical, psychological, and social dimensions of the patient’s life, often leading to a decline in maximal oxygen consumption (VO2max) and perceived comfort. One solution for increasing the decreased VO2max is cardiac rehabilitation. Cardiac rehabilitation is an effective preventive and recovery intervention that includes assessments of VO2max, and the effects of the incremental shuttle walk test (ISWT) on the VO2max and comfort of CAD …

The Strategies And Interventions For Interprofessional Collaboration To Improving Patient Safety In Hospitals: A Systematic Review, Keumalasari Keumalasari, Krisna Yetti, Enie Novieastari, Evi Martha

Jurnal Keperawatan Indonesia

Interprofessional collaboration strategies and interventions are carried out to improve patient safety in hospitals. This study aimed to analyze the strategies and interventions used in interprofessional collaboration to improve patient safety. Interprofessional collaboration strategies and interventions were searched using five English-language databases, eligible studies were extracted, and the risk of bias was independently evaluated by two authors. The literature search yielded a total of 10,729 registered papers. We conducted an analysis on 3,793 health professionals. The following articles were included: 1) articles that described an intervention interprofessional collaboration to improve patient safety; 2) those focused on interprofessional collaboration in hospitals; …

Community-Based Intervention For Type 2 Diabetes Management In Developing Countries: A Systematic Review, Lutfian Lutfian, Izdihar Javier Wardika, Aufa Azizah, Fahmi Wildana, Yusti Muzdalifa Taplo, Riki Wartakusumah

Jurnal Keperawatan Indonesia

Type 2 Diabetes Mellitus (T2DM) poses a significant public health challenge, especially in developing countries with limited healthcare resources. There is a critical need for community-based interventions (CBIs) to promote healthy lifestyles for individuals with T2DM. This study explores CBIs to improve health behavior among T2DM patients in developing countries. It systematically reviews articles from PubMed, Scopus, CENTRAL, and CINAHL databases. The search strategy employed specific keywords following the PRISMA Extension for Systematic Reviews. The quality of the included articles was appraised using the Joanna Briggs Institute (JBI). A narrative synthesis summarized the key findings across the selected articles. The …

From Disappointment To Predominance: Medicare Advantage's Ascendancy And Transformation Of Medicare, Rick Mayes, Micah Johnson

Health Studies Faculty Publications

From 2004 to 2024, Medicare Advantage (MA) went from being a “policy disappointment,” covering 12% of all Medicare beneficiaries, to predominance, covering more than one-half (52%), with more growth predicted in the future. Drawing on an extensive review and synthesis of the literature, Medicare Payment Advisory Commission (MedPAC) reports, congressional committee hearings, and Centers for Medicare and Medicaid Services (CMS) data, this paper analyzes the evolution of Medicare and managed care in three parts. First, it briefly traces the early efforts to build an integrated managed care option to the traditional, fragmented fee-for-service Medicare program and highlights four key changes …

The Effect Of Nursing Process Education On Students’ Perceptions Of Nursing Diagnoses, Ezgi Bağrıaçık, Burcu Totur Dikmen

Jurnal Keperawatan Indonesia

The aim of this study is to evaluate the effect of nursing process education on nursing students' perception of nursing diagnoses. This quasi-experimental study was conducted with the second-year students who took the course of internal medicine nursing. One hundred and eleven second-year students (91.72%) who were attending a nursing faculty were included in the pretest. Each of the training sessions given to the students lasted for 60 minutes, and a total of 12 sessions of training were applied as three sessions per week. The online training was given to students by an educator with a presentation and case discussion. …

Depressive Disorders, Bad Mental Health Days, And Diabetes Management Behaviors Among Non-Hispanic American Indian/Alaska Native Adults: Findings From The Behavioral Risk Factor Surveillance System, Kaipeng Wang, Luohua Jiang, Jie Zhu, Spero M. Manson

Graduate School of Social Work: Faculty Scholarship

Objective

This study examined the association between diagnosis of depressive disorder, the number of bad mental health days per month, and diabetes management behaviors among American Indian/Alaska Native (AI/AN) adults with diabetes.

Research design and methods

Data were drawn from the Behavioral Risk Factor Surveillance System (2018–2021), including 2,272 self-identified non-Hispanic AI/AN adults diagnosed with non-gestational diabetes. Key variables included a self-reported prior diagnosis of depressive disorder and the number of bad mental health days in the past month. Outcome variables were seven diabetes management behaviors, such as taking a diabetes management class and performing daily foot checks. Statistical analyses …