Public Health Commons^™

Impact Of Pre-Transplant Immune Checkpoint Inhibitor Use On Post-Transplant Outcomes In Hcc: A Systematic Review And Individual Patient Data Meta-Analysis, Mohammad Saeid Rezaee-Zavareh, Yee Hui Yeo, Tielong Wang, Zhiyong Guo, Parissa Tabrizian, Stephen C Ward, Fatma Barakat, Tarek I Hassanein, Shravan Dave, Veeral Ajmera, Sherrie Bhoori, Vincenzo Mazzaferro, David M H Chascsa, Margaret C Liu, Elizabeth S Aby, John R Lake, Miguel Sogbe, Bruno Sangro, Maen Abdelrahim, Abdullah Esmail, Andreas Schmiderer, Yasmina Chouik, Mark Rudolph, Davendra Sohal, Heloise Giudicelli, Manon Allaire, Mehmet Akce, Jessica Guadagno, Clara Y Tow, Hatef Massoumi, Paolo De Simone, Elise Kang, Robyn D Gartrell, Mercedes Martinez, Ricardo Paz-Fumagalli, Beau B Toskich, Nguyen H Tran, Gabriela Azevedo Solino, Dra Mariana Poltronieri Pacheco, Richard S Kalman, Vatche G Agopian, Neil Mehta, Neehar D Parikh, Amit G Singal, Ju Dong Yang

Faculty, Staff and Student Publications

Background & aims: Treatment with immune checkpoint inhibitors (ICIs) for hepatocellular carcinoma (HCC) prior to liver transplantation (LT) has been reported; however, ICIs may elevate the risk of allograft rejection and impact other clinical outcomes. This study aims to summarize the impact of ICI use on post-LT outcomes.

Methods: In this individual patient data meta-analysis, we searched databases to identify HCC cases treated with ICIs before LT, detailing allograft rejection, HCC recurrence, and overall survival. We performed Cox regression analysis to identify risk factors for allograft rejection.

Results: Among 91 eligible patients, with a median (IQR) follow-up of 690.0 (654.5) …

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 …

Protocol For The Houston Hospital-Based Violence Intervention Program, Alexander Testa, Eresha Bluth, Latanya Monroe, Karlton Harris, Sarah Beth Abbott, Mary E Aitken, Erin E Fox, Brian Heckler, Lillian S Kao, Ruosha Li, Susannah Meg Michael, Heidi M Mcpherson, Marisol Nieves, Christian P Owen, Kevin Rix, Hema Sarvani Jalaparthi, Vanessa Schick, Shreela V Sharma, Carlie Stratemann, Anne Marie V Thompson, Jack Tsai, Zixi Yang, Sandra Mckay

Faculty, Staff and Student Publications

Firearm violence is a leading cause of injury and mortality in the United States. Hospital-based violence intervention programs (HVIPs) are a promising public health strategy designed to reduce recurrent violence by engaging patients during hospitalization and connecting them to support services after discharge. This protocol describes the design and implementation of the Houston Hospital-Based Violence Intervention Program (Houston-HVIP), which will be evaluated by a randomized controlled trial conducted at a Level 1 trauma center in Houston, Texas. The study plans to enroll individuals aged 16-35 who present with gunshot wounds (GSW) at the Level 1 trauma center. Participants are randomized …

Hazardous Work Exposures And Working Conditions And The Risk Of Serious Injury Among Latino Day Laborers In Houston, Texas (2014–2021), Maria Eugenia Fernandez-Esquer, Cesar Leonardo Pinzon-Gomez, Celeste Monforton, Yuan Li, Vahed Maroufy, Martha Ojeda, Anabel Rodriguez

Faculty, Staff and Student Publications

Introduction: Latino day laborers (LDLs) are frequently exposed to workplace hazards that increase their risk of an injury. The purpose of this study was to assess the relative influence of worker and workplace characteristics on serious injuries reported by LDLs at four different time points. We examined the influence of demographic characteristics, hazardous chemical exposures and working conditions using data from four cross-sectional surveys conducted between 2014 and 2021.

Methods: A total of 740 LDL were randomly recruited from public job hiring locations (known as "corners") in Houston Texas to participate in surveys conducted as part of injury risk reduction …

Improved Depression Symptoms Among Low-Income Mexican Americans Participating In A Community-Clinical Diabetes Intervention, Minjae Lee, Joseph H Conroy, Zihan Yang, Sein Lee, Paul G Yeh, Juliana Z Lopez, Natalia I Heredia, Lisa A Mitchell-Bennett, Maribel Sifuentes, Belinda M Reininger

Faculty, Staff and Student Publications

Background: Adults with type 2 diabetes mellitus and comorbid depression face complex disease management. Salud y Vida, a diabetes management intervention for Mexican Americans in the Rio Grande Valley of Texas, may mitigate depression through social support and community-clinic referrals.

Methods: In a cohort study, 292 Salud y Vida participants completed the patient health questionnaire (PHQ-9) at baseline, month 6, and month 12. A PHQ-9 score of ≥5 indicated mild depression and activated a mental health referral. Using SAS 9.4 with significance set at < .05, we conducted multivariable longitudinal negative binomial regression to assess changes in depression level.

Results: The proportion of participants with a PHQ-9 ≥5 decreased from 36% at baseline to 18% …

Effects Of Cognitive Dual-Tasking On Biomechanics And Muscle Activity During Gait Initiation And Sit-To-Walk In Young Adults, Angeloh Stout, Kaye Mabbun, Ke'vaughn Waldon, Marvin Alvarez, Stacy Nguyen, Miguel Barcellano, Sandra Cuenca, Chuan-Fa Tang, Aanand D Naik, Gu Eon Kang

Faculty, Staff and Student Publications

The purpose of this study was to investigate the effects of cognitive dual-tasking on gait initiation and sit-to-walk. Twenty-eight healthy young adults performed gait initiation and sit-to-walk under two conditions: while engaging in serial subtraction (dual-task) and without any additional task (single-task). Motion data were collected using a 10-camera optoelectronic motion capture system, synchronized with force plates and surface electromyography. We analyzed spatiotemporal parameters, center of mass displacement, center of pressure trajectory, and lower limb muscle activation patterns. We found that dual-task conditions significantly affected both gait initiation and sit-to-walk patterns, increasing the duration of transitions and mediolateral center of …

A Comparison Of The Effect Of Remimazolam And Midazolam On Recovery And Preserved Memory Function For Patients With Dental Extraction Anxiety, Quan Jing, Weijia Wang, Limeng Wu, Lejunzi Wang, Boru Yuan, Yan Wang, Chengbin Wang, Lin Liu, Lei Guan, Riyue Yu, Yuelun Zhang, Daniel I Sessler, Yuguang Huang, Kuo Wan, Lijian Pei

Faculty, Staff and Student Publications

Purpose: Remimazolam is an ultrashort-acting benzodiazepine, which has been indicated to be effective in endoscopic surgery and general anaesthesia. Research on its use in outpatient dental procedures remains limited. This triple-blinded randomized clinical trial was designed to determine whether the quality of postoperative recovery is better with continuous intravenous remimazolam administration compared with midazolam administration for impacted wisdom tooth extraction in patients with dental anxiety.

Patients and methods: This study was a randomized, parallel triple-blinded, superiority trial conducted between 30 April 2022 and 24 June 2024. Participants aged ≥18 years who exhibited dental anxiety and who were eligible for impacted …

Navigating The Nexus Of Food Insecurity, Anxiety, And Depression In The Face Of Climate Change: A Longitudinal Study In Rural Kenya, Michael Goodman, Lauren Raimer-Goodman, Heidi M Hagen Mcpherson, Dawit Woldu, Shreela Sharma, Ryan Ramphul, Fridah Mukiri, Agnes Maigallo

Faculty, Staff and Student Publications

Objective: This study aims to address critical gaps in understanding the bidirectional relationships between food insecurity, anxiety, and depression in Meru County, Kenya. By employing a cross-lagged panel analysis, we seek to clarify these temporal dynamics, contributing to the design of targeted interventions that integrate food security and mental health in the context of climate change.

Methods: A cross-lagged panel analysis was conducted using data from 362 adult participants in a community-based empowerment program (2023) in Meru County, Kenya. Participants completed self-report measures of food insecurity, anxiety, and depression at two time points, 11 weeks apart.

Results: Food insecurity (T1) …

Prediction Of Preterm Birth Among Infants With Orofacial Cleft Defects, Katherine L Ludorf, Renata H Benjamin, Mark A Canfield, Michael D Swartz, A J Agopian

Faculty, Staff and Student Publications

Objective: To develop risk prediction models for preterm birth among infants with orofacial clefts.

Design: Data from the Texas Birth Defects Registry for infants with orofacial clefts born between 1999-2014 were used to develop preterm birth predictive models. Logistic regression was used to consider maternal and infant characteristics, and internal validation of the final model was performed using bootstrapping methods. The area under the curve (AUC) statistic was generated to assess model performance, and separate predictive models were built and validated for infants with cleft lip and cleft palate alone. Several secondary analyses were conducted among subgroups of interest.

Setting: …

Perspectives On Smoking Cessation In The Oncology Environment: Insights From Brazilian Patients And Healthcare Providers, Raquel Descie Veraldi Leite, Ricardo Ribeiro Gama, Fabiana De Lima Vazquez, Gabriela Beltrami Massarão, Raiany Carvalho, Renan De Jesus Teixeira, Vinicius De Lima Vazquez, Irene Tami-Maury

Faculty, Staff and Student Publications

Objective: The aim of this study was to identify barriers and facilitators to smoking cessation among Brazilian cancer patients, considering the perspectives of both patients and healthcare professionals at a leading oncology center in the country.

Methods: A cross-sectional study was conducted, collecting smoking-related data from two groups: cancer patients and healthcare professionals at the Barretos Cancer Hospital (BCH) between 2019 and 2021. The questionnaire for healthcare professionals was adapted from the 2012 International Association for the Study of Lung Cancer and the Global Adult Tobacco Survey. For the cancer patient group, sociodemographic and clinical data were collected, along with …

Optimizing Community-Based Hepatitis B And C Care For Engaging Housing-Insecure Individuals, Vanessa Schick, Abigail Grace, F Tiffany Quan, Cathy Troisi, Jack Tsai

Faculty, Staff and Student Publications

Introduction

Hepatitis B and C (HBV/HCV) are bloodborne infections, with individuals who have histories of substance use and homelessness bearing a disproportionate risk. Long-standing difficulties in engaging these populations have made testing and treatment challenging. This retrospective observational study describes a community-based approach to HBV/HCV prevention and treatment, comparing the effectiveness of different engagement site types in reaching and engaging this high-need population.

Methods

GRASSROOTS HEALTH was launched in 2018 to improve HBV/HCV care by providing on-site testing, HBV vaccination, treatment navigation, and adherence support across various housing and drop-in centers. Outcomes were tracked through REDCap and analyzed by engagement …

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 …

Recovery Housing And On-The-Ground Research Priorities: A Scoping Study Through The Lens Of Community Based Participatory Research, Patrick F Hibbard, Cameron W Tice, Jodie M Dewey, Kathryn R Gallardo, James Tompkins, Justin S Bell, Jasleen Sandhu, Michelle A Cruz, Kathryn Babbitt, Amy A Mericle, Ashli J Sheidow

Faculty, Staff and Student Publications

Introduction: Though communities have featured recovery housing (RH) for several decades, the base of evidence for best practices continues to grow - especially evidence needed by, and known to, those who operate and receive these services. The Initiative for Justice and Emerging Adult Populations (JEAP) engaged with three community boards (CBs) - consisting of young adults with experience in recovery from substance use issues, people who have a history of criminal legal system involvement and recovery, and payers and provider of substance use services and harm reduction - to understand on-the-ground priorities for research into recovery support services.

Methods: JEAP …

Community-Involved Economic Evaluation And Development Of A Cost-Effectiveness Calculator For Two Peer-Driven Substance Use Interventions, Sierra Castedo De Martell, Margaret B Moore, Hannah Wang, Lori Holleran Steiker, J Michael Wilkerson, Sheryl A Mccurdy, Nalini Ranjit, H Shelton Brown

Faculty, Staff and Student Publications

Introduction: While peer-driven substance use interventions have proliferated across the U.S., economic evaluations of these interventions have lagged behind. A key characteristic of these interventions is the centrality of the "nothing about us without us" ethos, which should extend into economic evaluation research. To that end, this study sought to take a community-based participatory research (CBPR) approach to conducting a cost-effectiveness analysis (CEA) of peer recovery support services (PRSS) and turning that CEA and a CEA of bystander naloxone distribution (BND) into components of a free, web-based calculator for use by recovery community centers (RCCs).

Methods: We engaged staff and …

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 …

Phenotypic Variation In Disease Severity Among Hospitalized Pediatric Patients With Covid-19: Assessing The Impact Of Covid-19 In The Epico Study, María Camila Sossa-Alarcón, Mónica Paola Gutiérrez, Natalia Becerra, Luz Yessenia Ortegon, María Camila David, Melisa Naranjo Vanegas, Gabriela Friedrich, Pablo Vásquez-Hoyos, María Lucía Mesa-Rubio, Luis Miguel Navarro-Ramirez, Sergio Moreno-Lopez, Olga Lucía Baquero, Luz Marina Mejía, Juan Gabriel Piñeros, Sonia Restrepo-Gualteros, Carlos Álvarez-Moreno, Alejandro Díaz-Díaz, Iván Gutierrez-Tobar, Andrés Camilo Mesa, William Ricardo Bachiller Tuta, Clara Esperanza Galvis Diaz, Martha Africano, José Manuel Nieto, Paola Marsela Pérez Camacho, Claudia Beltrán-Arroyave, Rosalba Vivas Trochez, Irati Gastesi, Cinta Moraleda, Alfredo Tagarro García, Blanca Herrero, Lourdes Calleja, Carlos Grasa, Paula Rodriguez, Susana Melendo, Antoni Soriano-Arandes, Irene Gómez Pastrana, Sonsoles García García, Victoria Fumado, Andrea Ramírez Varela

Faculty, Staff and Student Publications

Objective: To characterize the clinical phenotypes of SARS-CoV-2 infection in hospitalized children as part of the EPICO multicenter cohort study.

Methods: We included hospitalized children with confirmed SARS-CoV-2 infection from Colombian and Spanish institutions to assess disease evolution and outcomes. Cluster analysis was performed to identify clinical phenotypes.

Results: A total of 2318 patients were included (55% male, 36% infants). Five phenotype clusters emerged: Cluster 1 (26.5%): infants without comorbidities, low PICU admissions and mortality; Cluster 2 (18.5%): respiratory comorbidities, high microorganism co-detection and mortality; Cluster 3 (11.5%): fever, gastrointestinal symptoms, high PICU admissions; Cluster 4 (32%): mild unspecific symptoms, …

Factors Influencing Implementation Of A Self-Measured Blood Pressure Program In Community Health Centers: An Implementation Mapping Approach, Serena A Rodriguez, Fernanda Velasco-Huerta, Mahalia Sampson-Ansah, Ella R Garza, William B Perkison, Patenne D Mathews, Catherine Pulicken, Maria E Fernandez

Faculty, Staff and Student Publications

Objectives: Uncontrolled hypertension is a leading cause of cardiovascular disease, particularly among adults aged 45 years and older. Self-measured blood pressure (SMBP) is an evidence-based intervention that can help patients manage hypertension outside of the clinical setting. We conducted a needs and assets assessment to identify (1) health center adopters and implementers and (2) barriers and facilitators to SMBP adoption and implementation in six community health centers in Texas.

Methods: Data sources included: (1) needs and assets assessment surveys and semi-structured interviews; (2) site visits with participating health centers; and (3) detailed meeting notes and logs. Leaders and administrators from …

Adaptation Using Im Adapt Of An Evidence-Based Lifestyle Intervention To Support The Management Of Metabolic-Dysfunction Associated Steatotic Liver Disease Among Hispanic/Latino Adults, Natalia I Heredia, Sylvia A Ayieko, Serena A Rodriguez, Jessica P Hwang, Lorna H Mcneill, Maria E Fernandez

Faculty, Staff and Student Publications

The high prevalence of metabolic-dysfunction associated steatotic liver disease (MASLD), formerly non-alcoholic fatty liver disease (NAFLD), necessitates the availability of an evidence-based intervention to manage the condition among patients to prevent severe chronic liver disease and other cardiometabolic-related illnesses. IM Adapt (Intervention Mapping for Adaptation) is a systematic approach for planning modifications in interventions to improve fit and potential effectiveness. Following this stepped approach, we conducted interviews with the target population, conducted a literature review, solicited expert advice, and created a logic model describing expected program outcomes for the new population and setting. We searched for, selected, and adapted an …

Co-Creation Of Staff Training To Address Health-Related Social Needs In Emergencies, Linda Highfield, Gayla Ferguson

Faculty, Staff and Student Publications

Background: Health-related social needs (HRSN), such as housing and transportation barriers, contribute to poor health outcomes and increased healthcare costs. Patient navigators help connect patients to community resources, but workforce training gaps are a challenge. The Strengthening Peer AHC Navigation (SPAN) study aimed to enhance navigation training during the COVID-19 Public Health Emergency.

Methods: Using a stakeholder-driven peer planning approach, SPAN co-developed a quality improvement plan for patient navigation training. Training focused on housing and transportation navigation and included didactic sessions, hands-on case studies, and biweekly expert consultations. Self-efficacy surveys measured navigator confidence pre- and post-training, and changes in navigation …

A Mixed-Methods Usability Pilot Of A Value-Goal Elicitation Tool In The Inpatient Setting For Older Adults Anticipating Post-Acute Care, Kirstin M Piazza, Caroline Pascal, Syama R Patel, Caroline Sefcik, Marilyn M Schapira, Caroline Madrigal, Katherine C Ritchey, Longyi Yip, Aanand D Naik, Robert E Burke

Faculty, Staff and Student Publications

Age-Friendly Health Systems (AFHS) emphasize aligning care with "What Matters" most to older adults. Hospitalization represents a critical period where value-based goals could shape key decisions about post-acute care transitions. However, few tools designed for eliciting such goals have been adapted for use in the inpatient setting, where the acute nature of care poses unique challenges. This mixed-methods study evaluates the usability of the Health Priorities Primer Tool (HPPT) in older hospitalized adults who anticipate needing post-acute care, aiming to identify necessary adaptations for the inpatient setting. We conducted interviews, observations, and surveys with older hospitalized patients to understand their …

A Directed Content Analysis For Greatest Problems Among People With And Without Traumatic Brain Injury, Emily Dudek, Michael W Williams, Chung Lin Novelle Kew, Annalyn Demello, Brittany Wright, Alexandra B Holland, Alyssa Day-Gorman, Alexa S Gonzalez, Luis Leon Novelo, Xiangyi Liu, Shannon B Juengst

Faculty, Staff and Student Publications

Objective: To characterize the greatest problem or need among individuals with a history of traumatic brain injury (TBI), as compared with individuals with a history of other neurologic conditions, mental health conditions, and no history of neurologic or mental health conditions.

Design: A directed content analysis of open-text responses to a single online survey question using a framework guided by the Mayo-Portland Adaptability Inventory-4.

Setting: Community.

Participants: A total of 2861 community-dwelling adults (n=274 with TBI; n=289 with other neurologic conditions besides TBI; n=454 with mental health conditions but no neurologic conditions; and n=1844 controls).

Interventions: Not applicable.

Main outcome …

Association Between Trust In The Incumbent President And Covid-19 Preventive Behaviors During The Pandemic In Four Latin American Countries, Juliana Mejía-Grueso, Gloria Isabel Niño-Cruz, Javiera Alarcón-Aguilar, Pablo Roa-Urrutia, Sergio Mauricio Moreno-López, Adriano Akira Ferreira Hino, Alexandre Augusto De Paula Da Silva, Fernando López, Deborah Salvo, Rodrigo Siqueira Reis, Guillermo Rosas, Andrea Ramírez-Varela

Faculty, Staff and Student Publications

The COVID-19 pandemic revealed disparities in policy responses in Latin America. We examined the association between trust in the president and COVID-19 preventive behaviors in Brazil, Chile, Colombia, and Mexico. We used data from the Collaborative COVID-19 Response Survey by the McDonnell Academy at Washington University in St. Louis (United States), from September 2020 to March 2021. Nonprobabilistic sampling included adult citizens from the four countries. Multivariate negative binomial regression models were applied. The study included 8,125 participants, with Brazil showing the lowest adherence to preventive behaviors (65.5%). Increased adoption of preventive behaviors was linked with ages 18-26 (aIRR = …

A Comparison Of Floating Catchment Area Parameters With Applications To A Dataset Of Clinics Enrolled In A Statewide Child And Adolescent Psychiatric Consultation Program, Jocelyn Hunyadi, Lara S Savas, Kehe Zhang, Jeanette E Deason, Ryan Ramphul, Melissa F Peskin, Erica L Frost, Cici Bauer

Faculty, Staff and Student Publications

INTRODUCTION: Healthcare resources are often crucial but limited, requiring careful consideration and informed allocation based on population needs and potential healthcare access. In resource allocation settings, availability and accessibility of resources should be examined simultaneously. The two-step floating catchment area (2SFCA) method has been previously used to evaluate spatial accessibility to healthcare resources and services, and to address health-related disparities. The 2SFCA methods have regained significant popularity during the COVID-19 pandemic, as their application proved crucial in addressing priority public health data analysis, modeling, and accessibility challenges. However, comprehensive comparisons of the 2SFCA method input parameters in the context of …

Untargeted Metabolome Atlas For Sleep-Related Phenotypes In The Hispanic Community Health Study/Study Of Latinos, Ying Zhang, Brian W Spitzer, Yu Zhang, Danielle A Wallace, Bing Yu, Qibin Qi, Maria Argos, M Larissa Avilés-Santa, Eric Boerwinkle, Martha L Daviglus, Robert Kaplan, Jianwen Cai, Susan Redline, Tamar Sofer

Faculty, Staff and Student Publications

BACKGROUND: Sleep is essential to maintaining health and wellbeing of individuals, influencing a variety of outcomes from mental health to cardiometabolic disease. This study aims to assess the relationships between various sleep-related phenotypes and blood metabolites.

METHODS: Utilising data from the Hispanic Community Health Study/Study of Latinos, we performed association analyses between 40 sleep-related phenotypes, grouped in several domains (sleep disordered breathing (SDB), sleep duration, sleep timing, self-reported insomnia symptoms, excessive daytime sleepiness (EDS), and heart rate during sleep), and 768 metabolites measured via untargeted metabolomics profiling. Network analysis was employed to visualise and interpret the associations between sleep phenotypes …

Psychometric Evaluation Of A Novel Measure Of Trauma-Related Cannabis Use To Cope, Sage E. Hawn, Terrell A. Hicks, Christopher Latourrette, Anita Thomas, Daniela Chaname, Sarah Ehlke, Abigail Powers Lott

Psychology Faculty Publications

Background: Posttraumatic stress disorder (PTSD) and cannabis use disorder (CUD) are commonly comorbid and are associated with many negative public health outcomes. One plausible explanation for this comorbidity comes from a self-medication framework, which suggests people use cannabis to cope with PTSD symptoms. Despite theoretical and empirical evidence for PTSD-related cannabis use to cope, no measure of this construct exists.

Objective: We sought to address this gap by developing and validating a novel measure of PTSD-specific cannabis self-medication, which we have termed the Trauma-Related Cannabis Use to Cope (TRCU) questionnaire.

Method: The psychometric properties of the TRCU and how it …

Delayed Hypertension Diagnosis And Its Association With Cardiovascular Treatment And Outcomes, Yuan Lu, John E. Brush Jr, Chungsoo Kim, Yuntian Liu, Xin Xin, Chenxi Huang, Mitsuaki Sawano, Patrick Young, Jacob Mcpadden, Mark Anderson, John S. Burrows, Jordan R. Asher, Harlan M. Krumholz

Department of Medicine Faculty Publications

Importance Hypertension is a major risk factor for cardiovascular disease, yet delays in diagnosis may limit timely treatment initiation and increase cardiovascular risk.

Objectives To examine the timing of clinical hypertension diagnosis, its association with antihypertensive medication prescribing, and its association with long-term cardiovascular outcomes.

Design, Setting, and Participants This retrospective cohort study analyzed electronic health record (EHR) data from an integrated health care system. Adults aged 18 to 85 years with at least 2 outpatient blood pressure (BP) readings of 140/90 mm Hg or more recorded at least 30 days apart from January 1, 2010, to December 31, 2021, …

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 …

Development, Delivery, And Evaluation Of The Texas Epidemic Public Health Institute Pilot Infection Control Lecture Series, Kayla E Ruch, Anabel Rodriguez, Janelle Rios, Luis Ostrosky-Zeichner, Eric L Brown

Faculty, Staff and Student Publications

Introduction: The Texas Epidemic Public Health Institute (TEPHI) aims to keep Texans healthy and the economy strong by preparing for the next infectious disease outbreak. TEPHI's Small Rural Healthcare Preparedness core developed, delivered, and evaluated a pilot infection prevention and control webinar series called Infection Control for rural-serving health professionals and organizations based on infection prevention and control field best practices.

Methods: Data from the first year of the Infection Control series was collected through attendee registration forms, attendance records, knowledge, and post-lecture evaluation surveys using Qualtrics. The data were analyzed using Qualtrics software. Lectures were free and open to …

Longitudinal Host Transcriptional Responses To Sars-Cov-2 Infection In Adults With Extremely High Viral Load, Vasanthi Avadhanula, Chad J Creighton, Laura Ferlic-Stark, Divya Nagaraj, Yiqun Zhang, Richard Sucgang, Erin G Nicholson, Anubama Rajan, Vipin Kumar Menon, Harshavardhan Doddapaneni, Donna Marie Muzny, Ginger A Metcalf, Sara Joan Javornik Cregeen, Kristi Louise Hoffman, Richard A Gibbs, Joseph F Petrosino, Pedro A Piedra

Faculty, Staff and Students Publications

Current understanding of viral dynamics of SARS-CoV-2 and host responses driving the pathogenic mechanisms in COVID-19 is rapidly evolving. Here, we conducted a longitudinal study to investigate gene expression patterns during acute SARS-CoV-2 illness. Cases included SARS-CoV-2 infected individuals with extremely high viral loads early in their illness, individuals having low SARS-CoV-2 viral loads early in their infection, and individuals testing negative for SARS-CoV-2. We could identify widespread transcriptional host responses to SARS-CoV-2 infection that were initially most strongly manifested in patients with extremely high initial viral loads, then attenuating within the patient over time as viral loads decreased. Genes …