Health Services Research Commons^™

Trends In Opioid Usage And The Covid-19 Pandemic, Priya Brahmbhatt, Jeffery Powers

Rowan-Virtua Research Day

The opioid epidemic and the COVID-19 pandemic have affected individuals in the United States in various capacities, and new avenues to reduce the harmful effects of both public health crises must be explored. It has been found that those with substance use disorders have an increased risk for COVID-19 (Wang 2021). There have been more visits to emergency rooms for substance overdose during the COVID-19 pandemic compared to before the COVID-19 pandemic (Holland 2021). This research project attempted to understand the trends amongst opioid users during the COVID-19 pandemic compared to before the COVID-19 pandemic in the United States, in …

Effects Of Attention-Deficit/Hyperactivity Disorder On Patients Undergoing Percutaneous Coronary Intervention Procedure: Insights From The National Inpatient Sample, Rafail Beshai, Keri Anacker, Keith Anacker, Tony Elias, Veyola Rezkalla, Maziyar Daneshvar, Howard Weinberg

Rowan-Virtua Research Day

Introduction: Attention Deficit Hyperactivity Disorder (ADHD) is a neurodevelopmental disorder that can affect children and adults and is characterized by deficits in attention, self-regulation, and executive functioning. Symptoms can seriously affect daily functioning and may present as hyperactivity, inattentive behaviors, or a combination of both. There are data to suggest patients with ADHD suffer from increased rates of cardiovascular disease, however not much is known specifically regarding the relationship between ADHD and undergoing Percutaneous Coronary Intervention. We sought to examine this relationship in greater detail by perusing the national inpatient sample database to describe in-hospital trends and outcomes among these …

Growing Use Of Xylazine As An Adulterant In Opioids And Its Effects, Oluwapelumi Oluwo

Rowan-Virtua Research Day

Xylazine, according to the National Institutes of Health (NIH), is a non-opioid tranquilizer used in veterinary medicine. Although this drug has not been approved for human use, it can be linked to an increase in opioid overdose deaths due to its role as an adulterant in drugs like fentanyl.

Xylazine was detected in drugs involved in 41% of all opioid-involved unintentional deaths and in 44% of all unintentional overdose deaths with fentanyl involved in the year of 2021 in Philadelphia.

Factors That Influence The Decision To Get Vaccinated Against Covid-19, Rhea Bhargava, Meghan H. Foos, Brandy M. Gotti, Alexandra L. Mulvenna, Taylor O. Smith, Danielle Cooley, Venkateswar Venkataman

Rowan-Virtua Research Day

Since the start of the COVID-19 pandemic and the launch of the vaccine, healthcare workers have been encouraging people to get vaccinated to prevent the spread of the virus. However, there is a significant number of people who are vaccine hesitant, or uncertain about receiving the COVID-19 vaccine and its booster. Vaccine hesitancy represents a state of opportunity to make positive change; therefore, it is crucial for healthcare workers to identify those who are in this population. When factors contributing to the vaccine hesitancy, including gender, age, ethnicity, education level, and income were studied, it was found that women, those …

Analysis Of Implementing Best Practices For Co-Prescribing Naloxone In Your Agency Online Cme Training Module Via Pre- And Post- Knowledge Assessment., Alicia Podwojniak, Arvind Venkataraman, Richard Jermyn

Rowan-Virtua Research Day

The opioid epidemic poses substantial risk to society. Providers must ensure that their patients understand the uses and risks of both opioids and naloxone. One way to analyze this concept is via metacognition. This refers to a person’s knowledge about cognitive phenomena, and thus it regulates self-awareness abilities in decision making, such as planning and evaluating. It is not only important for providers to have knowledge on best practices, but also to have self-awareness, and confidence in their decision making to ensure optimal patient outcomes. True-false confidence weighted scoring can be utilized, whereby various levels of confidence are assessed from …

Association Of Maternal Biomarkers With Gestational Weight Gain And Pre-Eclampsia, Matthew Green, Xinhua Chen

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Background: There is convincing evidence that excessive gestational weight gain (GWG), based on the Institute of Medicine’s (IOM) 2009 guidelines, increases the risk of both maternal and neonatal complications.1-6 Although the association between excessive GWG and pre-eclampsia is well-established, the reason why this association exists remains unclear.

Methods: Previously collected data from a cohort of pregnant women in Camden, NJ between the years of 1998-2007 was used to examine the association between maternal serum biomarkers (C-peptide, IGF-1, Insulin and Homeostatic Model Assessment for Insulin Resistance (HOMA-IR)) collected at entry (week 16) and 3rd trimester (week 28) and longitudinally assessed gestational …

Assessing The Need For Mental Health Screenings In A Student-Run Free Clinic And A Family Medicine Office, Sahil Parikh, Emily Forester, Alisha Basak, Jennifer Walpow, Rebecca Chae, Sahiba Gill, Tara Pellegrino

Rowan-Virtua Research Day

Background: The US Preventive Services Task Force provides strong evidence that early screening helps identify depression in primary care settings, promotes intervention, and facilitates treatment. The Rowan Community Health Clinic (RCHC) in Lindenwold, NJ is a student-run free clinic who serves patients regardless of patient gender, race, income or insurance status. This study aims to determine if there is a need to build internal infrastructure at RCHC for depression and anxiety management.

Methods: This is an IRB-approved study that began in June 2021. Data was collected from Rowan Community Health Center and Rowan Family Medicine patients. Patients were administered mental …

Does Accountability Affect Adherence To Moisturizer Treatment In Atopic Patients With Xerosis?, Stuti Prajapati, Christina Kontzias, Steven Feldman

Rowan-Virtua Research Day

Introduction: Xerosis is common in atopic dermatitis (AD). Adherence depends on factors such as complexity of treatments, disease understanding and accountability. Accountability is a psychobehavioral construct, referring to the expectation that one must be responsible for their actions or inactions.

Objective: We sought to assess whether interventions expected to improve accountability would be associated with improved adherence to xerosis treatment.

Method: This is a prospective study of 30 patients diagnosed with xerosis . Patients were given moisturizer with an electronic monitor to record adherence and asked to apply it once daily for three months. Subjects were randomized into one of …

Comorbidities, Behaviors, And Socioeconomic Factors And Mortality From Diseases Of The Heart In New Jersey, Matthew Guariglia, Stephen Poos, Ahmed Gawash, David Lo, Aayush Visaria

Rowan-Virtua Research Day

Mortality from diseases of the heart claimed the lives of 186,074 New Jerseyans from 2010 to 2019. This study aims to establish correlations between each of health-related risk factors and death from heart disease in each of six New Jersey counties. Each of the counties ranked by age-adjusted mortality per 100,000 from diseases of the heart. The six counties were divided by the least (Hunterdon, Somerset, Bergen) and greatest (Cape May, Salem, and Cumberland) mortality rates from heart disease. Additionally, this data was broken down into three main categories that include comorbidities, socioeconomic status, and behavior patterns. Each main category …

Impact Of Covid-19 Pandemic On Patients With Depression In Different Socioeconomic Status In Different Age Groups, Alexander Kowalski, Harsh Patel

Rowan-Virtua Research Day

This study aimed to investigate the impact of COVID-19 on depression and how different age groups and socioeconomic classes were affected. The PHQ-9 survey was used to assess depression levels amongst 64 individuals of different age groups and socioeconomic statuses. Results indicated that the higher socioeconomic class had less impact on depression symptoms compared to lower socioeconomic classes. Younger age groups and lower socioeconomic classes were found to have a bigger impact on depression symptoms. However, the study acknowledges that numerous factors, such as lifestyle factors, financial stability, and social support, need to be considered while interpreting the results. Overall, …

Brief Review: Low Frequency Event Charts (G-Charts) In Healthcare, James Espinosa, David Ho, Alan Lucerna, Henry Schuitema

Rowan-Virtua Research Day

The ability to determine if a change in a system is actually an improvement—or worsening in function—is one of the essential desiderata of quality improvement efforts. There are many ways to look at the issue. A special problem occurs when the event being studied is low frequency by nature. By way of example, patient falls in a given hospital or division of a hospital may occur in a way that is low frequency—yet each event is important. Process engineering has developed an approach to low frequency events. Part of this approach may involve specialized charts that look at the “time-between-events”—as …

Breaking Down Barriers: Investigating Structural And Systemic Factors That Contribute To Covid-19 Disparities In African American Communities In New Jersey, Fazal Choudhary, Suraj Pothineni

Rowan-Virtua Research Day

Background: The COVID-19 pandemic has affected the lives of millions of Americans; however, minority communities have been hit the hardest as infection rates continue to sky rocket and new variants arise. As of October 5, 2021, the CDC reports that African Americans make up a similar share of cases relative to the overall population, at about 12%, but have a significantly higher rate of deaths compared to the population, at approximately14%. African American communities are being disproportionately affected because of higher incidence of chronic diseases, inadequate access to health care, and poorer living and working conditions, which increases their vulnerability …

The Effect Of Socioeconomic Status On Primary Care Access And Cancer Screening Rates, Seth Spicer, Liam Courtney, Alyssa Laguerta, Abdul Sanni-Adam, Bharathi Balaji

Rowan-Virtua Research Day

Background: Low cancer screening rates among specific demographics are major health issues that lead to disparities in health outcomes. Early cancer detection is crucial for cure; however, it is not well known how age, race, gender, primary care access, and socio-economic status affect cancer screening rates. This review discusses the importance of cancer screening and the factors that affect screening rates.

Purpose: The purpose of this paper is to investigate how access to primary care affects cancer screening rates, with consideration to age, race, socioeconomic status, and primary care access in order to improve screening rates in underserved populations.

Methods: …

Exploring Risk Factors For Major Depressive Disorder For Female Patients Aged 18 Or Older Living In Ocean County, New Jersey, James Mack

Rowan-Virtua Research Day

Background: The incidence and prevalence of major depressive disorder has been increasing worldwide, in the United States of America, and on a local level. The population of Ocean County, New Jersey, a predominantly Caucasian, female, middle-aged population, may be at increased risk of developing major depressive disorder.

Purpose: To explore the social determinants of health and risk factors for major depressive disorder for female patients aged 18 or older living in Ocean County, New Jersey.

Methods: This literature review mainly used PubMed and Scopus for journal articles and utilized governmental databases for additional population data.

Results: Analyses conducted on social …

Lead Poisoning, Education, And Advocacy For Prevention (L.E.A.P.) Study, Stephen Acheampong, Britney Aderinto, Zander Turcich, Ali Harb

Rowan-Virtua Research Day

Lead poisoning has been regarded as a major threat due to its irreversible and harmful effects. This includes severe cognitive and developmental impairments, especially in children.

Over the years, the CDC has reduced the benchmark for acceptable blood lead levels (BLL) from 10 μg/ml to 3.5 μg/ml to allow for earlier intervention and prevention.

Despite increased awareness and government programs that lead to a decline in mean blood levels across the country, testing for elevated BLLs, especially in low-income households, continues to be disproportionately lower.

Impact Of Behavioral Health Consultant Intervention On Health Outcomes In An Integrated Primary Care Setting, Arpita Suri, Attiyah Zaheer, Christine Leroy, Robert Steer, Bhavin Shah, Sahil Zaveri, Shideh Doroudi

Rowan-Virtua Research Day

Integrated Primary Care Models are fast gaining popularity, and often being advocated as an important step in enhancing patient care within a primary care setting. Several studies have shown a positive impact of Behavioral Health Consultant (BHC) intervention in terms of patient satisfaction, improvement in patient symptom scores and global mental functioning. However, additional studies are needed to assess if integrated behavioral health consultations can demonstrate measurable outcome improvements to quantify the benefits of this approach, related to some of the most commonly seen and treated medical diseases in a primary care setting. This study aims to measure three outcomes: …

Evaluating The Relationship And Outcomes Of Ischemic Stroke In Patients With Covid-19 While Also Reviewing Overall Incidence And Mortality Of Stroke In Vulnerable Populations In The Us, Jaime Dougherty

Rowan-Virtua Research Day

COVID-19 has affected the worldwide population since early 2020 and has remained a health issue. Among the various symptoms and outcomes people are encountering when infected with COVID-19, this virus has also been connected to severe vascular insults involving large vessel occlusions.

Current stroke statistics indicate a nearly twice as high risk of stroke in African Americans when compared to whites. This brings into question how social determinants of health are affecting COVID-19 and stroke incidence.

The purpose of this review is to investigate the relationship between COVID-19 and ischemic stroke while advocating for a more robust primary prevention approach …

Identifying Motivators For Getting Vaccinated Against Sars-Cov-2 In Those Who Have Been Vaccinated. A Single Center Cross-Sectional Study, Nicole Lacap, Suzanna Hosein

Rowan-Virtua Research Day

The purpose of this study is to explore the primary motivations of patients getting vaccinated against SARS-Cov-2 as well as to determine any correlations between demographic information and specific motivators. We hypothesized that generally internal motivators (being in the best interest of oneself) will predominate as the reason for vaccination. The sample consisted of 227 patients vaccinated against SARS-CoV-2 at the Rowan Medicine Vaccine Clinic during the month of June 2021. Patients were given an online questionnaire collecting demographic information as well as primary reason for getting vaccinated. Preliminary analysis shows that 63% of participants were motivated by reasons that …

Implementing A Case Management Program At A Free Student-Run Clinic, Shelly Sharma, Mark Conforti, Wali Kamran, Fatou Drame, Mary Kate Heard, Samuel Irungu

Rowan-Virtua Research Day

• The Rowan Community Health Center (RCHC) located in Lindenwold, New Jersey, reopened in September of 2019
• Patients come to RCHC for physicals/wellness checks or medical ailments
• Many patients are from underserved communities and may not have a primary care physician or insurance
• Trend in lack of follow up among patients
  • o Leads to discontinuity of care
  • o Unaware if patients are obtaining their prescribed medications, following up with recommended specialists, or if chief complaints/primary diagnosis are improving
• RCHC’s Special Projects Department decided to implement a Case Management program to improve patient follow-up and adherence to care

The Need For Depression And Anxiety Screenings At A Student-Run Clinic, Shayna Peterzell, Sahil Parikh, Alicia Podwojniak, Vibha Chauhan, Riya Tandra, Emily Forester, Saumil Parikh, Jessica-Sophie Horoschak, Patrick Pearce, Roma Padalkar, Sobiah Khan, Tara Pellegrino

Rowan-Virtua Research Day

General anxiety and major depressive disorder are common and treatable mental health disorders. The US Preventive Services Task Force provides strong evidence that early screening helps identify depression in primary care settings, promotes intervention and facilitates treatment. Many medical offices use validated screening tools, GAD-7 and PHQ-9, to measure symptom severities and further help guide treatment modalities for patients with anxiety and depression, respectively. The Rowan Community Health Clinic (RCHC) in Lindenwold, NJ is a student-run free clinic that serves patients regardless of patient gender, race, income, or insurance status. This study aims to determine if there is a need …

Preferences For Support Resources Among Loved Ones Of Adults Prescribed Opioid Medications, Mansi Patel, Desta M. Pulley, Daniel Manvich

Rowan-Virtua Research Day

The opioid epidemic continues to be a leading cause of overdose and related deaths in America. While most interventions are focused on the individuals with opioid and substance use disorder (OUD/SUD); the impact caregivers and family can have on the treatment of patients with OUD is non-existent. The purpose of this study is to collect pilot data on peers, friends, and family members of patients with SUD/OUD to understand the barriers in psychosocial support and maintaining treatment retention; barriers to accessing medication assisted therapy (MAT) and naloxone; and caregiver fatigue and barriers for caregivers. The collected data will be used …

Changing Internal Medicine Residents’ Perspectives On Social Determinants Of Health, Timsal Ghani, Diana Vargas, Yvette Wang

Rowan-Virtua Research Day

Social determinants of health (SDOH)

- conditions in which people are born, live, learn, work, play and worship

- affect wide range of health, functioning and quality of life

SDOH play enormous roles in health and well being

- annual US deaths attributable to SDOH equivalent to the number due to lung cancer

- place of birth, race and income all have strong influence on health outcomes

- place of birth is more strongly associated with life expectancy than race or genetics

There is growing awareness of importance of social factors in improving overall population health and wellbeing

- highlighted …

A Systematic Review Of The Barriers Of Opioid Addiction Treatment For Young Adult Males (Ages 18-26) Living In Low Income Areas In The United States Of America, Atish Gandhi, Asim Shafique, Jillian Baker

Rowan-Virtua Research Day

NOTE: This is a broad literature review, not a systematic review.

This systematic review aims to analyze the reasons behind reduced access to opioid addiction treatment for individuals of low socioeconomic standing. Understanding these barriers may allow communities to build a more comprehensive plan to lower addiction rates. In addition, this review will be examining further developments of theopioid crisis due to the recent COVID-19 pandemic. The literature search used publications from the following databases: PubMed, Google Scholar, and NCBI. The keywords searched were “opioid addiction”, “substance abuse”, “low-income area”, “barriers to treatment”, “young male addiction”, “opioid treatment”, “Narcan”. There …

Evaluating Reasons For Moderna Covid-19 Vaccine Hesitancy At A Vaccine Distribution Center In South Jersey, Arghyadeep Sarkar, Suzanna Hosein

Rowan-Virtua Research Day

RowanSOM held a student-run vaccine clinic in 2020 during the Covid-19 pandemic.

Despite published research stating the safety and efficacy of the vaccine, there were still vaccine-hesitant individuals.

While the CDC reported that hesitancy to receive vaccination against SARS-CoV-2 had decreased, 32.1% of American adults did not intend to get vaccinated as of December 2020.

Understanding reasons for this hesitancy could help create informational ads directed towards people’s concerns.

Examining The Relationship Between Adolescent Obesity Rates And School Health Programs In Grades 9-12 In The United States, Joseph Melillo, Alison Mancuso

Rowan-Virtua Research Day

- In the United States, it was found that the prevalence of obese adolescents ages 12-19 was 21.2%.1

- According to a study by Ward et. al published in the New England Journal of Health (NEJH), the researchers estimated 88.2% of obese 19-year-olds would still be obese by the age of 35.2

- The purpose of this study was to evaluate school provided health programs and their impact on BMI values of students within these schools.

- This study aimed to compare health outcomes between different schools across the United States and identify aspects of school programming that can be …

Helicopter Ems And Its Outcomes In Stroke Patients During Transport From Rural Ed To Comprehensive Stroke Center, Asim Shafique, Jillian Baker

Rowan-Virtua Research Day

The theory that will be examined in this review pertains to creating an algorithm based upon whether patients suffering from a stroke with a large vessel occlusion should be taken to a stroke center from rural emergency departments for a mechanical thrombectomy via helicopter EMS (HEMS) or ambulance transport. Such an algorithm does not exist in healthcare, so this literature review will have the potential to be clinically applicable. This review will aim to identify the proper method of transportation during an ischemic stroke with the goal of reducing mortality rates and improving outcomes. Most rural communities are over an …

Improving Health Literacy In Underserved Youth, Paul Lee, Stephanie Parks, Sydney Wiredu, Dhaval Shah, Archana Salek

Rowan-Virtua Research Day

Health literacy is an individual’s capacity to obtain, process and understand basic health information needed to make appropriate health decisions. There are disparities in health literacy across age, gender, ethnicity, location and socioeconomic status. Children aged 12-17 are an important target group regarding health literacy research because of the fundamental cognitive, physical and emotional development processes occurring that affect health related skills and behaviors.

The objectives of this project were to:

• Identify the disparities of health literacy in varying demographics with regards to age, gender, location and socioeconomic areas
• Determine barriers affecting health literacy comprehension and knowledge in the target …

Implementing Best Practices For Co-Prescribing Naloxone In Your Agency: A Guide For Healthcare Professions, Michael Anyanwu, Emmanuel Asenso Jr., Ahmad Hussein, Jessica Baaklini, Michael Sunderhauf

Rowan-Virtua Research Day

From April 2020 to April 2021, it has been recorded that there have been 75,673 opioid overdose-related deaths in the United States. This number is up almost 20,000 more from the last period that deaths were recorded, coming in at 56,064 from April 2019 to April 2020. The use of naloxone, has been proven to save the lives of overdose patients on opioids by reversing its effects. It has already shown significant reduction in opioid overdose related mortality. Pharmacists are now able to prescribe naloxone with opioid prescriptions without a script from a doctor. EMS units are active in communities …

Sex, Race, And Primary Language On Opioid Prescribing In Pediatrics, Lubna Begum, Brian Begley, Catherine Cerniglia, Mones Aboeletta, Grace Gilbert, Justin Matthew, Stephen Meixner, Corinna Franklin, Rey Ramirez

Rowan-Virtua Research Day

Over-prescription of pain medication has led to an opioid epidemic in the United States. Many factors can contribute to the amount of pain medication prescribed to patients. The amount of pain medication prescribed to patients is affected by many factors and previous research has shown:

• Men are prescribed more than women
• Whites more than non-whites
• English-speaking more than non-English-speaking

The goal of the study was to look at whether this held true in a pediatric orthopedic population. We also looked at the trends in opiate prescribing over time.

The Effectiveness Of Culturally Relevant Obesity Programs On Decreasing Bmi Of Hispanic Children, Cindy Nativi

Rowan-Virtua Research Day

Obesity epidemic a public health concern in the United States

• significantly increases health burden in affected individuals
• linked to increased risk of diabetes, cardiovascular disease and cancer
• childhood obesity linked to earlier onset or presence in adulthood of the same diseases
• crucial to address this disease at the preventative level

Centers for Disease Control and Prevention reports obesity affects 19.3% of children and adolescents in the United States

• affects all ethnicities, but increased burden on minority populations of low socioeconomic status
• 1 in 5 Hispanic children considered obese

Latinos one of the fastest growing minority populations

• comprise approximately 17% of …