Health Services Research Commons^™

Trends In Prenatal Care Accessibility In Rural Mississippi And How These Trends Affect Unfavorable Birth Outcomes, Maura Isabella Webb

Honors Theses

This thesis investigated the level of accessibility to prenatal care in rural Mississippi areas and how this affects or has affected Mississippi’s high rates of unfavorable birth outcomes. The research questions included specifically looked at how lack of prenatal care in rural areas of Mississippi plays a role, if any, in extremely high rates of unfavorable birth outcomes as well as what policy can be implemented to expand education regarding unfavorable birth outcomes. To understand the effects of accessibility and eligibility of rural women’s health care, seven women were interviewed. Interviews were conducted with these women who met the criteria …

Dexmedetomidine To Reduce Ponv, Amanda Johnson Srna, Joshua Lawrence Srna, Staci Martinez Srna, Taylor Mayberry Srna, Dwayne Accardo Dnp, Crna, Aprn

Doctor of Nursing Practice Projects

Purpose/Background Postoperative nausea and vomiting (PONV) contribute to patient dissatisfaction, discomfort, adverse outcomes, and increased healthcare costs. Despite current protocols that aim to reduce PONV by prevention/antiemetic administration, PONV continues to be a common manifestation in many postoperative patients (Elvir-Lazo et al., 2020). This scoping review aimed to analyze available research on the efficacy of dexmedetomidine to reduce perioperative opioid requirements and PONV.

Methods Synthesis of this scoping review began with a systematic approach to search databases and identify eligibility criteria articles. Of the 21 articles that met criteria, a synthesis table was formed to visualize the qualitative (smoking status, …

Ageism, Eldercare, And Healthcare: An Examination Of Growing Old In Costa Rica, Akshaya Vijayasankar

Honors Theses

The world’s aging population and the Covid-19 pandemic have revealed the high level of ageism against older adults around the globe, which has resulted in an overall decreased quality of life for elders. Societies are now faced with the challenge of creating a suitable and equitable model of care to support their aging population. Despite the recent publication of the World Health Organization's Global Report on Ageism, there is still a large gap in the literature regarding ageism. This paper addresses the issues of institutional ageism in the eldercare and healthcare sector. I argue that Costa Rica serves as a …

Interrogating Race And Place-Based Inequities In Hiv And Covid-19, Rohan Khazanchi

MD Honors Theses

Over the last four years, I have developed a research focus examining the intersections of race, place, and health. My M.D. Honors Thesis reflects a snapshot of these efforts. In this collection of brief research reports, I leverage area-based measures to investigate structural inequities in three contexts: the HIV epidemic in our hyperlocal community, the early stages of the COVID-19 pandemic, and clinical trials for novel COVID-19 therapeutics. I apply novel social epidemiologic tools to measure and explore disparate outcomes. And, in reflecting upon my findings, I discuss concrete implications for clinicians, researchers, and policymakers alike.

Chapter 1: Neighborhood-Level Deprivation …

Spending On Public Benefit Programs And Exposure To Adverse Childhood Experiences, Megan Collins

Research Days

Watch recording of live presentation.

Background: Adverse childhood experiences (ACEs) have been shown to be associated with poor health outcomes, and children living in poverty are more likely to experience ACEs. Our objective was to estimate the association between spending on benefit programs and cumulative exposure to ACEs among children.

Methods: This cross-sectional study examined state and federal spending, at the state-level, on 5 categories of public benefit programs: cash, housing, and in-kind assistance; housing infrastructure; childcare assistance; refundable Earned Income Tax Credit; and Medical Assistance Programs (e.g., Medicaid). The primary exposure was median annual spending per person living below …

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 …

The Effect Of Covid-19 On Depression In Hispanic Vs. Non-Hispanic Populations In South Jersey, Rana Cheikhali, Daniel Casal

Rowan-Virtua Research Day

The COVID-19 pandemic has been challenging for Americans and the world as a whole. It has especially taken a toll on mental health. Studies show that the incidence of depression in the United States was three times greater during the pandemic compared to pre-pandemic times. One specific community in the United States that has been greatly affected by the pandemic is the Hispanic American community. Many Americans across the country have received federal surveys that aim to determine the social and economic impacts of COVID-19. Results revealed that the Hispanic population had the greatest rise in mental illness, with 40% …

The Influence Of Parental Knowledge Of Nutrition Labels On Child Bmi, Daniella R. Toto, Alexander Kowalski

Rowan-Virtua Research Day

The purpose of this study is to better understand parental knowledge of nutrition labels and how this knowledge affects their child’s BMI. A large proportion of US parents have limited health literacy skills on how to read and use labels. Socioeconomic status and other demographics may affect this knowledge. We predict that children of parents who lack nutrition label knowledge will have higher BMIs than children whose parents have nutrition label knowledge.

What Motivates Patients To Enroll In A Naloxone Co-Prescribing Program?, Christina Kanagawa, David Aloisio, Eshani Choksi, Manasa Gowda, Tyler Klecha, Charles M. Defendorf

Rowan-Virtua Research Day

Patients were contacted via phone call to establish knowledge of and prescription status regarding naloxone. They were then invited to enroll in a research study consisting of two online surveys.

The patients who had been prescribed naloxone by the time the study had started ranked being persuaded by a medical professional as being the most important reason for accepting the naloxone prescription.

Insufficient data collected during the six-week time frame to draw statistically significant conclusions about what motivates patients to receive naloxone co-prescriptions.

Correlations seen in this study are interesting and warrant further investigation.

Understanding Changes In Mortality With Implementation Of Safe Injection Sites, Shubh Bhambri

Rowan-Virtua Research Day

The purpose of this study is to analyze mortality due to overdose in areas that have implemented supervised injection sites and understand what factors these facilities affect that can lead to a change in outcomes.

Income And Its Effects On Health Literacy: A Study Between A Student-Run Free Clinic And A Family Medicine Office, Shayna Peterzell, Sahil Parikh, Thomas Ruta, Rabiye Ayaz, Srujan Dadi, Emily Forester, Olivia Choi, Rachel Fletcher-Slater, Melodi Harfouche, John Cruz, Roma Padalkar, Sobiah Khan, Rebecca Moore

Rowan-Virtua Research Day

More than 1/3 of people nationwide (80+ million) have limited health literacy, which contributes to poor health outcomes and lifestyle choices. Health literacy is defined as the understanding and application of words, numbers & documents (i.e., medication labels, medical forms). The Rowan Community Health Center (RCHC), located in Lindenwold NJ, is a student-run clinic that wanted to assess the health literacy of our patients in order to further provide better care. RCHC provides cost-free primary care services regardless of income, insurance, or legal status. To assess health literacy, RCHC used the New Vital Signs (NVS) literacy assessment tool to investigate …

Analyzing The Effects Of The Covid-19 Pandemic On Mood Disorders In Patients, Alexa Golub, Joanna Petrides, Meagan Vermeulen

Rowan-Virtua Research Day

The COVID-19 pandemic brought about restrictions on social interactions, altered work settings/job losses, decreased access to groceries and essentials, and more

With strict prevention measures and isolating quarantine experiences, it was anticipated that the lockdown would have psychological effects

Some contributing psychological stressors included duration of quarantine, fear of infection, boredom, lack of supplies, inadequate information, and finances

This study aimed to quantify and evaluate any change in mood disorder diagnoses since the onset of the COVID-19 pandemic

Literature Review: Palliative Care In The Emergency Department, Alice Chang, James Espinosa, Alan Lucerna, Neelesh Parikh

Rowan-Virtua Research Day

With current medical advances, our patient population continues to age. This poses new challenges for healthcare practitioners to provide for elderly patients with complex and multifactorial medical needs. Particularly, this is a growing challenge in the emergency department (ED), where patients often present towards the last months of their lives. A study conducted by UCSF indicates 75% of patients in their last 6 month of life visited the ED. 56% to 99% of older adults do not have advance directives available at ED presentation. Therefore, ED visits towards the end of life is an opportune teaching moment for physicians to …

A Geographically Targeted Approach For A Preceptor Tax Incentive Using Primary Care Health Professional Shortage Areas (Hpsas), Julia Mattingly, Sarah Belcher, Samuel C. Kessler

Commonwealth Policy Papers

Years before the COVID-19 pandemic brought on a health care shortage in Kentucky, its rural areas were already struggling to obtain and attract primary care medical practitioners. Even though the number of medical school graduates in the U.S. has steadily increased throughout the years, there is a general disinterest in rural or small-town practice, and legislators throughout the country have pondered ways to address this issue plaguing communities. Versions of Preceptor Tax Incentive legislation in Kentucky have been proposed in the General Assembly to address care shortages in the state, however, all have been unsuccessful at truly targeting rural areas …

Transferring Patients To A Higher Level Of Care, Chiquita Rockiemore Rn, Msn, Olubunmi Osinloye Bsn, Rn, Angela Uta Bsn, Rn, Tracy Mcclinton Dnp, Ag-Acnp-Bc

Doctor of Nursing Practice Projects

The purpose of this study is to determine whether the transfer of critically ill patients, who require a higher level of care, to another facility impacts morbidity and mortality within 24-72 hours post transfer