Health Services Research Commons^™

Preparing For The Next Disaster: Lessons Learned From The Early Experiences Of Autistic Adults During The Covid-19 Pandemic, Amber Pomponio Davidson, Cecilia Feeley, Beth Pfeiffer, Mark Salzer

Internet Journal of Allied Health Sciences and Practice

Purpose: Disasters, such as the worldwide COVID-19 pandemic, create significant disruptions for individuals and their communities. Understanding these disruptions is a first step towards planning for future events and disaster recovery. This research aims to explore how the initial COVID-19 restrictions, including lockdowns, impacted adults with Autism (ASD). Method: Using semi-structured interviews to understand how individuals with ASD experienced the early months of the COVID-19 pandemic, twelve participants were interviewed: six individuals with ASD (ages 20-38), three parents of individuals with ASD, and three support staff for individuals with ASD. Analysis: Grounded theory methods were used to analyze the impacts …

The Factors That Influence Clinicians To Choose Rural Settings To Deliver Health Services, Julia Mattingly

Posters-at-the-Capitol

Years before the COVID-19 pandemic brought on a health care shortage in the United States, its rural areas were already struggling to obtain and attract primary care medical practitioners. The federal government has designed many programs with the intent of exposing clinicians to life in rural areas, but few have been successful at keeping medical practitioners in the long-term. Clinicians who are recruited to rural areas via loan repayment programs or other short-lived incentives often leave after only a few years.

In order to learn more about this long-running health policy problem, we set out to study the factors that …

Epidemiological/Disease And Economic Burdens Of Cervical Cancer In 2010–2014: Are Younger Women At Risk?, Chuhao Xi, Jay J. Shen, Betty Burston, Soumya Upadhyay, Shoujun Zhou

Healthcare Administration and Policy Faculty Research

Objective: Cervical cancer is an important factor threatening women’s health in China. This study examined the epidemiological and economic burden of cervical cancer among the medically insured population, which could provide data support for government departments to formulate policies. Methods: All new cases of cervical cancer under the Urban Employee Basic Medical Insurance (UEBMI) plan in a provincial capital city in eastern China from 2010 to 2014 were collected. The Cox proportional hazard model was used to analyze the factors affecting the survival rates for cervical cancer. Outpatient and hospitalization expenses were used to assess the direct economic burden, and …

Role Of Nativity In Mental Health Service Utilization Among Asian Americans: A Weighted Analysis Of Complex Survey Data, Anne Dumadag, Hadiza Galadima

College of Health Sciences Posters

Asian Americans represent both the fastest-growing population and the smallest group of consumers of mental health services (MHS) in the United States. The current study aimed to identify factors associated with MHS use and explore differences in MHS use by nativity among Asian Americans. Data from the 2015-2018 National Health and Nutrition Examination Survey (NHANES) were used to examine past-year MHS use among Asian Americans ages 18 and older. Weighted analyses were used to determine the distribution of the population by nativity and other covariates, and Rao-Scott Chi-Square tests were used to explore the association between past-year MHS use and …

A Systematic Literature Review Of Research From 2010 To 2020 Addressing User-Generated Online Comments Related To Health Issues And Recommendations For Future Research, Muhammad Ittefaq, Mauryne Abwao, Ioana A. Coman, Waqas Ejaz

School of Communication Studies - Faculty Scholarship

This systematic literature review was conducted to provide insights into how online readers’ comments have been studied in the context of health over a 10-year span. About 593 studies published between 2010 and 2020; of these, 34 met the research criteria for inclusion. Our findings reveal that 60% of the studies focused on the United States, and a qualitative method was used in 74.3% of these studies. About 23.5% of the studies explored vaccine-related issues. Our results reveal that among the selected studies, 76.5% and 20.6% had female and male first authors, respectively. Textual analysis of abstracts shows that the …

Addressing The Barriers To Mammography Screening In Rural And Urban Ohio Counties, Carly Perkowski, Isabelle Fox

Scholarship in Medicine - All Papers

Mammography screenings have the potential to protect individuals from the burden of cancer and can even save lives. However, in Ohio, many women are not receiving regular screenings. Recent research indicates that social determinants of health, such as income and education, can impact an individual’s ability to access mammography. Yet, we lack a comprehensive understanding of how these factors hinder an individual's ability to obtain mammography screenings, particularly in urban and rural areas of Ohio. The introduction of mammography has facilitated early detection of breast cancer in women. By identifying gaps in access to mammography and implementing changes to improve …

Gaps In Behavioral Health Care In Rural Primary Care Clinics And The Promise Of Vbhi: Perspectives From Clinic Staff, Monique Gill

Articles, Abstracts, and Reports

No abstract provided.

Association Between Surgical Technical Skills And Clinical Outcomes: A Systematic Literature Review And Meta-Analysis, Michael S Woods, Joshua N Liberman, Pinyao Rui, Emily Wiggins, Joan White, Bruce Ramshaw, Jonah J Stulberg

Faculty, Staff and Student Publications

BACKGROUND: A systematic literature review and meta-analysis was conducted to assess the association between intraoperative surgical skill and clinical outcomes.

METHODS: Peer-reviewed, original research articles published through August 31, 2021 were identified from PubMed and Embase. From the 1,513 potential articles, seven met eligibility requirements, reporting on 151 surgeons and 17,932 procedures. All included retrospective assessment of operative videos. Associations between surgical skill and outcomes were assessed by pooling odds ratios (OR) using random-effects models with the inverse variance method. Eligible studies included pancreaticoduodenectomy, gastric bypass, laparoscopic gastrectomy, prostatectomy, colorectal, and hemicolectomy procedures.

RESULTS: Meta-analytic pooling identified significant associations between …

Addressing Breast Health Disparities Among Recent, Established African-Born Immigrant Women And Second-Generation Americans In Prince George County, Maryland, Omolola Okunromade

College of Graduate Studies: Theses & Dissertations

Background: Breast health disparities and underutilization of screening methods are major concerns in the United States (US), particularly affecting Black women who experience lower survival rates and advanced diagnoses. Despite the rapid growth of the African-born immigrant population, breast health among this group in the US is notably under-examined. This study aims to investigate the breast health knowledge and practices of first-generation African-born immigrants and second-generation immigrant women of African descent, aiming to understand the distinctive attributes of this group and the impact of acculturation on this public health issue.

Methods: Interviews were conducted among First Generation African immigrants and …

Sheprep: Examining The Influence Of The Messaging And The Messenger Associated With Prep Uptake Among African American Women, Christian C. Spears

College of Graduate Studies: Theses & Dissertations

African American Women (AAW) make up less than 15% of the female population in the United States but account for over 50% of new HIV diagnoses among females. This largely preventable health disparity can be mitigated by advocating and prescribing Pre-exposure Prophylaxis (PrEP), a preventive HIV medication, to persons at risk. Despite advances in medication options, there are less than 13% of Black people who could benefit from having been prescribed PrEP, and limited research and promotion on the effectiveness of PrEP for AAW. The “ShePrEP Study” aimed to assess awareness, perceptions, and receptivity toward PrEP among AAW. This study …

Access To Hiv Prevention, Care, And Treatment Services In The Us: The Role Of Primary Care, Jessica S. Kiernan

Theses and Dissertations

This dissertation examines the role of access to primary care in benefitting HIV outcomes through increased access to HIV prevention, care, and treatment services, among populations disproportionately affected by HIV in the US. Over 30,000 individuals are newly diagnosed with HIV annually in the US and diagnoses are concentrated in specific populations. At an individual-level, ~ 70% of new diagnoses are among gay and bisexual men and of those diagnoses, 70% are among Non-Hispanic Black and Hispanic gay and bisexual men. At a community-level, over 50% of new HIV diagnoses occur in less than 2% of US counties (48), Washington, …

A Global Perspective Of Advanced Practice Nursing Research: A Review Of Systematic Reviews Protocol, Kelley Kilpatrick, Isabelle Savard, Li-Anne Audet, Abby Kra-Friedman, Reneé Atallah, Mira Jabbour, Wentao Zhou, Kathy Wheeler, Elissa Ladd, Deborah C. Gray, Colette Henderson, Lori A. Spies, Heather Mcgrath, Melanie Rogers

Ellmer School of Nursing Faculty Publications

Introduction

In 2020, the World Health Organization called for the expansion and greater recognition of all nursing roles, including advanced practice nurses (APNs), to better meet patient care needs. As defined by the International Council of Nurses (ICN), the two most common APN roles include nurse practitioners (NPs) and clinical nurse specialists (CNSs). They help ensure care to communities as well as patients and families with acute, chronic or complex conditions. Moreover, APNs support providers to deliver high quality care and improve access to services. Currently, there is much variability in the use of advanced practice nursing roles globally. A …

Containment Measures During The Covid Pandemic: The Role Of Non-Pharmaceutical Health Policies, Michael Funke, Tai-Kuang Ho, Andrew Tsang

Faculty, Staff and Student Publications

Many countries have imposed a set of non-pharmaceutical health policy interventions in an effort to slow the spread of the COVID-19 pandemic. The objective of this paper is to examine the effects of the interventions, drawing on evidence from the OECD countries. A special feature here is the mechanism that underlies the impact of the containment policies. To this end, a causal mediation analysis decomposing the total effect into a direct and an indirect effect is conducted. The key finding is a dual cause-effect channel. On the one hand, there is a direct effect of the non-pharmaceutical interventions on the …

Effects Of Insurance Coverage On Healthcare Access And Outcomes For Children In Ohio, Haley Hurst, Patrick Ruz

Scholarship in Medicine - All Papers

Objective: Despite health insurance coverage correlating to improved child health outcomes and reduced healthcare costs, it is estimated that 8.7% of children in America lack continuous insurance. Although coverage has expanded multiple times through the Children's Health Insurance Program (CHIP) initiated in 1997, rates for child insurance vary drastically across regions of the country. In this study we investigated child insurance rates over time and by state, as well as explored the effects of having insurance and child health outcomes. To do this, we measured the association of uninsured children to primary care physician access and child mortality in the …

Clustering Hospital Performance Using Group-Based Multi-Trajectory Modeling With Singular Bayesian Information Criterion, Gaixin Du

Theses and Dissertations--Epidemiology and Biostatistics

Hospital performance is complex and patient-experience oriented. Currently, the Centers for Medicare and Medicaid Services (CMS) evaluate hospitals yearly with a single score of one to five ("Star Rating") using composite measures from five domains. However, a single composite score cannot fully describe it, and alternative measures should be considered. Healthcare quality improvement needs long-term data to validate effectiveness. Group-based multi-trajectory modeling (GBMTM) estimates probabilities of latent group membership based on longitudinal profiles from multiple outcomes. We use GBMTM to identify groups of hospitals with similar performance in SAS PROC TRAJ.

We downloaded Medicare-eligible hospitals (N=5,111) that provided patient care …

Evaluating The Impact Of Mental Health Needs And Services Disruption: Covid-19 & Wisconsin Children’S Welfare Services, Gavin Rienne

Theses and Dissertations--Epidemiology and Biostatistics

Children’s traumatic experiences have lifelong impacts on their mental health and quality of life, therefore mental health services are a critical part of necessary community resources. The increased frequency and severity of natural disasters such as hurricanes, tornadoes, and pandemics reinforces the need to examine and understand the importance of mental health and child services in response to disaster events. This research assesses the relationship between disasters and subsequent health service utilization amongst children and adolescents. We investigated current research on the relationship between children’s mental health and community mental health resource efficacy and accessibility after a major disaster by …

Alternative Pharmacology: Exploring Ketamine Use For Treatment Resistant Mental Health Disorders, Kiersten L. Ash

Soaring: A Journal of Undergraduate Research

No abstract provided.

Gender Differences In Administration Of Tpa In Treatment Of Ischemic Stroke, Christina Annerino

CURE Proceedings

As medicine and pharmacology advance through the years, new life-saving treatments are studied or discovered every day, and a medical emergency is no longer a death sentence. Even with conditions as serious as ischemic stroke, there is hope for survival and rehabilitation with the ‘clot-busting’ drug, tissue plasminogen activator, colloquially known as ‘tPA’. tPA is a thrombolytic agent, a substance that acts on fibrin in clots to dissolve them so they can no longer cause ischemia in blood vessels that results in a stroke. (Vega, 2022). tPA is an extremely effective treatment for ischemic stroke, demonstrated in 2013 by a …

Still, We Thrive: Understanding How Gay, Bisexual, Transgender, And Other Men Who Have Sex With Men (Gbtmsm) Experience Structural Barriers & Facilitators To Wellness, Lucas Gergyek

Theses and Dissertations (Comprehensive)

Historically and concurrently, structural violence has been a significant force influencing the sexual health and broader health of gay, bisexual, transgender and other men who have sex with men (GBTMSM). Yet to date, the majority of projects exploring the health inequities facing GBTMSM have focused on intrapsychic and behavioural factors as most related to poor health outcomes. As well, these studies are sometimes deficits focused, and fail to evaluate how GBTMSM continue to thrive, and maintain positive health. As a result, the ways in which systems and policies underlie and perpetuate health inequities facing GBTMSM have been somewhat obscured. Connectedly, …

Effect Of Medicaid Expansion On Inflammatory Bowel Disease And Healthcare Utilization, Brittany Levy

Theses and Dissertations--Public Health (M.P.H. & Dr.P.H.)

Inflammatory bowel disease (IBD) affects over 3 million adults in America, relaying a

need for chronic disease management. Along with 24 other states, Kentucky expanded the

Medicaid program January 1, 2014. We hypothesize, Medicaid expansion adoption results in

reduced emergency healthcare services, and increased elective healthcare services with a

reduction in overall healthcare utilization by individuals in the adult IBD population.

The Hospital Inpatient Discharge and Outpatient Services Database identify encounters

related to ulcerative colitis or Crohn’s disease from 2009-2020, in Kentucky. Patient

demographics, admission type, discharge, length of stay, and hospital charges were compared.

3386 pre-expansion and 24255 post …

Modeling The Bidirectional Relationship Between Shared-Patient Physician Networks And Patient Longitudinal Treatment Patterns: Application To Physician Risky-Prescribing, Xin Ran

Dartmouth College Ph.D Dissertations

Risky-prescribing is a pressing public health concern in the United States. Opioids, benzodiazepines, and non-benzodiazepine sedative-hypnotics (sedative-hypnotics) are three commonly-prescribed but potentially risky drug groups, prescribed alone or in combination. Physician shared-patient networks provide a unique perspective in studying physician network characteristics and structures, as well as their association with the delivery of health care. Understanding how physician shared-patient networks are related to their prescribing may inform network-based interventions targeting risky-prescribing, which is yet to be fully studied.

We investigated patient receipt of risky prescriptions and physician risky-prescribing intensity through the scope of shared-patient networks. We used retrospective Medicare insurance …

The Small Intestinal Microbiome: Vibing With Intestinal Stem Cells, Victoria Poplaski, Faith Sawyer, Sarah E Blutt

Faculty, Staff and Students Publications

The epithelial lining of the small intestine mediates its absorptive and secretory function and thus is a critical component of human health. Regeneration and renewal of the epithelium is the result of proliferation of intestinal stem cells (ISCs). Many cell types and molecular factors are known to regulate the ability of ISCs to proliferate, including adjacent neighboring epithelial cells and the underlying, supportive stromal cells. The microbiome resides in the lumen of the small intestine and is in close contact with the epithelium. Due to its proximity to ISCs, it has been hypothesized that species within the microbiome have the …

Gene-Environment Interactions Underlying The Etiology Of Neural Tube Defects, Carlo Donato Caiaffa, Cristiane Sá Roriz Fonteles, Lei Yunping, Richard H Finnell

Faculty, Staff and Students Publications

Neural tube defects (NTDs) consist of severe structural malformations of the brain and spinal cord and are the second most common structural birth defect in humans, accounting for approximately 2700 affected pregnancies every year in the United States. These numbers are highly significant, considering that birth defects remain a leading cause of infant mortality in the United States, affecting approximately 120,000 babies born annually. Survivors of these congenital malformations face long-term disability and lifelong challenges imposed by severe physical burdens compromising the afflicted individual's overall quality of life. Clearly, birth defects, and especially NTDs remain a global public health challenge, …

Perspective: Developing Future Veterans Affairs Scientists Through A Diversity, Equity, And Inclusion Program, Darius B Dawson, Valerie Lewis, Terri L Fletcher, Robert Hal Scofield

Faculty, Staff and Students Publications

For >95 years, the Department of Veterans Affairs Office of Research and Development (ORD) has been improving the lives of Veterans and all Americans through health care discovery and innovation. Scientists and trainees from diverse backgrounds and life experiences bring different perspectives and creativity to address complex health-related problems, which helps to foster scientific innovation, improve quality of research, and advance the likelihood that underserved populations participate in and benefit from clinical and health services research. In this study, we will discuss our experiences in developing future scientists through mentored research supplements supported by ORD.

Expanding Access To Evidence-Based Psychotherapy In Va Settings: Implementation Of The Brief Cognitive Behavioral Therapy For Depression Program, Joseph Mignogna, Derrecka Boykin, Raquel D Gonzalez, Andrew Robinson, Darrell Zeno, Shubhada Sansgiry, Jennifer Broderick-Mcdaniel, Richard B Roberson, Kristen Sorocco, Jeffrey A Cully

Faculty, Staff and Students Publications

Introduction: Evidence-based psychotherapies (EBPs) are effective for mental health conditions, but access to these services remains limited and rural Veterans are particularly underserved. Specialized implementation and dissemination programs are needed to improve access to known EBPs.

Methods: The current project sought to improve access to a known EBP-brief Cognitive Behavioral Therapy for depression (Brief CBT). Diverse Veterans and those from rural settings were a focus of this work. Aligned with the RE-AIM framework, a multifaceted implementation program was used to train and support VHA providers in their use of Brief CBT in VHA mental health settings, with specific outreach efforts …

Crossing The Decarbonization Chasm: A Call To Action For Hospital And Health System Leaders To Reduce Their Greenhouse Gas Emissions, Hardeep Singh, Walt Vernon, Terri Scannell, Kathy Gerwig

Faculty, Staff and Students Publications

No abstract provided.

A Pregnant Patient Presents With Leakage Of Vaginal Fluid In The Second Trimester, Alison N Goulding, Jennifer R Mckinney, Diana Crabtree Sokol, Anitra D Beasley

Faculty, Staff and Students Publications

Morning Report is a time-honored tradition where physicians-in-training present cases to their colleagues and clinical experts to collaboratively examine an interesting patient presentation. The Morning Report section seeks to carry on this tradition by presenting a patient’s chief concern and story, inviting the reader to develop a differential diagnosis and discover the diagnosis alongside the authors of the case.

This report examines the story of a 43-year-old (gravida 3, para 2) woman who sought evaluation for leakage of vaginal fluid at 15 weeks of gestation. Using questions, physical examination, and testing, an illness script for the presentation emerges. As her …

Effectiveness Of Elbasvir/Grazoprevir Plus Ribavirin For Hepatitis C Virus Genotype 1a Infection And Baseline Ns5a Resistance, Deanna D Hill, Jennifer R Kramer, Kassie R Chaffin, T Christopher Mast, Michael N Robertson, Fasiha Kanwal, Barbara A Haber

Faculty, Staff and Students Publications

Introduction and objectives: In clinical trials, patients with hepatitis C virus (HCV) genotype (GT)1a infection and baseline resistance-associated substitutions (RASs) at amino acid positions 28, 30, 31, or 93 receiving elbasvir/grazoprevir for 12 weeks achieved lower rates of sustained virologic response (SVR) than those without baseline RASs. SVR rates in patients with RASs were improved when elbasvir/grazoprevir treatment duration was extended from 12 to 16 weeks and administered concomitantly with ribavirin.

Materials and methods: This was a retrospective, observational analysis using electronic health record abstraction. Patients with HCV GT1a infection and RASs at positions 28, 30, 31, or 93 who …

The Effect Of A Plasma Next-Generation Sequencing Test On Antimicrobial Management In Immunocompetent And Immunocompromised Patients-A Single-Center Retrospective Study, Denise Marie A Francisco, Laila Woc-Colburn, Travis J Carlson, Todd Lasco, Miriam Barrett, Mayar Al Mohajer

Faculty, Staff and Students Publications

Objective: To describe the use of next-generation sequencing (NGS) and to determine whether NGS leads to changes in antimicrobial management.

Design and setting: This retrospective cohort study included patients aged ≥18 years admitted to a single tertiary-care center in Houston, Texas, with an NGS test performed between January 1, 2017, and December 31, 2018.

Patients: In total, 167 NGS tests were performed. Most patients were of non-Hispanic ethnicity (n = 129), white (n = 106), and male (n = 116), with a mean age of 52 years (SD, 16). Moreover, 61 patients were immunocompromised: solid-organ transplant (n = 30), patients …

Innate Immune Cell Dysfunction And Systemic Inflammation In Children With Chronic Liver Diseases Undergoing Transplantation, Krupa R Mysore, Sunil Kannanganat, Jeremy M Schraw, Philip J Lupo, John A Goss, Kenneth D R Setchell, Farrah Kheradmand, Xian C Li, Benjamin L Shneider

Faculty, Staff and Students Publications

Advanced liver diseases (ALD) can affect immune function and compromise host defense against infections. In this study, we examined the phenotypic and functional alterations in circulating monocyte and dendritic cells (DCs) in children with ALD undergoing liver transplantation (LT). Children were stratified into 2 clusters, C1 (mild) and C2 (severe), on the basis of laboratory parameters of ALD and compared with healthy pediatric controls. Children in C2 had a significant reduction in frequencies of nonclassical monocytes and myeloid DCs. Children in C2 displayed monocyte and DC dysfunction, characterized by lower human leucocyte antigen DR expression and reduced interleukin 12 production, …