Health Policy Commons^™

Ambulance Deserts: Geographic Disparities In The Provision Of Ambulance Services [Chartbook], Yvonne Jonk Phd, Carly Milkowski Mph, Zachariah Croll Mph, Karen Pearson Mlis, Ma

Emergency Medical Services (EMS)

This chartbook begins with a broad overview of ambulance services including common types of organizational structure(s) and workforce and reimbursement issues. The methods section provides our definition of ambulance deserts and describes how ambulance deserts are illustrated in the national and state maps. The results section begins with an overall description of the prevalence of ambulance deserts in rural and urban counties across the 41 states for which data were available at the time, and the variation in the percent of people living in ambulance deserts across the four census regions. States are ranked in terms of the percent of …

Western Maine Addiction And Recovery Initiative's Substance Misuse Prevention And Wellness Day: Year 1 Feedback Survey For Ohchs And Telstar, Tyler Egeland Ba, Evelyn Ali Bs, Mary Lindsey Smith Phd

Substance Use Research & Evaluation

As part of the evaluation of the Western Maine Addiction Recovery Initiative’s (WMARI) HRSA Rural Communities Opioid Response Program grant, staff from the Catherine Cutler Institute developed a survey to gather feedback from individuals who participated in the SUD Day events. Two separate PRE/POST surveys were deployed at each high school (OHCHS and Telstar) to assess knowledge gain, beliefs, and satisfaction. For more information, please contact Lindsey Smith at [email protected]

Attitudes Towards Gluten Free Foods And Celiac Disease In Italy, Joellyn Speredelozzi

Senior Honors Projects

This project addresses the perception and realities of living with Celiac’s Disease in Italy. I combine a literature review with my own anecdotal experiences as an individual with Celiac’s Disease who has lived and studied in Italy. In my paper, I first describe the high awareness of gluten-free living that I noted the first time I studied abroad, being the impetus of this project. I follow this with the history and science of Celiac’s Disease for those who may be unaware of this serious chronic medical condition. I then continue to describe personal experiences I had while living in Naples, …

National Cancer Control Plan Of The Korea: Current Status And The Fourth Plan (2021-2025), Kyu-Tae Han, Jae Kwan Jun, Jeong-Soo Im

Faculty, Staff and Student Publications

Cancer management has become a major policy goal for the government of the Korea. As such, the government introduced the National Cancer Control Plan (NCCP) to reduce the individual and social burdens caused by cancer and to promote national health. During the past 25 years, 3 phases of the NCCP have been completed. During this time, the NCCP has changed significantly in all aspects of cancer control from prevention to survival. The targets for cancer control are increasing, and although some blind spots remain, new demands are emerging. The government initiated the fourth NCCP in March 2021, with the vision …

Ethical Hazards Of Health Data Governance In The Metaverse, Kristin Kostick-Quenet, Vasiliki Rahimzadeh

Center for Medical Ethics and Health Policy Staff Publications

Metaverse-enabled healthcare is no longer hypothetical. Developers must now contend with ethical, legal and social hazards if they are to overcome the systematic inefficiencies and inequities that exist for patients who seek care in the real world.

A Concept Analysis Of The Patient Experience, Tanja Avlijas Rn, Mscn, Janet E. Squires Rn, Phd, Michelle Lalonde Rn, Phd, Chantal Backman Rn, Phd

Patient Experience Journal

Patient experience, an essential indicator of quality patient care, is of increasing importance to hospitals that want to improve and maintain strong patient experience metrics to remain competitive in the business of healthcare. The aim of this study was to clarify the concept of the patient experience by identifying its existing definitions, methods of measurement, and underlying themes and attributes, to differentiate it from similar concepts and propose an operational and theoretical definition to guide valid and reliable development of future assessment tools. Walker and Avant’s eight-step methodology served as the framework for this concept analysis. A literature search, using …

The Effects Of Multiple Micronutrient Fortified Beverage And Responsive Caregiving Interventions On Early Childhood Development, Hemoglobin, And Ferritin Among Infants In Rural Guatemala, Alysse J. Kowalski, Victor Alfonso Mayen, Silvia De Ponce, Kaley B. Lambden, Nick Tilton, Lisa M. Villanueva, Ana M. Palacios, Greg A. Reinhart, Kristen M. Hurley, Maureen M. Black

Health Policy & Community Health: Faculty Publications

Undernutrition and a lack of learning opportunities can jeopardize long-term growth and development among infants in low- and middle-income countries. We conducted a 6-month 2 × 2 cluster-randomized trial to assess the effects of multiple micronutrient-fortified beverages and responsive caregiving interventions among infants 6–18 months in 72 community sectors in southwest Guatemala. We administered baseline and endline assessments of childhood development (Bayley Scales of Infant and Toddler Development) and socioemotional development (Brief Infant Toddler Socio-Emotional Assessment) and measured ferritin and hemoglobin on a subsample. The trial was analyzed using linear mixed models. At the baseline, the mean age (SD) was …

Framing The Family: A Qualitative Exploration Of Factors That Shape Family-Level Experience Of Pediatric Genomic Sequencing, Hadley Stevens Smith, Emily S Bonkowski, Madison R Hickingbotham, Raymond Belanger Deloge, Stacey Pereira

Center for Medical Ethics and Health Policy Staff Publications

Families of children with rare and undiagnosed conditions face many psychosocial and logistical challenges that may affect their approach to decisions about their child’s care and their family’s well-being. As genomic sequencing (GS) is increasingly incorporated into pediatric diagnostic workups, assessing the family-level characteristics that shape the experience of pediatric GS is crucial to understanding how families approach decision-making about the test and how they incorporate the results into their family life. We conducted semi-structured interviews with parents and other primary caregivers of pediatric patients who were evaluated for a suspected genetic condition and who were recommended to have GS …

Framing The Family: A Qualitative Exploration Of Factors That Shape Family-Level Experience Of Pediatric Genomic Sequencing, Hadley Stevens Smith, Emily S Bonkowski, Madison R Hickingbotham, Raymond Belanger Deloge, Stacey Pereira

Center for Medical Ethics and Health Policy Staff Publications

Families of children with rare and undiagnosed conditions face many psychosocial and logistical challenges that may affect their approach to decisions about their child’s care and their family’s well-being. As genomic sequencing (GS) is increasingly incorporated into pediatric diagnostic workups, assessing the family-level characteristics that shape the experience of pediatric GS is crucial to understanding how families approach decision-making about the test and how they incorporate the results into their family life. We conducted semi-structured interviews with parents and other primary caregivers of pediatric patients who were evaluated for a suspected genetic condition and who were recommended to have GS …

Comparing Levels Of Situational Empathy Based On Medium Of Exposure To Covid-19 Mortality Information And Proximity To Others, Beth Durkin

Honors Projects

In response to the COVID-19 pandemic, many people expressed a lax attitude to the policies put in place to keep the public safe despite the high risk of infection and its devastating effects on health across the United States. It is possible that this response may be partially due to a “numbness to numbers,” a phenomenon that describes diminished empathy for a large group of people experiencing a negative event (eg. COVID-19). The present study explored the relationship between levels of situational empathy and the medium of exposure to COVID-19 mortality information (eg. personal story or fact sheet) in an …

A Better Life: Factors That Help And Hinder Entry And Retention In Mat From The Perspective Of People In Recovery, Adam D. Baus, Martha Carter, Jennifer Boyd, Erin Mcmullen, Trey Bennett, Alexandra Persily, Danielle M. Davidov, Christa Lilly

Journal of Appalachian Health

Introduction: Opioid addiction and opioid-related overdoses and deaths are serious public health problems nationally and in West Virginia, in particular. Medication-assisted treatment (MAT) is an effective yet underutilized treatment for opioid use disorder (OUD).

Purpose: Research examining factors that help individuals succeed in MAT has been conducted from provider and program perspectives, but little research has been conducted from the perspective of those in recovery.

Methods: This study, co-developed with individuals in recovery, took place in West Virginia-based MAT programs using an exploratory sequential mixed methods approach. The survey was open February through August 2021. Data were analyzed late 2021 …

Environmental And Social Factors Associated With High Chronic Kidney Disease Mortality Rates In Municipalities Of Guatemala: An Ecological Study Of Municipal-Level Mortality Data, Alejandro Cerón

Anthropology: Faculty Scholarship

The purpose of this study was to determine the association between social and environmental indicators and high mortality rates from chronic kidney disease (CKD) in municipalities of Guatemala. An ecological study of municipal-level factors associated with CKD mortality in Guatemala was conducted. Crude mortality rates were calculated for the 2009–2019 period for each of the country’s 340 municipalities, by gender and age groups. Municipal-level social and environmental indicators were used as independent variables. Linear regression was used for bivariate and multivariate analysis. A total of 28,723 deaths from CKD were documented for the 2009–2019 period. Average crude mortality rate for …

Exploring Hapi Incidence In Patients Admitted Through The Ed: A Quality Improvement Initiative, Alexa L. Tietgens

DNP Projects

Each year in the U.S., pressure injuries, or PIs, are responsible for more than 60,000 patient deaths and billions of dollars’ worth of treatment costs. Research shows that roughly 95% of all PIs are preventable by following evidence-based practice guidelines which include early identification of patients at risk, frequent skin assessments, and implementation of prevention strategies. However, the ED environment creates unique risks for PI development due to the routine use of hard surfaces (i.e., stretchers, backboards, exam tables) and frequent hospital overcrowding. Although nurses play a pivotal role in PI prevention, frequent staffing shortages, high patient acuity levels, and …

(Un)Weighted Assumptions: Anti-Fatness & Health, Kieran Chase, Nell Carpenter, Madysen Schreiber

OHSU-PSU School of Public Health Annual Conference

This lecture/discussion session aims to expand and add nuance to public health students’, professors’, and practitioners’ understanding of the interplay between body size and health. We will begin by naming and challenging common assumptions about the relationship between bodyweight and health outcomes. We will then argue for the consideration of weight-related stigma as a Fundamental Cause of Disease as defined by Phelan and Link, and for institutionally embedded anti-fat bias at the policy level (e.g., insurance policy, medical equipment) as a cause of population health inequity as defined in Whitehead’s Health Equity Framework. We offer these frameworks in contrast to, …

Maternal Healthcare Access And Obstetric Complications: A Cause And Effect Relationship?, Lena Sharara

Independent Study Project (ISP) Collection

Poverty-stricken migrant women, named ‘Kayayei or Kayayo’ because of the nature of their job in the informal sector, have high birth rates and are said to have many barriers affecting their access to maternal health resources. In this study, Kayayei in Madina Market were interviewed and both quantitative and qualitative data were gathered to determine whether a relationship exists between access to maternal health and the obstetric complications and outcomes experienced by Kayayei. A Chi-Squared Test of Independence and a Qualitative Content Analysis were both used to analyze the data. Due to a non-significant p-value, it was found that the …

Migrants Sans Papiers: The Impact Of Cantonal Program And Policy Discrepancies On Undocumented Migrant Healthcare Utilization In Switzerland, Denise Peng

Independent Study Project (ISP) Collection

While Switzerland houses what is generally considered one of the best healthcare systems globally, regional policy discrepancies leave undocumented migrants (UDM) in precarious conditions that threaten the nation’s claim to universal health coverage. Critical analyses of existing UDM-catering structures in different cantons, the Swiss Confederation member states, reveal that local discrepancies in healthcare utilization are functional gradients of cantonal support and public endorsement. Relationships with these authorities are instrumental in steering health outcomes not only with program funding and outreach but also management of studies to better understand UDM health determinants and inform future preventative measures.

UDM services and initiatives …

Observaciones De La Medicina Mapuche Y El Mito De La Medicina Interculturalidad En Chile Con La Machi Rosita Barboza, Anat Gilligan-Steinberg

Independent Study Project (ISP) Collection

Chile cuenta con un sistema de salud intercultural, que promueve el acceso a servicios de salud culturalmente competentes para la población indígena. A través de mi pasantía con la machi Rosita Barboza, acompañándola a centros de salud, en ceremonias de sanación mapuche y ayudando en la preparación y distribución de remedios; he llegado a la conclusión de que no es más que un mito de la interculturalidad. Existe un conflicto constante entre las definiciones de salud occidental e indígena, que impiden la disponibilidad de salud complementaria. La salud occidental se basa en una definición biomédica de la salud, la cosmovisión …

Inclusión Cultural En Fonasa: Parto Aymara Como Un Estudio De Caso, Madison Singleton

Independent Study Project (ISP) Collection

Los primeros años de la década de 2000s sirven como un período legal transformador en Chile, debido al auge de los grupos de representación indígena y la introducción de la ley 20.584 que asegura un modelo de interculturalidad en los servicios de salud. El objetivo de esta investigación es comprender los factores que impactaron en la priorización de la inclusión cultural en el sistema público de salud (FONASA), utilizando el parto aymara en Arica como un estudio de caso. Esta investigación toma forma en un diseño de investigación cualitativa y exploratoria utilizando 5 entrevistas y 5 observaciones, así como las …

Medicina Tradicional En La Urbe: El Funcionamiento Del Sistema De Salud Mapuche En Santiago, Mariko Yatsuhashi

Independent Study Project (ISP) Collection

En Santiago, Chile, una ciudad con más de 5 millones de personas, el pueblo originario Mapuche ha logrado la reconstrucción de su sistema tradicional de salud para servir la comunidad urbana de la comunidad mapuche. Hoy en día, la mayoría de gente mapuche viven en ambientes urbanos debido a una migración masiva desde su territorio ancestral en el sur, que creó una población distinta de gente mapuche llamada warriache, o gente de la ciudad. Después de una expansión nacional de los derechos básicos de pueblos originarios en los años ‘90, el pueblo originario Mapuche, junto con otros pueblos originarios, podía …

International Society For Prenatal Diagnosis 2022 Debate 3-Fetal Genome Sequencing Should Be Offered To All Pregnant Patients, Ignatia B Van Den Veyver, Yuval Yaron, Zandra C Deans

Center for Medical Ethics and Health Policy Staff Publications

Prenatal trio exome sequencing (ES) has become integrated into the care for pregnant women when the fetus has structural anomalies. Details regarding optimizing indications for prenatal exome sequencing, its detection rates with different categories of fetal anomalies, and principles of interpretation of pathogenicity of sequence variants are still under investigation. However, there is now growing consensus about its benefits for finding the cause of fetal structural anomalies. What is not established, is whether exome or genome sequencing (GS) has a place in the care of all pregnant women. This report is a summary of the debate on this topic at …

Development And Pilot Testing Of Internet-Delivered, Family-Based Cognitive Behavioral Therapy For Anxiety And Obsessive-Compulsive Disorders In Autistic Youth, Andrew G Guzick, Sophie C Schneider, Amanda B Perozo Garcia, Minjee Kook, Rebecca L Greenberg, David Riddle, Morgan Mcneel, Servando Rodriguez-Barajas, Michelle Yang, Blake Upshaw, Eric A Storch

Center for Medical Ethics and Health Policy Staff Publications

Cognitive behavioral therapy adapted for autistic youth with anxiety and/or OCD has a strong evidence base, but few have access. A 12-week family-based, Internet-delivered cognitive behavioral therapy (iCBT) program for 7-15 year-old autistic youth with anxiety and/or OCD was developed as a potential method to address this problem. Quantitative and qualitative feedback from stakeholders (parents, youth, clinicians) was gathered on an initial draft of content before conducting a pilot trial. This feedback suggested high quality, engagement, usability, and informativeness of the material. Suggestions were incorporated into the treatment program that was tested in a pilot trial. Eight families were randomized …

Fixing The System: A Comparative Review Of The United Kingdom, Germany, And United States’ Healthcare Systems And Lessons Learned For Potential Improvements In The United States, Jessica Goddard

Senior Theses

In an effort to provide recommendations to the United States’ considerations of a universal healthcare system, this thesis analyzes the United States healthcare system alongside the sophisticated systems of the United Kingdom and Germany. Literature review and an analysis of 10 health outcomes and indicators guided the framework for a set of interview questions to be asked of healthcare professionals in all three countries. The interview response data was then organized and used to guide the suggested recommendations to the United States in its path towards universal healthcare. While a limited number of solutions could be provided given the time …

Girls Just Want To Be Safe: An Analysis Of Drugged Drinking And Prevention Amongst Students At The University Of South Carolina, C. Gray Forsberg

Senior Theses

Drink-spiking has become a well-known phenomenon since the turn of the century, especially on college campuses in the United States. Drink-spiking or drugging can be defined as “adding alcohol or drugs into someone’s drink without their knowledge or permission” (Alcohol and Drug Foundation, 2006). Drink-spiking is not just relevant to the concern of an illicit substance being placed into an alcoholic drink, but adding additional alcohol to drinks or adding alcohol or drugs to non-alcoholic drinks is considered drugging as well. This study collected data through a survey sent to 250 current students at the University of South Carolina regarding …

Things That Make You Go Hmm: Myths And Misconceptions Within Cognitive-Behavioral Treatment Of Obsessive-Compulsive Disorder, Samuel D Spencer, Jordan T Stiede, Andrew D Wiese, Andrew G Guzick, Matti Cervin, Dean Mckay, Eric A Storch

Center for Medical Ethics and Health Policy Staff Publications

The past four decades have yielded a robust body of evidence supporting the efficacy and effectiveness of cognitive-behavioral therapy (CBT) as a gold-standard treatment for obsessive-compulsive disorder (OCD) across the lifespan. Exposure and response prevention (E/RP) has been identified as a key component of this approach. Despite robust research support for CBT with E/RP, several myths and misconceptions continue to proliferate in both research and practice settings. Such myths and misconceptions are concerning, as they lack empirical basis, may hinder widespread dissemination and implementation of CBT for OCD, and run contrary to the practice of evidence-based psychological medicine. Focusing on …

Key Drivers Of Family-Level Utility Of Pediatric Genomic Sequencing: A Qualitative Analysis To Support Preference Research, Hadley Stevens Smith, Emily S Bonkowski, Raymond Belanger Deloge, Amanda M Gutierrez, Alva M Recinos, Tara A Lavelle, David L Veenstra, Amy L Mcguire, Stacey Pereira

Center for Medical Ethics and Health Policy Staff Publications

Given that pediatric genomic sequencing (GS) may have implications for the health and well-being of both the child and family, a clearer understanding of the key drivers of the utility of GS from the family perspective is needed. The purpose of this study is to explore what is important to caregivers of pediatric patients regarding clinical GS, with a focus on family-level considerations. We conducted semi-structured interviews with caregivers (n = 41) of pediatric patients who had been recommended for or completed GS that explored the scope of factors caregivers considered when deciding whether to pursue GS for their child. …

Are Human Papillomavirus Knowledge And Vaccine Uptake Associated With Hiv Status And Social Determinants Of Health In Young Sexual Minority Men?, Trisha L Amboree, Alan G Nyitray, John Schneider, Nick Gargurevich, Jacky Kuo, Elizabeth Y Chiao, Lu-Yu Hwang, Kayo Fujimoto

Center for Medical Ethics and Health Policy Staff Publications

This brief report examines the relationship, if any, between human immunodeficiency virus (HIV) status, and individual-level and socio-sexual partner-level factors of social determinants of health (SDOH) that are associated with human papillomavirus (HPV) knowledge and vaccine uptake in young sexual minority men (YSMM). We used data from 126 YSMM recruited by network-based sampling during 2015-2016 in Houston, Texas. Descriptive statistics and regression analyses were conducted to test the association between HIV status, SDOH, and HPV knowledge and vaccine uptake. Those living with HIV had lower odds of knowledge of HPV-associated anal cancer (OR: 0.43, 95% CI: 0.18-0.97) and knowledge of …

Physician Workforce In The Mountain West, Hira Ahmed, Caitlin J. Saladino, William E. Brown Jr.

Health

Using data from the Association of American Medical College’s State Physician Workforce Data Report, this fact sheet synthesizes Mountain West data on the numbers of active physicians and active physician demographics in Arizona, Colorado, Nevada, New Mexico, and Utah. This fact sheet focuses on active physicians in the Mountain West region by gender, race and ethnicity, as well as the number of students pursuing medical and premedical education.

Rural Working-Age Adults Report More Cost Barriers To Health Care, Erika C. Ziller Phd, Carly Milkowski Mph, Amanda Burgess Mppm, Mph

Access / Insurance

Using the 2019-2020 National Health Insurance Survey, researchers at the Maine Rural Health Research Center examined rural-urban differences in affordability of care and cost-saving strategies among working-age adults. Rural adults (18-64) were more likely than their urban counterparts to report problems paying, or being unable to pay, their medical bills. They were also more likely to delay or go without needed care because of the cost. Compared with urban adults, those in rural areas were more likely to engage in prescription drug cost-saving measures such as skipping doses, delaying refills, or taking less medication than prescribed. For all affordability measures, …

Congenital Lobar Overinflation, Dr Sudha Kiran Das Dr, Vikram Patil Dr

Radiology Teaching Files

1 year old girl with history of recurrent respiratory infections associated with wheeze.

Gender And Financial Implications Of Parental Leave Utilization At A Major Us Academic Institution, Maurgan Lee, Lucki Word, Mayra Shafique, Julie Crego, Leah Robinson Phd, Anil Aranha Phd, Beena Sood

Medical Student Research Symposium

Background and Purpose: In the United States, women on average are paid $0.83 for every dollar earned by male counterparts. Creating a family can promote heightened obligations for both parents, however, women tend to take on amplified responsibility associated with childrearing. Studies show females are more likely to utilize parental leave (PL) compared to men. Our study aims to evaluate the impact of PL usage on financial and earning potential based on gender.

Methods: Analysis of retrospective human resources data of WSU employees was conducted. Data parameters included: demographics, length, usage, and number of parental leaves. Data was analyzed using …