Health Policy Commons^™

Development Of A Web-Based Diabetes Prevention Program (Dpp) For Chinese Americans: A Formative Evaluation Approach, Ming-Chin Yeh, Wincy Lau, Zoey Gong, Margrethe Horlyck-Romanovsky, Ho-Jui Tung, Lin Zhu, Grace X. Ma, Judith Wylie-Rosett

Health Policy & Community Health: Faculty Publications

Increasing evidence demonstrates that an online Diabetes Prevention Program (DPP) can delay the onset of type 2 diabetes. However, little has been done for Chinese Americans. This study, using Community-Based Participatory Research and Intervention Mapping approaches, describes a formative research process in the development of a culturally and linguistically tailored online DPP program among Chinese Americans with prediabetes living in New York City. Using a triangulation approach, data were collected to inform the development of an online DPP curriculum through (1) a literature review, (2) three focus groups (n = 24), and (3) a community advisory board meeting among 10 …

Ai In The Hands Of Imperfect Users, Kristin M Kostick-Quenet, Sara Gerke

Center for Medical Ethics and Health Policy Staff Publications

As the use of artificial intelligence and machine learning (AI/ML) continues to expand in healthcare, much attention has been given to mitigating bias in algorithms to ensure they are employed fairly and transparently. Less attention has fallen to addressing potential bias among AI/ML's human users or factors that influence user reliance. We argue for a systematic approach to identifying the existence and impacts of user biases while using AI/ML tools and call for the development of embedded interface design features, drawing on insights from decision science and behavioral economics, to nudge users towards more critical and reflective decision making using …

Covid-19 Vaccines: The Imperfect Instruments Of Vaccine Diplomacy, Peter J Hotez

Center for Medical Ethics and Health Policy Staff Publications

Although true vaccine diplomacy in the form of sharing vaccine development technologies and scientific cooperation with low- and middle-income countries has not been a dominant theme in the COVID-19 pandemic, this aspect is now taking off and generating some exciting new possibilities.

Association Of Gulf War Illness With Characteristics In Deployed Vs Non-Deployed Gulf War Era Veterans In The Cooperative Studies Program 2006/Million Veteran Program 029 Cohort: A Cross-Sectional Analysis, Linh M Duong, Alice B S Nono Djotsa, Jacqueline Vahey, Lea Steele, Rachel Quaden, Kelly M Harrington, Sarah T Ahmed, Renato Polimanti, Elani Streja, John Michael Gaziano, John Concato, Hongyu Zhao, Krishnan Radhakrishnan, Elizabeth R Hauser, Drew A Helmer, Mihaela Aslan, Elizabeth J Gifford

Center for Medical Ethics and Health Policy Staff Publications

Gulf War Illness (GWI), a chronic multisymptom illness with a complex and uncertain etiology and pathophysiology, is highly prevalent among veterans deployed to the 1990-1991 GW. We examined how GWI phenotypes varied by demographic and military characteristics among GW-era veterans. Data were from the VA's Cooperative Studies Program 2006/Million Veteran Program (MVP) 029 cohort, Genomics of GWI. From June 2018 to March 2019, 109,976 MVP enrollees (out of a total of over 676,000) were contacted to participate in the 1990-1991 GW-era Survey. Of 109,976 eligible participants, 45,169 (41.1%) responded to the 2018-2019 survey, 35,902 respondents met study inclusion criteria, 13,107 …

A Community-Led Central Kitchen Model For School Feeding Programs In The Philippines: Learnings For Multisectoral Action For Health, Vanessa T. Siy Van, Carmina P. Siguin, Andrew C. Lacsina, Lean Franzl Yao, Zarah G. Sales, Normahitta P. Gordoncillo, Leslie Advincula-Lopez, Joselito T. Sescon, Eden Delight Miro

Health Sciences Faculty Publications

In devolved governments like the Philippines, local government units (LGUs) must be engaged to develop and coordinate responses to tackle the multisectoral problem of childhood undernutrition. However, current Philippine nutrition interventions, such as decentralized school feeding programs (SFPs), generally rely on the national government, public school teachers, or the private sector for implementation, with mixed results. The central kitchen model for SFPs was developed by 2 Philippine nongovernmental organizations and facilitated large-scale in-school feeding through community multisectoral action. This case study documented coordination processes in February 2018 for 1 urban city and 1 rural province-the model's earliest large-scale implementation sites-that …

Factors Associated With A Diagnosis Of Sarcoidosis Among Us Veterans Of Iraq And Afghanistan, Nisha Jani, Israel C Christie, Tianshi David Wu, Daniel E Guzman, Jaehwan Han, Bryan Broderick, Michael J Falvo, Anays Sotolongo, Omowunmi Y Osinubi, Drew A Helmer

Center for Medical Ethics and Health Policy Staff Publications

This study evaluated risk factors of sarcoidosis among Airborne Hazards and Open Burn Pit Registry (AHOBPR) participants using a retrospective age and sex-matched case-control design of AHOBPR participants deployed to Afghanistan or Southwest Asia with and without sarcoidosis diagnosed in the Veterans Health Administration (VHA). Logistic regression models tested for associations between sarcoidosis and self-reported cumulative deployment-related exposures. 661 Veterans (0.37%) were diagnosed with sarcoidosis in VHA. Logistic regression demonstrated lower odds of sarcoidosis in Hispanic participants (OR 0.08, CI 0.04-0.15) and those who served in the Navy (OR 0.40, CI 0.21-0.72). African American veterans (OR 2.27, CI 1.66-3.11) and …

Improving Access For Medicare Inpatient Psychiatric Patients: A Health Policy Analysis, Malinda B. Whitfield

Doctors of Nursing Practice (DNP) Final Projects, 2020-current

The Medicare Inpatient Psychiatric Services (IPS) policy, originally developed in the 1960s and without any significant or meaningful updates since the 1980’s, is physician specific, does not reflect the current model of care for psychiatric inpatients, and is restrictive for psychiatric mental health nurse practitioner (PMHNP) practice. The policy is complex, consists of outdated regulations, and results in millions of dollars in compliance costs for Inpatient Psychiatric Facilities (IPFs) annually (NABH, 2019). Although clearly an important part of the inpatient psychiatric services team, PMHNPs are not identified or defined in the policy (Center for Medicare and Medicaid Services [CMS], 2019). …

Births In The Mountain West, 2016-2020, Corryn Richardson, Hira Ahmed, Caitlin J. Saladino, William E. Brown Jr.

Health

This fact sheet examines state-level data on births and health indicators from the National Center for Health Statistics (NCHS), a government health statistics unit of the Center for Disease Control and Prevention (CDC). This fact sheet presents data related to births in the Mountain West states of Arizona, Colorado, New Mexico, Nevada, and Utah.

Healthfulness Of Fast-Food And Full-Service Restaurants In 16 Georgia Counties After Mandatory Menu Labeling, Janani Rajbhandari-Thapa, Donglan Zhang, Nicole Katapodis, Dana Alvin, Melanie Andrews

Journal of the Georgia Public Health Association

Background: Despite that the effect of menu labeling on consumer choices has been studied, there are gaps in the research on the healthfulness of the restaurant food environment post-mandatory menu labeling, specifically in the Southern United States. This study aims to assess the healthfulness of fast-food and full-service chain restaurant environments after compliance with mandatory menu labeling.

Methods: The healthfulness of 46 representative fast-food and full-service chain restaurants in 16 Georgia counties was examined using the Nutritional Environment Measures in Restaurants (NEMS-R) survey. The scores were compared between full-service and fast-food restaurants using t-tests across several healthfulness measures such as …

Depaul Digest

DePaul Magazine

Marquee - Peace Team: Daniel Schober and Chicago-area graduate students collaborate with community partners to understand and reduce gun violence; Memoranda: Alumni & Family Weekend 2022; Milestones: DePaul news briefs; In Memoriam: Trustee John L. Brennan (1962-2022); Master Class: How to make a festive eggnog

Salus Populi: Educating Judges On The Social Determinants Of Health, Faith Khalik, Alisa Lincoln

Journal of Legal Education

No abstract provided.

Rural Health Action Network Enhanced Outreach Initiative. Year One Final Report, Mary Lindsey Smith Phd, Karen Pearson Mlis, Ma, Evelyn Ali Bs

Substance Use Research & Evaluation

Healthy Community Coalition (HCC), in coordination with the Rural Health Action Network (RHAN) of greater Franklin County, is implementing a multi-faceted outreach program to improve health outcomes among the rural poor living with chronic conditions in greater Franklin County, Maine.

The goals of the Franklin County Rural Health Action Network Enhanced Outreach Initiative (RHAN-EOI) include:

• Expand access to quality services;
• Expand training for community health extenders;
• Decrease hospital admissions, emergency department use, and costs; and
• Improve communication and care coordination across project partners

This report highlights the implementation and progress of HCC RHAN in Year 1. For more information, please …

Healthy Acadia Downeast Community Opioid Response Program: Year 1 Summary, Mary Lindsey Smith Phd, Evelyn Ali Bs, Tyler Egeland Ba, Katie Rosingana Ba

Substance Use Research & Evaluation

The Downeast Substance Treatment Network is a group of diverse organizations working to improve integration and access to treatments and services for people with substance use disorder. The consortium’s Rural Communities Opioid Response Program grant project aims to: (1) expand the reach of their treatment network, (2) increase awareness and practice of harm reduction, and (3) facilitate transitions of care to improve partner efficacy. This project included a mixed-methods evaluation led by Catherine E. Cutler Institute’s Substance Use Research and Evaluation Team (SURE). This year 1 summary presentation includes feedback from program partners and key informants, in addition to HRSA-required …

Medication Assisted Treatment: Prescription Drug And Opioid Addiction Expansion Project, Mary Lindsey Smith Phd, Katharine Knight Mph, Mark Richards Bs, Tyler Egeland Ba, Evelyn Ali Bs

Substance Use Research & Evaluation

Greater Portland Health (GPH) in collaboration with Preble Street Resource Center was awarded a Medication Assisted Treatment: Prescription Drug & Opioid Addiction (MOUD-PDOA) grant from SAMHSA. The GPH MOUD-PDOA project will include a mixed-methods evaluation led by Catherine E. Cutler Institute. The evaluation team will build knowledge and provide feedback to inform the implementation and refinement of the GPH MOUD-PDOA Program.

Evaluation Goals:

• Document program strategies and identify barriers and facilitators to implementation
• Examine the efficacy of using a continuum of treatment services to increase access to MOUD among vulnerable populations in underserved communities
• Assess the impact of the intervention …

Nursing Abroad: A Comparison Of Healthcare In Italy, Sweden, And The Us, Sadie Stark

The Eleanor Mann School of Nursing Undergraduate Honors Theses

No healthcare system is perfect, nor does one system work for all populations. History and culture have dictated the mindset of people for generations. It is the ever-changing mindset of patients and providers that will continue to expand and improve international healthcare by first changing daily practices. Nursing in Italy, Sweden, and the United States look very similar but also have a number of differences. Each country’s healthcare system works for its population, but efforts for international collaboration could still prove beneficial. Whether it be universal or private, centralized or localized, a patient centered focus is the driving force behind …

Staff Matters: What Will Be The Impact Of Changes To Michigan’S New Paid Sick Leave Law?, Jodi Schafer Sphr, Shrm-Scp

The Journal of the Michigan Dental Association

Michigan's paid sick leave law has seen several changes in recent years, and the latest updates, if upheld, will go into effect in February 2023. The original ballot-initiated law requires most employers to provide paid sick leave to employees. Employers need to be proactive in understanding the potential impact of these changes, including accrual rates, usage limits, notice requirements, and supporting documentation. It's crucial to review current leave policies and prepare for compliance if the law takes effect.

Headquarters Report: Mda Strategic Plan: In The Rear View Mirror And Around The Curve, Karen Burgess Cae

The Journal of the Michigan Dental Association

The Association Executive Director's year-end report discusses the accomplishments and challenges of the MDA's 2021-25 Strategic Plan. Member value remains high, as indicated by a Net Promoter Score of 43 and positive feedback on benefits like TDSC.com. However, younger practitioners are less engaged due to pandemic-related challenges. Member engagement saw a successful in-person Annual Session and increased online engagement. Organizational sustainability remains strong, but efforts are focused on maintaining membership participation. Diversity, equity, and inclusion initiatives, including a collaborative website, made significant progress. Advocacy efforts resulted in Medicaid reform and defeating restrictive bills. The report concludes by emphasizing the evolving …

Dentistry And The Law: Employee Vs. Independent Contractor, Dan Schulte Jd

The Journal of the Michigan Dental Association

This month’s Dentistry and the Law column discusses hiring a dentist as an employee or an independent contractor. Employing a dentist as an independent contractor offers advantages such as avoiding compliance with various employment laws and not having to withhold taxes. However, there is uncertainty regarding whether tax and other authorities will recognize the independent contractor relationship. Factors like supervision and control play a significant role in this determination. To mitigate uncertainty, practices can contract with an entity owned by the dentist, providing a potential solution. Legal counsel is recommended for setting up such arrangements.

Lack Of Consensus Among Healthcare Professionals At A Large Academic Medical Center On The Use Of Exome Sequencing For Prenatal Diagnosis, Kylie Johnson, Hadi Erfani, Mohamad Ali Maktabi, Ignatia Van Den Veyver, Salma Nassef

Center for Medical Ethics and Health Policy Staff Publications

Prenatal exome sequencing (ES) is increasingly used for prenatal diagnosis because emerging data indicate it has incremental diagnostic benefit in pregnancies with fetal anomalies without identified genetic abnormalities by karyotyping and chromosomal microarray analysis. The aim of this study was to evaluate the medical community's attitude toward the clinical utility and use of exome sequencing for prenatal diagnosis and to address differences in attitudes and responses by type of practitioner, level of training, and years passed since last full-time training. We analyzed the answers of 109 trainees and professionals in the fields of genetic counseling, laboratory science, and medicine to …

Prenatal Phenotyping Of Fetal Tubulinopathies: A Multicenter Retrospective Case Series, Bobby K Brar, Marisa Gilstrop Thompson, Neeta L Vora, Kelly Gilmore, Karin Blakemore, Kristen A Miller, Jessica Giordano, Andreas Dufke, Beatrix Wong, Samantha Stover, Billie Lianoglou, Ignatia Van Den Veyver, Esther Dempsey, Mara Rosner, Karen Chong, David Chitayat, Teresa N Sparks, Mary E Norton, Ronald Wapner, Kristin Baranano, Angie C Jelin, Fetal Sequencing Consortium

Center for Medical Ethics and Health Policy Staff Publications

Objective: Tubulinopathies refer to conditions caused by genetic variants in isotypes of tubulin resulting in defective neuronal migration. Historically, diagnosis was primarily via postnatal imaging. Our objective was to establish the prenatal phenotype/genotype correlations of tubulinopathies identified by fetal imaging.

Methods: A large, multicenter retrospective case series was performed across nine institutions in the Fetal Sequencing Consortium. Demographics, fetal imaging reports, genetic screening and diagnostic testing results, delivery reports, and neonatal imaging reports were extracted for pregnancies with a confirmed molecular diagnosis of a tubulinopathy.

Results: Nineteen pregnancies with a fetal tubulinopathy were identified. The most common prenatal imaging findings …

Incidence Of An Insulin-Requiring Hyperglycemic Syndrome In Sars-Cov-2-Infected Young Individuals: Is It Type 1 Diabetes?, Massimo Pietropaolo, Peter Hotez, Nick Giannoukakis

Center for Medical Ethics and Health Policy Staff Publications

Pancreatic ACE2 receptor expression, together with increased prevalence of insulin-requiring hyperglycemia in patients with coronavirus disease 2019 (COVID-19), suggested that severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pancreatic infection might trigger a β-cell-selective inflammation precipitating autoimmune type 1 diabetes (T1D). We examined T1D incidence in patients with COVID-19 inside a large, global population using a "big data" approach. The incidence in 0-30-year-old patients with confirmed COVID-19 over an ∼15-month period from the beginning of the COVID-19 pandemic was compared with an age-matched population without COVID-19 inside the TriNetX COVID-19 Research Network (>80 million deidentified patient electronic medical records globally). …

Germline Genetic And Treatment-Related Risk Factors For Diabetes Mellitus In Survivors Of Childhood Cancer: A Report From The Childhood Cancer Survivor Study And St Jude Lifetime Cohorts, Melissa A Richard, Sogol Mostoufi-Moab, Nisha Rathore, Jessica Baedke, Austin L Brown, Stephen J Chanock, Danielle N Friedman, M Monica Gramatges, Rebecca M Howell, Kala Y Kamdar, Wendy M Leisenring, Lillian R Meacham, Lindsay M Morton, Kevin Oeffinger, Leslie L Robison, Yadav Sapkota, Charles A Sklar, Gregory T Armstrong, Smita Bhatia, Philip J Lupo

Center for Medical Ethics and Health Policy Staff Publications

Purpose: To characterize germline genetic risk factors of diabetes mellitus among long-term survivors of childhood cancer.

Methods: Adult survivors of childhood cancer from the Childhood Cancer Survivor Study (CCSS) Original Cohort (n = 5,083; 383 with diabetes) were used to conduct a discovery genome-wide association study. Replication was performed using the CCSS Expansion (n = 2,588; 40 with diabetes) and the St Jude Lifetime (SJLIFE; n = 3,351; 208 with diabetes) cohorts. Risk prediction models, stratified on exposure to abdominal radiation, were calculated using logistic regression including attained age, sex and body mass index, diagnosis, alkylating chemotherapy, age at cancer …

Malnutrition Vaccines For An Imminent Global Food Catastrophe, Peter J Hotez

Center for Medical Ethics and Health Policy Staff Publications

Together with climate change, both the geopolitical events in Ukraine and social disruptions in supply chains from the COVID-19 pandemic could produce global food shortages or even mass starvation events. Promising new interventions include vaccines to prevent infectious causes of malnutrition or infections disproportionately causing death among the malnourished.

Clinical And Demographic Factors Contributing To Asparaginase-Associated Toxicities In Children With Acute Lymphoblastic Leukemia, Priyadarshani Dharia, Michael D Swartz, M Brooke Bernhardt, Han Chen, M Monica Gramatges, Philip J Lupo, Austin L Brown, Michael E Scheurer

Center for Medical Ethics and Health Policy Staff Publications

A total of 548 patients (age range: 1-22 years, 60.4% Hispanic, 55.8% male) diagnosed with acute lymphoblastic leukemia were reviewed for pegaspargase-associated hypersensitivity (14.8%), hyperbilirubinemia (9.7%), venous thromboembolism (VTE, 9.7%), and pancreatitis (5.3%). Odds ratios (OR) and 95% confidence intervals (CI) evaluated associations between clinical factors and each toxicity, cumulative number of toxicities, and toxicity clusters identified using k-mode analysis. Most (68.9%) did not experience any toxicity, 24.6% experienced one toxicity, and 6.3% two or more. Age >10 years was associated with hyperbilirubinemia (OR = 3.83; 95% CI: 1.64-8.95), pancreatitis (OR = 3.72; 95% CI: 1.29-10.68), VTE (OR = 4.65; …

Phase I Car-T Clinical Trials Review, Shaun Bulsara, Mengfen Wu, Tao Wang

Center for Medical Ethics and Health Policy Staff Publications

Background/aim: Chimeric antigen receptor (CAR) T cells with tumor specificity are being increasingly investigated. Phase I trials are the first step of testing for safety of novel CAR-T therapy to determine the maximum tolerated dose (MTD). Several dose escalation methods have been developed over time including rule-based, model-based, and model-assisted designs. The goal of this project is to overview the phase I designs used in current CAR-T trials.

Materials and methods: We searched PubMed for peer-reviewed literature published between January 1, 2015 and December 31, 2021. The search was limited to human studies in the English language using the keywords …

Effect Of Problem-Solving Treatment On Self-Reported Disability Among Veterans With Gulf War Illness: A Randomized Clinical Trial, Lisa M Mcandrew, Karen S Quigley, Shou-En Lu, David Litke, Joseph F Rath, Gudrun Lange, Susan L Santos, Nicole Anastasides, Beth Ann Petrakis, Lauren Greenberg, Drew A Helmer, Wilfred R Pigeon

Center for Medical Ethics and Health Policy Staff Publications

Importance: Few evidence-based treatments are available for Gulf War illness (GWI). Behavioral treatments that target factors known to maintain the disability from GWI, such as problem-solving impairment, may be beneficial. Problem-solving treatment (PST) targets problem-solving impairment and is an evidence-based treatment for other conditions.

Objective: To examine the efficacy of PST to reduce disability, problem-solving impairment, and physical symptoms in GWI.

Design, setting, and participants: This multicenter randomized clinical trial conducted in the US Department of Veterans Affairs compared PST with health education in a volunteer sample of 511 Gulf War veterans with GWI and disability (January 1, 2015, to …

Quality Of Life Of Hypertensive Patients Undergoing Chronic Disease Management Program During The Covid-19 Pandemic, Widya Astuty Lolo, Gayatri Citraningtyas, Deby Afriani Mpila, Heri Wijaya, Sandeep Poddar

Kesmas

The COVID-19 pandemic has restricted some common activities for hypertensive patients undergoing the Chronic Disease Management Program/Program Pengelolaan Penyakit Kronis in primary health care, decreasing the quality of life. This study aimed to measure the quality of life of hypertensive patients undergoing the Chronic Disease Management Program at primary health care of Manado City, North Sulawesi Province, Indonesia, during the COVID-19 pandemic and determine the factors influencing hypertension such as sex, age, education, employment status, monthly income and duration of hypertension. This cross-sectional study was carried out on 150 hypertensive patients randomly sampled at primary health care from June to …

The Potential Of Private Health Insurance Ownership Based On The 2018-2020 National Socioeconomic Survey Data, Arief Rosyid Hasan, Adang Bachtiar, Cicilya Candi

Kesmas

In 2014, the Indonesian Government introduced a social security program in the health sector. However, Indonesia’s out-of-pocket expenses remain high due to a lack of public interest in National Health Insurance services. Financing expensive health services with high out-of-pocket expenses has the potential to cause poverty. Private health insurance is considered a solution to this problem. This study aimed to determine the socioeconomic factors of private health insurance ownership and its potential in Indonesia. This study used secondary data from the 2018, 2019, and 2020 National Socioeconomic Surveys. Logistic regression analysis showed that the variables related to private health insurance …

Long-Term Care In The United States: History, Financing, And Directions For Reform, George A. (Sandy) Mackenzie

Upjohn Press

This book is a concise survey of the development of U.S. long-term care and its financing, with comparisons with other rich countries. It also includes a brief comparative account of the impact of the COVID-19 pandemic in the United States and several other countries. The study finds much that is amiss with American long-term care and proposes three sets of progressively more ambitious reforms.

Financial Well-Being Of Frontline Healthcare Workers: The Importance Of Employer Benefits, Mathieu Despard, Sophia Fox-Dichter, Haotian Zheng, Grace Anderson, Olivia Borland, Kourtney Gilbert

Social Policy Institute Research

Frontline healthcare workers – especially direct care workers (DCWs), such as home health aides, struggle due to low pay, lack of benefits, and difficult working conditions. The need for these workers is growing. Unless frontline healthcare jobs improve, positions may be difficult to fill, and care for vulnerable members of society may be compromised.

In this study, we surveyed 2,321 frontline healthcare workers and conducted in-depth interviews with 30 of these workers concerning pay, benefits, work conditions, and financial well-being. Key survey findings included:

• Only 39% of workers were eligible for at least four out of five major benefits (e.g., …