Health Policy Commons^™

A Systematic Review Of Naldemedine And Naloxegol For The Treatment Of Opioid-Induced Constipation In Cancer Patients, Ursula K Braun, Leanne K Jackson, Mary A Garcia, Syed N Imam

Center for Medical Ethics and Health Policy Staff Publications

Background: Opioid-induced constipation (OIC) is a pervasive and distressing side effect of chronic opioid therapy in patients with cancer pain, significantly impacting their quality of life. Peripherally acting μ-opioid receptor antagonists (PAMORAS) were developed for treatment-resistant OIC but most studies were conducted with non-cancer patients.

Objective: to discuss two oral formulations of PAMORAs, naldemedine and naloxegol, and to review available evidence of the effectiveness of these drugs for OIC in cancer patients.

Methods: a comprehensive search to identify primary literature for either naldemedine or naloxegol for OIC in cancer patients.

Results: Only three prospective randomized, double-blind, placebo-controlled clinical trials for …

Environmental Detection Of Parasites In The Marginalized Paiute Reservations Compared To A Nearby Area, Shannon Mckim, Kristen Kopystynsky, Nathaniel Wolf, Fahim A Akbar, Maria Elena Bottazzi, Peter J Hotez, Rojelio Mejia

Center for Medical Ethics and Health Policy Staff Publications

The amounts of parasite DNA in soil samples from different playgrounds and other public areas can help identify areas of possible microbe transmission and give indications of the possible occurrence of parasite infection in nearby communities. We collected 207 soil samples from parks in Paiute indigenous tribal areas in southwestern Utah and from the higher income city of St. George, Utah, and tested them for 11 parasites that can cause human disease. Molecular tests revealed an elevated odds ratio (OR) of 3.072 (range, 1.114-8.065) for detecting the helminth Trichuris trichiura and an elevated OR of 3.036 (range, 1.101-7.966) for any …

Pornography: Social, Emotional And Mental Implications Among Adolescents, William K. Canady

National Youth Advocacy & Resilience Conference

This presentation will explain the historical development of pornography. It will highlight three segments: 1- Porn’s impact on brain development of reward pathways, ultimately increasing the appetite for more porn. 2- Porn can be a false substitute for real intimacy, resulting in decreased sexual satisfaction with a real person and increased verbal and physical aggression. 3- Porn promotes sex trafficking, promotes multiple sex partners and reduced STD prevention.

Governmental Affairs Update, Neema Katibai Jd

The Journal of the Michigan Dental Association

The article presents the American Dental Association's federal advocacy achievements during the first half of the 118th Congress. The ADA has made significant strides in influencing policy and regulations across various categories, including workforce issues, dental insurance reform, access to care, student loan debt, Medicaid, practice management, veterans' affairs, health information technology, and public health. Their efforts span from urging legislative action to collaborating with federal agencies and Congress members. These accomplishments showcase the ADA's commitment to advancing dental profession interests nationally.

Western Maine Addiction And Recovery Initiative's Substance Misuse Prevention And Wellness Day: Year 2 Planning Survey Summary For Ohchs, Evelyn Ali Bs, Tyler Egeland Ba, Mary Lindsey Smith Phd

Substance Use Research & Evaluation

The RCORP local evaluation team at the Catherine Cutler Institute deployed a survey to Oxford Hills Comprehensive High School (OHCHS). The purpose of the survey was to understand needs unique to OHCHS to plan for types of activities and information presented at the school’s Substance Use Prevention and Wellness Day. For more information, please contact Lindsey Smith at [email protected]

Special Insert: Guideline For Delegation Of Duties For Allied Dental Personnel In Michigan, David Foe Ma

The Journal of the Michigan Dental Association

Dental assistants, registered dental assistants, and registered dental hygienists have specific duties they can perform for patients as outlined by the Michigan Public Health Code and the Michigan Board of Dentistry General Rules. Permitted delegated services vary based on a team member’s level of training, licensure, and available supervision by a licensed dentist.

The Journal of Michigan Dental Association provides this pullout insert to guide the dental team. This easy-to-read chart quickly identifies recent changes to the duties each dental auxiliary can legally perform.

Identifying Rural Health Clinics Within The Transformed Medicaid Statistical Information System (T-Msis) Analytic Files, Katherine Ahrens Mph, Phd, Zachariah Croll, Yvonne Jonk Phd, John Gale Ms, Heidi O'Connor Ms

Rural Health Clinics

Researchers at the Maine Rural Health Research Center describe a methodology for identifying Rural Health Clinic encounters within the Medicaid claims data using Transformed Medicaid Statistical Information System (T-MSIS) Analytic Files.

Background: There is limited information on the extent to which Rural Health Clinics (RHC) provide pediatric and pregnancy-related services to individuals enrolled in state Medicaid/CHIP programs. In part this is because methods to identify RHC encounters within Medicaid claims data are outdated.

Methods: We used a 100% sample of the 2018 Medicaid Demographic and Eligibility and Other Services Transformed Medicaid Statistical Information System (T-MSIS) Analytic Files for 20 states …

Self-Sampling For Human Papillomavirus Testing: Acceptability In A Us Safety Net Health System, Susan L Parker, Trisha L Amboree, Shaun Bulsara, Maria Daheri, Matthew L Anderson, Susan G Hilsenbeck, Maria L Jibaja-Weiss, Mohammed Zare, Kathleen M Schmeler, Ashish A Deshmukh, Elizabeth Y Chiao, Michael E Scheurer, Jane R Montealegre

Center for Medical Ethics and Health Policy Staff Publications

Introduction: Self-sampling for human papillomavirus testing is increasingly recognized as a strategy to expand cervical cancer screening access and utilization. Acceptability is a key determinant of uptake. This study assesses the acceptability of and experiences with mailed self-sampling kits for human papillomavirus testing among underscreened patients in a safety net health system.

Methods: A nested telephone survey was administered between 2021 and 2023 to a sample (n=272) of the 2,268 participants enrolled in the Prospective Evaluation of Self-Testing to Increase Screening trial. Trial participants include patients of a safety net health system aged 30-65 years who were not up to …

Parental Descriptions Of Childhood Avoidance Symptoms After Trauma, Zoe Blair-Andrews, Alison Salloum, Stephanie Evans, Vicky Phares, Eric A Storch

Center for Medical Ethics and Health Policy Staff Publications

Recognizing and diagnosing the avoidance symptom cluster of posttraumatic stress disorder (PTSD) in young children has been challenging. This study examines caregivers' descriptions of young children's avoidance reactions. By describing parents' examples of childhood avoidance, clinicians, researchers, and educators may be able to provide more specific psychoeducation which may improve identification of avoidance behaviors in young children. Caregivers (N=73) of young children (age 3-7 years) participated in a semi-structured diagnostic clinical interview prior to enrolling in a clinical trial for childhood trauma. The assessment regarding the caregiver's description of the child's avoidance was audio recorded and transcribed for a thematic …

Case Sampling For Evaluating Hospital Postoperative Morbidity In Us Surgical Quality Improvement Programs, Vivi W Chen, Tracey Rosen, Yongquan Dong, Peter A Richardson, Jennifer R Kramer, Laura A Petersen, Nader N Massarweh

Center for Medical Ethics and Health Policy Staff Publications

Importance: US surgical quality improvement (QI) programs use data from a systematic sample of surgical cases, rather than universal review of all cases, to assess and compare risk-adjusted hospital postoperative complication rates. Given decreasing postoperative complication rates over time and the types of cases eligible for abstraction, it is unclear whether case sampling is robust for identifying hospitals with higher than expected complications.

Objective: To compare the assessment of hospital 30-day complication rates derived from sampling strategy used by some US surgical QI programs relative to universal review of all cases.

Design, setting, and participants: This US hospital-level analysis took …

Pretesting Discrete-Choice Experiments: A Guide For Researchers, Nicola B Campoamor, Christi J Guerrini, Whitney Bash Brooks, John F P Bridges, Norah L Crossnohere

Center for Medical Ethics and Health Policy Staff Publications

Discrete-choice experiments (DCEs) are a frequently used method to explore the preferences of patients and other decision-makers in health. Pretesting is an essential stage in the design of a high-quality choice experiment and involves engaging with representatives of the target population to improve the readability, presentation, and structure of the preference instrument. The goal of pretesting in DCEs is to improve the validity, reliability, and relevance of the survey, while decreasing sources of bias, burden, and error associated with preference elicitation, data collection, and interpretation of the data. Despite its value to inform DCE design, pretesting lacks documented good practices …

Pretesting Discrete-Choice Experiments: A Guide For Researchers, Nicola B Campoamor, Christi J Guerrini, Whitney Bash Brooks, John F P Bridges, Norah L Crossnohere

Center for Medical Ethics and Health Policy Staff Publications

Discrete-choice experiments (DCEs) are a frequently used method to explore the preferences of patients and other decision-makers in health. Pretesting is an essential stage in the design of a high-quality choice experiment and involves engaging with representatives of the target population to improve the readability, presentation, and structure of the preference instrument. The goal of pretesting in DCEs is to improve the validity, reliability, and relevance of the survey, while decreasing sources of bias, burden, and error associated with preference elicitation, data collection, and interpretation of the data. Despite its value to inform DCE design, pretesting lacks documented good practices …

A Phase 1 Trial Utilizing A Pharmacokinetic Endpoint To Determine The Optimal Dose Of Ramucirumab In Children And Adolescents With Relapsed Or Refractory Solid Tumors, Including Central Nervous System Tumors, Kristy L Pilbeam, Kamnesh Pradhan, James Croop, Charles G Minard, Xiaowei Liu, Stephan D Voss, Emasenyie Isikwei, Stacey L Berg, Joel M Reid, Elizabeth Fox, Brenda J Weigel

Center for Medical Ethics and Health Policy Staff Publications

Background: Ramucirumab is a monoclonal antibody that binds the extracellular domain of vascular endothelial growth factor receptor (VEGFR-2) and prevents binding of VEGF ligands. Based on population pharmacokinetic (PK) analysis and correlation with efficacy in adults, a target steady state trough concentration (Css,min ) ≥ 50 µg/mL was established.

Procedures: This phase 1 trial (ADVL1416) used a rolling six design and a PK primary endpoint to define the recommended phase 2 dose (RP2D) of ramucirumab in children with recurrent/refractory solid tumors. Two dose levels (DL) were planned (DL1: 8 mg/kg, DL2: 12 mg/kg administered intravenously [IV] every 2 weeks). Toxicity …

Igg In The Trenches: Results Of An In-Depth Interview Study On The Practice, Politics, And Future Of Investigative Genetic Genealogy, Christi J Guerrini, Whitney Bash Brooks, Jill O Robinson, Stephanie M Fullerton, Emily Zoorob, Amy L Mcguire

Center for Medical Ethics and Health Policy Staff Publications

Investigative genetic genealogy (IGG) is a new technique for identifying criminal suspects and unidentified deceased and living persons that has sparked controversy. In a criminal case, the technique involves uploading genetic information left by a putative perpetrator at the crime scene to one or more direct-to-consumer genetic genealogy databases with the intention of identifying the perpetrator's genetic relatives and, eventually, locating the perpetrator on the family tree. In 2018, IGG helped to identify the Golden State Killer, and it has since been used in hundreds of investigations in the United States. Here, we report findings from in-depth interviews with 24 …

Building Effective Mentoring Relationships During Clinical Ethics Fellowships: Pedagogy, Programs, And People, Trevor M Bibler, Ryan H Nelson, Bryanna Moore, Janet Malek, Mary A Majumder

Center for Medical Ethics and Health Policy Staff Publications

How should clinical ethicists be trained? Scholars have stated that clinical ethics fellowships create well-trained, competent ethicists. While this appears intuitive, few features of fellowship programs have been publicly discussed, let alone debated. In this paper, we examine how fellowships can foster effective mentoring relationships. These relationships provide the foundation for the fellow's transition from novice to competent professional. In this essay, we begin by discussing our pedagogical commitments. Next, we describe the structures our program has created to assist our fellows in becoming competent ethicists. We then outline the kinds of knowledge, skills, and professional attributes mentors should possess. …

Grievance Politics And Technocracy In A Developmental State, Ijlal Naqvi, Federico M. Rossi, Rayner Kay Jin Tan

Research Collection School of Social Sciences

This article uses a process-tracing approach to understand changes in Singapore’s health sector from the start of self-rule in 1959 to the end of the COVID-19 pandemic in 2022. Singapore is a developmental state recognized for its effective management of healthcare costs and its lack of political freedom. In both respects, the ‘Singapore model’ is of interest to other cities and nations. The standard narrative is one of technocratic proficiency in a context in which civic freedoms are heavily constrained, but this article identifies the surprisingly important role of social voices at key moments. It finds episodes in which effective …

Implementation Of Digital Health In Addressing Global Threats: Lessons From The Use Of Technology During Covid-19 Pandemic In Indonesia, Naili Shifa, Anisa Tiasari, Kemal N. Siregar

Kesmas

This research conducted a systematic literature review to explore the implementation of digital health in Indonesia, focusing on the digital health policies, usage during the COVID-19 pandemic, benefits, and lessons learned. The study identified 10 relevant journals through database searches and analyzed the trends in publication, productive journals, and top institutions involved in digital health research. The findings revealed an increasing interest in digital health, with a growing number of published articles from 2021 to 2023. ScienceDirect emerged as the most productive journal, followed by PubMed and MDPI. The University of Indonesia and the University of Gajah Mada were the …

The Structural Equation Modelling Of First Level Health Facilities’ Performance-Based Capitation Payment In National Health Service, Ari Dwi Aryani, Adang Bachtiar, Cicilya Candi

Kesmas

The BPJS Healthcare Security implemented performance-based capitation/Kapitasi Berbasis Kinerja(KBK) payments to conduct structured and ongoingmonitoring of the First Level Health Facilities/Fasilitas Kesehatan Tingkat Pertama(FKTP)'s performance throughout Indonesia. This study aimed to examinethe direct and indirect effects of FKTP capacity on KBK and FKTP performance. This study was conducted in February 2023, and Structural EquationModelling analysis was performed with secondary data from the BPJS Healthcare Security system database in 2021. Human resources were defined as theavailability of doctors in FKTP, infrastructure as credentialing value, ownership and type of FKTP, and KBK, and performance as first contact, non-specialistoutpatient referral ratios, and Chronic …

Implementation Of National Movement For The Acceleration Of Nutrition Improvement Policy For The First 1,000 Days Of Life In Indonesia, Muhammad Ryman Napirah, Vidyanto Vidyanto, Nurdin Rahman, Arum Sekar Ningrum, Asmawati Asmawati, Meita Veruswati

Kesmas

The national movement for accelerating nutrition improvement in the first 1,000 days of life is an effort to strengthen the Indonesian Government's commitment to the national strategic agenda and tackling stunting. This study aimed to determine communication, resources, disposition, and bureaucratic structure in implementing the movement at the Biromaru Primary Health Care (PHC) and Loru Village, Sigi District, Indonesia. The mixed method approach was carried out with informants consisting of several parties from the PHC, health cadres, and the local community through triangulation and questionnaires. The results showed poor communication was inhibited by a lack of community outreach, the attitude …

Evidence Review And Considerations For Use Of First Line Genome Sequencing To Diagnose Rare Genetic Disorders, Kristen M Wigby, Deanna Brockman, Gregory Costain, Caitlin Hale, Stacie L Taylor, John Belmont, David Bick, David Dimmock, Susan Fernbach, John Greally, Vaidehi Jobanputra, Shashikant Kulkarni, Elizabeth Spiteri, Ryan J Taft

Center for Medical Ethics and Health Policy Staff Publications

Early use of genome sequencing (GS) in the diagnostic odyssey can reduce suffering and improve care, but questions remain about which patient populations are most amenable to GS as a first-line diagnostic test. To address this, the Medical Genome Initiative conducted a literature review to identify appropriate clinical indications for GS. Studies published from January 2011 to August 2022 that reported on the diagnostic yield (DY) or clinical utility of GS were included. An exploratory meta-analysis using a random effects model evaluated DY based on cohort size and diagnosed cases per cohort. Seventy-one studies met inclusion criteria, comprising over 13,000 …

On Achieving Strategic Fit For Suvidha Sanitary Napkins Distributed Under Pradhan Mantri Janaushadhi Program In India, Priyank Sinha, Romi Sainy, Chandra Prakash Garg

Management Dynamics

In this research paper, we discuss the transformation of India's menstrual hygiene product (MHP) market and the challenges faced in achieving a strategic fit for the Suvidha scheme within the Pradhan Mantri JanAushadhi program. The paper analyzes the misalignment in marketing and supply chain strategies with respect to the overall competitive strategy, and proposes optimal strategies for different consumer segments. It draws insights from Roger's diffusion model to target various adopter categories effectively. The paper emphasizes the need for continuous assessment, collaboration with stakeholders, and adaptation to ensure the scheme's success in providing affordable and eco-friendly sanitary napkins.

What Influences Reproductive Rights Policy? State Abortion Restrictions And The Level Of State Democracy, Dylan C. Naughton

Scholarly Horizons: University of Minnesota, Morris Undergraduate Journal

The overturning of Roe v. Wade in 2022 greatly altered the way reproductive rights policy is regulated in the United States. Sole policy-making jurisdiction was given to individual states, and many states have already passed legislation that both expands and restricts abortion access. This research examines what factors have the most influence on state-level abortion policy-making, specifically testing to determine how significant the level of democracy is in deciding how restrictive reproductive rights policies are implemented. Multiple regression models were run using various other variables to examine their impact on state reproduction restriction ranking using multiple subsets of data. Through …

A Review Of Olanzapine In The Treatment Of Cancer Anorexia-Cachexia Syndrome, Ivy O Poon, Veronica Ajewole, Ursula K Braun

Center for Medical Ethics and Health Policy Staff Publications

Background: Cancer anorexia-cachexia syndrome (CAS) is a multifactorial condition that is highly prevalent in advanced cancer patients and associated with significant reduction in functional performance, reduction in quality of life, and increased mortality. Currently, no medications are approved for this indication. Recently, the American Society of Clinical Oncology (ASCO) released a rapid recommendation suggesting that low-dose olanzapine once daily may be used to treat cancer cachexia. Many questions still exist on how to use olanzapine for this indication in clinical practice. The objective of this review is to identify existing knowledge on the use of olanzapine for CAS.

Methods: A …

Predicting Sedentarism And Its Impact On Caloric Requirements, Jacob Michels, John C. Beghin

Yeutter Institute International Trade Policy Review

A recent study conducted by PhD candidate Jacob Michels and Agricultural economist John Beghin delves into the question of whether global estimates of food insecure populations need a reevaluation of their methodology to account for increasing sedentarism. This reevaluation is prompted by the increasing prevalence of sedentary lifestyles worldwide, which calls for a redefinition of caloric thresholds indicating the onset of food insecurity. In this short article, we provide a nontechnical summary of their investigation recently published in Michels and Beghin (2024).

Advocacy Spotlight: 2024 Regulatory Reminders, Neema Katibai Jd

The Journal of the Michigan Dental Association

The Advocacy Spotlight column delves into critical regulatory reminders for dentists in 2024, emphasizing compliance challenges and potential disruptions to practice. Key areas covered include licensing, amalgam separator renewal, electronic prescribing, and Beneficial Ownership Information reporting. The article stresses the importance of staying informed about evolving regulations to ensure seamless practice operations.

Alzheimer’S Disease And Inflammatory Biomarkers Positively Correlate In Plasma In The Uk-Adrc Cohort, Kate E. Foley, Zachary Winder, Tiffany L. Sudduth, Barbara J. Martin, Peter T. Nelson, Gregory Jicha, Jordan P. Harp, Erica M. Weekman, Donna M. Wilcock

Neurology Faculty Publications

INTRODUCTION: Protein-based plasma assays provide hope for improving accessibility and specificity of molecular diagnostics to diagnose dementia. METHODS: Plasma was obtained from participants (N = 837) in our community-based University of Kentucky Alzheimer’s Disease Research Center cohort. We evaluated six Alzheimer’s disease (AD)- and neurodegeneration-related (Aβ40, Aβ42, Aβ42/40, p- tau181, total tau, and NfLight) and five inflammatory biomarkers (TNF𝛼, IL6, IL8, IL10, and GFAP) using the SIMOA-based protein assay platform. Statistics were performed to assess correlations. RESULTS: Our large cohort reflects previous plasma biomarker findings. Relationships between biomarkers to understand AD–inflammatory biomarker correlations showed significant associations between AD and inflammatory …

Determinants Of Referral Network Size For Screening Colonoscopies In The Veterans Health Administration After The Implementation Of The Mission Act, Chase S Eck, Vivian Ho, Cheng Jiang, Laura A Petersen

Center for Medical Ethics and Health Policy Staff Publications

Objective: To measure key characteristics of the Veterans Health Administration's (VHA) Community Care (CC) referral network for screening colonoscopy and identify market and institutional factors associated with network size.

Data sources: VHA electronic health records, CC claim data, and National Plan and Provider Enumeration System.

Study design: In this retrospective cross-sectional study, we measure the size of the VHA's CC referral networks over time and by VHA parent facility (n = 137). We used a multivariable linear regression to identify factors associated with network size at the market-year level. Network size was measured as the number of physicians who performed …

Gene-Specific Acmg/Amp Classification Criteria For Germline Apc Variants: Recommendations From The Clingen Insight Hereditary Colorectal Cancer/Polyposis Variant Curation Expert Panel\, Isabel Spier, Xiaoyu Yin, Marcy Richardson, Marta Pineda, Andreas Laner, Deborah Ritter, Julie Boyle, Pilar Mur, Thomas V O Hansen, Xuemei Shi, Khalid Mahmood, John-Paul Plazzer, Elisabet Ognedal, Margareta Nordling, Susan M Farrington, Gou Yamamoto, Stéphanie Baert-Desurmont, Alexandra Martins, Ester Borras, Carli Tops, Erica Webb, Victoria Beshay, Maurizio Genuardi, Tina Pesaran, Gabriel Capellá, Sean V Tavtigian, Andrew Latchford, Ian M Frayling, Sharon E Plon, Marc Greenblatt, Finlay A Macrae, Stefan Aretz, Insight-Clingen Hereditary Colon Cancer/Polyposis Variant Curation Expert Panel

Center for Medical Ethics and Health Policy Staff Publications

Purpose: The Hereditary Colorectal Cancer/Polyposis Variant Curation Expert Panel (VCEP) was established by the International Society for Gastrointestinal Hereditary Tumours and the Clinical Genome Resource, who set out to develop recommendations for the interpretation of germline APC variants underlying Familial Adenomatous Polyposis, the most frequent hereditary polyposis syndrome.

Methods: Through a rigorous process of database analysis, literature review, and expert elicitation, the APC VCEP derived gene-specific modifications to the ACMG/AMP (American College of Medical Genetics and Genomics and Association for Molecular Pathology) variant classification guidelines and validated such criteria through the pilot classification of 58 variants.

Results: The APC-specific criteria …

Risk Factors For Childhood Brain Tumours: A Systematic Review And Meta-Analysis Of Observational Studies From 1976 To 2022, Felix M Onyije, Roya Dolatkhah, Ann Olsson, Liacine Bouaoun, Isabelle Deltour, Friederike Erdmann, Audrey Bonaventure, Michael E Scheurer, Jacqueline Clavel, Joachim Schüz

Center for Medical Ethics and Health Policy Staff Publications

BACKGROUND: Childhood brain tumours (CBTs) are the leading cause of cancer death in children under the age of 20 years globally. Though the aetiology of CBT remains poorly understood, it is thought to be multifactorial. We aimed to synthesize potential risk factors for CBT to inform primary prevention.

METHODS: We conducted a systematic review and meta-analysis of epidemiological studies indexed in the PubMed, Web of Science, and Embase databases from the start of those resources through 27 July 2023. We included data from case-control or cohort studies that reported effect estimates for each risk factor around the time of conception, …

Utility Of A Low-Cost 3-D Printed Microscope For Evaluating Esophageal Biopsies, Daniel G Rosen, Evandro Sobroza De Mello, Sadhna Dhingra, Sanford M Dawsey, Joe Knapper, Richard Bowman, Sharmila Anandasabapathy

Center for Medical Ethics and Health Policy Staff Publications

In this manuscript we assessed the utility of a low-cost 3D printed microscope to evaluate esophageal biopsies. We conducted a comparative analysis between the traditional microscope and our 3-D printed microscope, utilizing a set of esophageal biopsy samples obtained from patients undergoing screening endoscopy. Two pathologists independently examined 30 esophageal biopsies by light microscopy and digital images obtained using a low-cost 3D printed microscope (Observer 1 and 2). The glass slide consensus diagnosis was compared to the findings of 2 additional pathologist who independently just reviewed the digital images (Observer 3 and 4). The intra-observer agreement was substantial to almost …