Health Policy Commons^™

Improving Individualized Rhabdomyosarcoma Prognosis Predictions Using Somatic Molecular Biomarkers, Mark Zobeck, Javed Khan, Rajkumar Venkatramani, M Fatih Okcu, Michael E Scheurer, Philip J Lupo

Center for Medical Ethics and Health Policy Staff Publications

Purpose: Molecular markers increasingly influence risk-stratified treatment selection for pediatric rhabdomyosarcoma (RMS). This study aims to integrate molecular and clinical data to produce individualized prognosis predictions that can further improve treatment selection.

Methods: Clinical variables and somatic mutation data for 20 genes from 641 patients with RMS in the United Kingdom and the United States were used to develop three Cox proportional hazard models for predicting event-free survival (EFS). The Baseline Clinical (BC) model included treatment location, age, fusion status, and risk group. The Gene Enhanced 2 (GE2) model added TP53 and MYOD1 mutations to the BC predictors. The Gene …

Revisiting What Constitutes A Neglected Tropical Disease?, Paul J Brindley, Peter J Hotez, Shaden Kamhawi

Center for Medical Ethics and Health Policy Staff Publications

PLOS Neglected Tropical Diseases (PLOS NTDs) publishes research devoted to pathogenesis and other clinical aspects, epidemiology, prevention, diagnosis, treatment, and control of the neglected tropical diseases (NTDs), as well as work relevant to public health policy. We define NTDs as poverty-promoting infectious diseases that can negatively impact the quality of life in rural areas and poor urban areas of low- and middle-income countries but which can also affect specific communities within high-income countries. The poverty-inducing effects of the NTDs operate by impairing child health and development, pregnancy outcomes for both mother and child, worker productivity, and quality of life. The …

Longitudinal Phage-Bacteria Dynamics In The Early Life Gut Microbiome, Michael J Tisza, Richard E Lloyd, Kristi Hoffman, Daniel P Smith, Marian Rewers, Sara J Javornik Cregeen, Joseph F Petrosino

Center for Medical Ethics and Health Policy Staff Publications

Microbial colonization of the human gut occurs soon after birth, proceeds through well-studied phases and is affected by lifestyle and other factors. Less is known about phage community dynamics during infant gut colonization due to small study sizes, an inability to leverage large databases and a lack of appropriate bioinformatics tools. Here we reanalysed whole microbial community shotgun sequencing data of 12,262 longitudinal samples from 887 children from four countries across four years of life as part of the The Environmental Determinants of Diabetes in the Young (TEDDY) study. We developed an extensive metagenome-assembled genome catalogue using the Marker-MAGu pipeline, …

Determinants Of Physicians' Brain Drain In Egypt, Mennatallah Elbeheiry

Theses and Dissertations

Egypt is enduring a significant shortage of physicians, despite the annual graduation of approximately 10,000 medical students from its 27 medical schools. In 2016, the physician density was alarmingly low, with only one doctor per 12,285 people. This shortage is exacerbated by a physicians’ brain drain, as Egypt is a leading exporter of physicians to countries like the United Kingdom and Australia. As of 2020, the Egyptian Medical Syndicate reported 212,835 registered physicians, yet 56 percent of them work abroad, and only about 62,000 are actively employed in public hospitals, serving a population of over 110 million. The government’s efforts …

The Readiness For Integrated Primary Health Care (Ilp) At Puskesmas Pamulang In Tangerang Selatan City, Firda Safitri Rachmaningsih, Kurnia Sari

Journal of Indonesian Health Policy and Administration

. Integrated primary healthcare (ILP) is part of the transformation of primary healthcare aimed at improving access to quality healthcare. This study aims to analyze the readiness of Pusat Kesehatan Masyarakat (Puskesmas) and their networks to implement ILP. This research used a qualitative approach, focusing on a case study of a Puskesmas in an urban setting, specifically in the operational area of Puskesmas Pamulang in South Tangerang. Data collection methods include in-depth interviews, observations, and document reviews. This research adopts the conceptual framework of PHC monitoring based on WHO and Weiner's theory of organizational change readiness. The research findings indicate …

The Relationship Between Self-Efficacy And Self-Management Behavior In Gestational Diabetes Mellitus Control, Fatimah Dwi Cahyani, Shrimarti Rukmini Devy

Journal of Indonesian Health Policy and Administration

Diabetes mellitus gestasional (DGM) merupakan kondisi kesehatan yang meningkat dalam kehamilan dan dapat menyebabkan komplikasi serius bagi ibu dan janin. Self-management yang mencakup pemahaman, penerapan, dan pemeliharaan perilaku kesehatan memiliki peran kunci dalam mengelola DGM. Health Belief Model (HBM) digunakan sebagai kerangka kerja teoretis yang membentuk dasar intervensi untuk meningkatkan self-efficacy pada ibu hamil dengan GDM. Studi ini menganalisis hubungan antara efikasi diri dan manajemen diri dalam pengendalian diabetes gestasional pada ibu hamil. Artikel ini adalah tinjauan pustaka dengan menerapkan metode pencarian literatur. Pencarian literatur dilaksanakan melalui tiga basis data yaitu PubMed, Scopus, dan Google Scholar, yang mencakup artikel-artikel yang …

Contextualizing Policy Adoption: A Case Study Of Tuberculosis Control Policy In Depok City, Tri Auri Putri Ayuningtyas, Adang Bachtiar

Journal of Indonesian Health Policy and Administration

This study analyzes the formulation and implementation process of Depok Mayor Regulation No. 61 of 2023 on Tuberculosis (TB) Control using Friedman’s legal system theory (1975) and the eight General Principles of Good Governance (Asas Umum Pemerintahan yang Baik – AUPB). The regulation provides a comprehensive framework, encompassing promotive, preventive, curative, and rehabilitative aspects to support TB control. The legal structure includes the establishment of a cross-sectoral Tuberculosis Control Acceleration Team, involving government agencies and community organizations. Findings reveal that while the regulation has fulfilled several AUPB principles, such as legal certainty, utility, and public interest, there are areas …

Implementation Of Emr System In Indonesian Health Facilities: Benefits And Constraints – A Case Study Of Two Clinics In Central Java, Rasyid Juliansyah, Bukhori Aqid, Andien Putri Salsabila, Kurnia Nurfiyanti

Journal of Indonesian Health Policy and Administration

This paper delves into the widespread implementation of Electronic Medical Records (EMR) within healthcare facilities across Indonesia. It addresses the challenges encountered by clinic owners and healthcare providers in transitioning to these digital systems. The study is supported by empirical data collected through a mixed-method approach, combining internal data from Klinik Pintar with qualitative validation from key stakeholders responsible for clinic operations. The research focuses on two case studies: Lembaga Pemasyarakatan (LAPAS) II Purwokerto Clinic and Palang Merah Indonesia (PMI) Purbalingga Clinic, where the adoption of EMR is analyzed in terms of efficiency, compliance with regulatory standards set by the …

Analysis Of Covid-19 Prevention And Control Policy Implementation In Islamic Boarding Schools In Dki Jakarta, Dickha Adi Wibowo, Fajar Ariyanti

Journal of Indonesian Health Policy and Administration

Indonesia, as one of the countries affected by COVID-19, has implemented various efforts to prevent the transmission of COVID-19. One effort that can be implemented is the implementation of COVID-19 prevention protocols. Apart from that, according to the COVID-19 Handling Task Force, Islamic boarding schools are locations with high mobility. This research aims to determine the implementation of policies related to the prevention and control of COVID-19 in Islamic boarding schools in the DKI Jakarta Province. This research used descriptive research with a qualitative approach, with the number of respondents being three Islamic boarding school leaders and students. The results …

Fairs - A Framework For Evaluating The Inclusion Of Sex In Clinical Algorithms, Katherine E Goodman, Jennifer Blumenthal-Barby, Rita F Redberg, Diane E Hoffmann

Center for Medical Ethics and Health Policy Staff Publications

No abstract provided.

Gut Microbial Changes Associated With Obesity In Youth With Type 1 Diabetes, Heba M Ismail, Dimuthu Perera, Rabindra Mandal, Linda A Dimeglio, Carmella Evans-Molina, Tamara Hannon, Joseph Petrosino, Sara Javornik Cregeen, Nathan W Schmidt

Center for Medical Ethics and Health Policy Staff Publications

Context: Obesity is prevalent in type 1 diabetes (T1D) and is problematic with higher risk for diabetes complications. It is unknown to what extent gut microbiome changes are associated with obesity and T1D.

Objective: This work aimed to describe the gut microbiome and microbial metabolite changes associated with obesity in T1D. We hypothesized statistically significant gut microbial and metabolite differences in lean T1D youth (body mass index [BMI]: 5%-< 85%) vs those with obesity (BMI: ≥95%).

Methods: We analyzed stool samples for gut microbial (using metagenomic shotgun sequencing) and short-chain fatty acid (SCFA) differences in lean (n = 27) and obese (n = 21) T1D youth in …

The Healing Power Of Antitrust, Theodosia Stavroulaki

Northwestern University Law Review

Millions of Americans live in hospital deserts—communities where people lack geographic access to hospitals and primary care physicians. People living in these deserts often miss doctor appointments, delay necessary care, and stop adhering to their treatment. In this way, hospital deserts exacerbate the health disparities plaguing America. This Article demonstrates that hospital deserts are not inevitable but the result of several business strategies—including noncompete agreements and merging with competitors—and antitrust enforcers’ unwillingness to recognize these harmful practices as antitrust violations. To cure the issue of hospital deserts, this Article makes three proposals. First, antitrust enforcers and the courts should expand …

Lessons For Public Policy From The Covid-19 Pandemic, Olga Shvetsova

Political Science Faculty Scholarship

In the early 2020s, as the COVID-19 pandemic unfolded, governments, bureaucracies, and health practitioners around the globe faced unforeseen tasks and responsibilities. The novelty and intensity of the crisis spurred innovation and experimentation in public policy, health policy, and crisis management. However, the pandemic also revealed bottlenecks and adverse incentives within policy framework and healthcare systems. From this experience, critical lessons emerged: the paramount importance of swift and well-informed policy responses and the ability to optimize ongoing policy response as the crisis unfolds.

A Caution Against Customized Ai In Healthcare, Kristin M Kostick-Quenet

Center for Medical Ethics and Health Policy Staff Publications

This article critiques the shift towards personalized AI in healthcare and other high-stakes domains, cautioning that without careful deliberation, customized AI systems can compromise the diversity and reach of human knowledge by restricting exposure to critical information that may conflict with users' preferences and biases. Customized AI should be applied with caution and intention where access to a wide and diverse range of perspectives is essential for impartial, informed decision making.

Us Military Veterans’ Perceived Concordance With Their Providers Regarding Persistent Physical Symptoms Prospectively Predicts Satisfaction With Care And Adherence To Care Plans, L Alison Phillips, Laura M Lesnewich, Katharine Bloeser, Yong Lin, Rachel L Boska, Justeen K Hyde, Peter J Bayley, Helena K Chandler, Matthew J Reinhard, Susan L Santos, Rachel Stewart, Drew A Helmer, Lisa M Mcandrew

Center for Medical Ethics and Health Policy Staff Publications

Background: Medically unexplained, persistent physical symptoms and syndromes are commonly seen in primary care. These are debilitating for patients and difficult to treat, causing frustration for patients and providers.

Purpose: This study investigates how well US military veterans with multiple persistent physical symptoms (PPS), called Gulf War illness (GWI), agree with their healthcare providers about their illness. This agreement, called perceived concordance, is hypothesized to influence veterans' satisfaction with care, adherence to care plans, and disability levels.

Methods: Participants were 230 veterans with GWI deployed to the 1990-1991 Gulf War who were recruited from Veteran Affairs primary care and War …

Predictors Of Mental Health Clinic Staff Self-Efficacy In Recognizing And Responding To Suicide Risk, Hannah Ritz

Theses and Dissertations

Staff self-efficacy is critical to suicide prevention, yet its predictors within Zero Suicide initiatives are not well understood. Among 1,038 CCBHC staff, perceived organizational support, response-focused training, and lower suicide myth endorsement most strongly predicted self-efficacy. Clinical role and prior experiences contributed modestly, highlighting multilevel influences on workforce readiness.

An Evaluation Of Nhmrc Funded Dementia And Diabetes Research, Etienne Vignola-Gagné Phd, Dmitrii Malkov, Elisabeth Browning, Jörg Hellwig Phd, Luigi Rocco Phd, Henrique Pinheiro, Alexandre Bédard-Vallée

Public Reports

This report, commissioned by the National Health and Medical Research Council (NHMRC), provides comprehensive insights into the research outputs, outcomes, and impacts of NHMRC-funded health and medical research in the areas of dementia and diabetes to support NHMRC's mission of ‘building a healthy Australia.’

Association Between Neighborhood-Level Social Vulnerability And Hypertension Outcomes, John E. Brush Jr., Chungsoo Kim, Yuntian Liu, Xin Xin, Chenxi Huang, Iris J. Lundy, Jordan R. Asher, Mitsuaki Sawano, Patrick Young, Jacob Mcpadden, Mark Anderson, John S. Burrows, Harlan M. Krumholz, Yuan Lu

Department of Medicine Faculty Publications

Background

Neighborhood-level social vulnerability is associated with hypertension prevalence and severity and with cardiovascular complications in conditions other than hypertension, but its association with cardiovascular complications in patients with hypertension is understudied.

Objectives

The aim of the study was to examine how the neighborhood-level social vulnerability index (SVI) influences cardiovascular outcomes in a large, diverse cohort of patients with hypertension.

Methods

We used electronic health data to examine the association between census tract-level rankings for the SVI with a composite endpoint of incident myocardial infarction, congestive heart failure, or stroke.

Results

In a longitudinal cohort of 330,972 patients with hypertension …

Rural Hospital Closure And Medicaid Expansion, Jason White

Theses, Dissertations and Capstones

Introduction: In the United States, hospitals in rural areas have been under financial pressure and have been closing at an increasing rate.  This reduces access to care for rural citizens.  The Affordable Care Act of 2010 was passed in order to increase access to medical care, partially through an optional expansion of Medicaid coverage to a larger percentage of the population.  As some states adopted the expansion and some states did not, an opportunity was created to examine the policy’s effect on rural hospital stability.

Purpose of the Study:  This study was designed to examine the effect of …

Barriers And Facilitators To Accessing Mental And Physical Health Care Among Sexual Minority Women: A Qualitative Exploration, Charlotte A. Dawson, A. Moulder, Kristin E. Heron

Department Psychiatry & Behavioral Science Faculty Publications

Cisgender sexual minority women (SMW, e.g., lesbian, queer) are at greater risk for poor mental and physical health compared to heterosexual women and face challenges when accessing health care. Previous research has largely focused on general sexual and gender minority barriers to health care, but more research is needed on the experiences of specific subgroups, including cisgender SMW. The current study qualitatively explored barriers and facilitators for cisgender SMW seeking health care. Twenty cisgender SMW aged 18-40 recruited using Meta advertisements and past participant lists completed 45 min semi-structured interviews and a brief survey. Thematic analysis conducted by two coders …