Health Policy Commons^™

Addressing The Public Health Concern Of Maternal Mortality In Houston, Texas, Lucy Couture

Dissertations and Theses (Open Access)

Maternal mortality remains a pressing public health concern in the United States, with disproportionate consequences for marginalized communities. Despite being a developed nation, the U.S. reports one of the highest maternal mortality rates among its peers, with approximately 80% of maternal deaths deemed preventable. Texas reflects this national crisis, particularly affecting Black women, whose maternal mortality rate is significantly higher than that of other racial and ethnic groups. This thesis explores maternal mortality trends in Houston, Texas, analyzing the roles of systemic inequities, social determinants of health, and disparities in access to quality care. Drawing on data from the Texas …

Obesity: Influencing Behavioral Consumption Through Meal Kit Distribution, Alejandro Hernandez

Capstone Projects and Master's Theses

Founded in 2002, Everyone’s Harvest is a grassroots nonprofit dedicated to providing access to healthy, affordable fruits and vegetables through certified farmers markets and community food programs. Its key initiatives—Fresh Rx, Market Match, Edible Education and Farms Together —focus on alleviating nutrition insecurity and combating diet-related health conditions by providing vulnerable populations the resources to purchase, or receive, fresh produce and gain nutritional knowledge. This study explores a new intervention: the distribution of farmers' market meal kits as a complementary strategy to the current Edible Education program. These meal kits, which feature seasonally available produce and pre-measured ingredients, aim to …

Association Of Common And Rare Variants With Alzheimer’S Disease In More Than 13,000 Diverse Individuals With Whole-Genome Sequencing From The Alzheimer’S Disease Sequencing Project, Wan-Ping Lee, Seung Hoan Choi, Margaret G Shea, Po-Liang Cheng, Beth A Dombroski, Achilleas N Pitsillides, Nancy L Heard-Costa, Hui Wang, Katia Bulekova, Amanda B Kuzma, Yuk Yee Leung, John J Farrell, Honghuang Lin, Brian W Kunkle, Adam Naj, Elizabeth E Blue, Frederick Nusetor, Dongyu Wang, Eric Boerwinkle, William S Bush, Xiaoling Zhang, Philip L De Jager, Josée Dupuis, Lindsay A Farrer, Myriam Fornage, Eden Martin, Margaret Pericak-Vance, Sudha Seshadri, Ellen M Wijsman, Li-San Wang, Alzheimer's Disease Sequencing Project, Gerard D Schellenberg, Anita L Destefano, Jonathan L Haines, Gina M Peloso

Center for Medical Ethics and Health Policy Staff Publications

Introduction: Alzheimer's disease (AD) is a common disorder of the elderly that is both highly heritable and genetically heterogeneous.

Methods: We investigated the association of AD with both common variants and aggregates of rare coding and non-coding variants in 13,371 individuals of diverse ancestry with whole genome sequencing (WGS) data.

Results: Pooled-population analyses of all individuals identified genetic variants at apolipoprotein E (APOE) and BIN1 associated with AD (p < 5 × 10-8). Subgroup-specific analyses identified a haplotype on chromosome 14 including PSEN1 associated with AD in Hispanics, further supported by aggregate testing of rare coding and non-coding variants in the region. Common variants in LINC00320 were observed associated with AD in Black individuals (p = 1.9 × 10-9). Finally, we observed rare non-coding variants in the promoter of TOMM40 distinct of APOE in pooled-population analyses (p = 7.2 × 10-8).

Discussion: We observed that complementary pooled-population and subgroup-specific analyses offered unique insights into the genetic architecture of AD.

Highlights: We determine the association of genetic variants with Alzheimer's disease (AD) using …

Practice Unveils Weaknesses: Analysing The Implementation Of Regulations On Seafarers’ Work/Rest Hours, Bikram S. Bhatia

World Maritime University Ph.D. Dissertations

Seafarers’ fatigue risk management is rooted in regulations on manning and work/rest hours. These regulations establish a minimum fatigue management standard achieved through work/rest hours compliance. Seafarers must maintain daily records of their work/rest hours and report any non-compliance to their company. However, adjustments to these records have been reported in the literature. Such malpractice obscures instances of non- compliance and hinders the feedback necessary for resolving these issues, including flag State review and amendments to minimum safe manning documents. It compromises the integrity of fatigue risk management and underscores the need for further research.

This study examined the implementation …

Implementing And Assessing Climate Change Education In A Pediatrics Residency Curriculum, Mark Mcshane, Shelley Kumar, Linessa Zuniga

Center for Medical Ethics and Health Policy Staff Publications

Background For physicians to effectively combat the growing health crisis that is climate change, they should begin learning during medical training about its health implications. However, there is little data on residents' knowledge of the climate crisis, and even less data regarding the effectiveness and acceptability of climate change education in graduate medical training programs. Objective To incorporate a new educational session on the health implications of climate change into a residency curriculum and evaluate the acceptability of the session and its effects on residents' knowledge, attitudes, and perceptions of the topic.

Methods In July 2021, a 90-minute, interactive, small-group …

Langerhans Cell Histiocytosis In Children Born After Assisted Reproductive Technology, Carrie L Williams, Kathryn J Bunch, Charles Stiller, Michael F G Murphy, Beverley J Botting, Melanie C Davies, Barbara Luke, Philip J Lupo, Alastair G Sutcliffe

Center for Medical Ethics and Health Policy Staff Publications

Research question: Are children born after assisted reproductive technology (ART) at higher risk of developing Langerhans cell histiocytosis (LCH)?

Design: Records of children born after ART recorded by the UK Human Fertilisation & Embryology Authority were linked to National Registry of Childhood Tumours records to determine the number of children developing LCH. Calculated person-years at risk were used in conjunction with the incidence of LCH in the general population to determine the expected number of cases if the cohort had the same incidence as the general population with similar age and sex, over the same calendar years. The standardized incidence …

Incorporating An Analytical Approach To Ethical Reasoning Into An Ethics Case Conference For Residents, Holland Kaplan, Alyssa Kahl, Jonathan Lim

Center for Medical Ethics and Health Policy Staff Publications

Educating residents to apply ethical principles in clinical practice is critical in achieving standards in professionalism. We implemented biweekly ethics morning report case conferences incorporating a validated analytical tool in medical ethics, the Four-Box Method, from July 2022 to June 2023 in our internal medicine residency program. In 24 ethics morning reports, over 73% of participants reported that the intervention helped them achieve each of three learning objectives in ethics education. Ninety-two percent of cases addressed > 1 ethical issue. Our intervention may be easily integrated into the morning report conference structure as an educational tool in medical ethics across internal …

Mortalidad Por Cirrosis En Guatemala 2018: Patrones E Inequidades, Cristian Ramírez, Luis Pablo Méndez-Alburez, María Fernanda Piedrasanta, Alejandro Cerón

Anthropology: Faculty Scholarship

El presente estudio busca analizar la mortalidad por cirrosis en Guatemala. El propósito es identificar posibles criterios epidemiológicos que orienten la priorización de acciones de salud pública. El riesgo de morir por cirrosis en Guatemala muestra marcadas desigualdades por departamento, las cuales son mayores al comparar por municipio. El riesgo de morir es también más alto en hombres, en personas mestizas o ladinas, en niveles educativos bajos, y en personas que se dedican a ocupaciones elementales. Las medidas de salud pública orientadas a los municipios y grupos en mayor riesgo son de suma importancia para la prevención de muerte por …

Economic Growth, Poverty Gap, And Health Inequality: Implications Based On Panel Analysis Of Organization For Economic Cooperation And Development Data, Sangik Han

Kesmas

This study investigated the impact of economic growth and income distribution on health inequality using data from the Organization for Economic Cooperation and Development (OECD). Employing a panel analysis, this study amalgamated 21 years of data (spanning from 2000 to 2020) from 37 OECD countries. The dependent variables (life expectancy and avoidable mortality) were scrutinized against independent variables (gross domestic product and poverty gap). Control variables encompassed body mass index, consumption patterns, smoking rates, health workers availability, number of beds in health facilities, national medical expenses, and unemployment rates. This study revealed significant associations between economic growth, poverty gap, and …

Social Determinants Of Neonatal Health Outcomes In Indonesia: A Multilevel Regression Analysis, Rooswanti Soeharno, Amal Chalik Sjaaf

Kesmas

Indonesia’s neonatal mortality rate remains alarmingly high. This study addressed the determinants of neonatal outcomes in Indonesia, including the effects of a decentralized health system, socioeconomic disparities, and geographic variations. The analysis used 2018 national survey data across 34 provinces, 513 cities/districts, and 300,000 households, with a sample of 73,864 women aged 10-54 years who have given birth in the preceding five years. The multilevel regression was used to assess the impact of social determinants and systemic inequalities on neonatal health. Key findings revealed a neonatal mortality rate that, despite being preventable in many cases, remained high with significant disparities. …

Telemedicine Adoption In Developing Economies: A Systematic Review On The Enablers And Barriers, Zaidbren Macabato, Lemuel Clark Velasco, Art Brian Escabarte, Mae-Lanie Ong Poblete, Armando Isla Jr., Rentor Cafino, Sarah Lizette Aquino-Cafino, Frevy Teofilo-Orencia

Kesmas

Telemedicine’s adoption has been effective in certain contexts despite being controversial in certain settings because of its tendency to cause misdiagnosis and concerns about data privacy. This study aimed to synthesize the research findings on the factors leading to the adoption of telemedicine among developing economies. The study utilized Preferred Reporting Items for Systematic Reviews and Meta-Analysis methodology to analyze 27 related literature and the Unified Theory of Acceptance and Use of Technology to map out the factors considered enablers and barriers in adopting telemedicine. Results showed that performance expectancy, effort expectancy, social influence, and facilitating conditions were significant predictors. …

The Southern Nevada Care Economy: Addressing Child Care And Elder Care Challenges, The Lincy Institute

Lincy Institute Events

This community forum examines the economic and societal impact of the “care economy” in Southern Nevada in collaboration with Tripp Umbach, a nationally recognized consulting firm that provides comprehensive services including research and strategic plans to further the operations and activities of healthcare services.

Central to the care economy is elder care and child care. Having access to elder care and child care services is essential to working age adults, many of whom need one or both types of services to continue participating in the workforce. The delivery of child care and elder care services have far-reaching implications for our …

Ethical Issues In Implementation Science: Perspectives From A National Heart, Lung, And Blood Institute Workshop, Neal W Dickert, Donna Spiegelman, Jennifer S Blumenthal-Barby, Garth Graham, Steven Joffe, Jeremy M Kahn, Nancy E Kass, Scott Y H Kim, Meeta P Kerlin, Aisha T Langford, James V Lavery, Daniel D Matlock, Kathleen N Fenton, George A Mensah

Center for Medical Ethics and Health Policy Staff Publications

Ethical issues arise in the context of implementation science that may differ from those encountered in other research settings. This report, developed out of a workshop convened by the Center for Translation Research and Implementation Science within the United States National Heart, Lung, and Blood Institute, identifies six key themes that are important to the assessment of ethical dimensions of implementation science. First, addressing ethical challenges in implementation science does not require new ethical principles, commitments, or regulations. However, it does require understanding of the specific contexts arising in implementation research related to both study design and the intervention being …

Nevada’S Care Workforce: Obstacles And Opportunities For Policymakers, David Damore, Caitlin J. Saladino, William E. Brown Jr., Fatma Nasoz

Policy Briefs and Reports

The care economy includes “the paid and unpaid labor and services that support caregiving in all its forms.” This work includes caring for children, the elderly, and those who are ill or have disabilities. Care work is often undervalued, underpaid, and without a fair system of work benefits in place (e.g. contracts, paid leave, workers’ rights) that in many cases falls disproportionately on women and communities of color. In this policy brief, we examine the care economy in Nevada by focusing on three areas of care: (1) child care; (2) elder care; and (3) mental and behavioral health care. In …

Downeast Community Opioid Response Program: Final Summary Report, Tyler Egeland Ba, Gordon Mcintire Ba, Evelyn Ali, Mary Lindsey Smith Phd, 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 3 final summary presentation includes feedback from program partners and key informants, in addition to …

The Southern Nevada Care Economy: Challenges And Opportunities, Tripp Umbach

Policy Briefs and Reports

National policymakers increasingly recognize the care economy as an essential economic driver, contributing $648 billion annually to the U.S. economy and supporting 3.6 million jobs. The care economy is also critical in driving economic development and prosperity in Southern Nevada. Yet, as this Tripp Umbach analysis finds, Southern Nevada’s care economy dramatically underperforms compared to national benchmarks and peer regions. High caregiving costs and limited access to care for children, seniors, and individuals with disabilities in Southern Nevada strain families, businesses, and public resources. This burden reduces workforce participation, productivity, and economic growth. Low pay and high turnover among care …

Impacting Community Well-Being Through Effective Engagement Using The Seed Method, Carlin Rafie, Emily B. Zimmerman, Angelina Hargrove, Theodora Biney Amissah, Samantha Lee

Journal of Extension

Cooperative Extension can make a significant impact on health in the United States through effective community engagement that focuses on the complex socio-ecological factors that impact health. The Stakeholder Engagement in Question Development Method (SEED Method) employs community based participatory research principles to engage communities in research, problem-solving, and action planning. Projects employing the SEED Method engage community members from diverse backgrounds, create community capacity, result in tangible outcomes, and foment inter-organizational trust and networking. A SEED Toolkit is available on the Extension Foundation Campus site and provides implementation instructions, tools and timelines, and potential applications within Extension.

Update On Recommendations For Cancer Screening And Surveillance In Children With Genomic Instability Disorders, Yoshiko Nakano, Roland P Kuiper, Kim E Nichols, Christopher C Porter, Harry Lesmana, Julia Meade, Christian P Kratz, Lucy A Godley, Luke D Maese, Maria Isabel Achatz, Payal P Khincha, Sharon A Savage, Andrea S Doria, Mary-Louise C Greer, Vivian Y Chang, Lisa L Wang, Sharon E Plon, Michael F Walsh

Center for Medical Ethics and Health Policy Staff Publications

Genomic instability disorders are characterized by DNA or chromosomal instability, resulting in various clinical manifestations, including developmental anomalies, immunodeficiency, and increased risk of developing cancers beginning in childhood. Many of these genomic instability disorders also present with exquisite sensitivity to anticancer treatments such as ionizing radiation and chemotherapy, which may further increase the risk of second cancers. In July 2023, the American Association for Cancer Research held the second Childhood Cancer Predisposition Workshop, where multidisciplinary international experts discussed, reviewed, and updated recommendations for children with cancer predisposition syndromes. This article discusses childhood cancer risks and surveillance recommendations for the group …

Knowledge, Attitudes, And Concerns About Psilocybin And Mdma As Novel Therapies Among Us Healthcare Professionals, Erin Wang, David S Mathai, Natalie Gukasyan, Sandeep Nayak, Albert Garcia-Romeu

Center for Medical Ethics and Health Policy Staff Publications

Psychedelic-assisted therapy (PAT) with substances like psilocybin and MDMA has shown promise for conditions including depression and post-traumatic stress disorder. Psilocybin and MDMA may become approved medicines in the coming decade. This study assessed knowledge and attitudes regarding PAT among 879 U.S. healthcare professionals via anonymous online survey. Multivariable linear regression was used to identify predictors of openness to clinical use. Most participants (71.2%) were female and White (85.8%), with a mean (SD) age of 45.5 (12.7) years. Registered nurses (25.4%) and physicians (17.7%) comprised the largest professional groups. Respondents endorsed strong belief in therapeutic promise, and moderate openness to …

Genetic Variants In Canonical Wnt Signaling Pathway Associated With Pediatric Immune Thrombocytopenia, Taylor Olmsted Kim, Jennifer M Geris, Jonathan M Flanagan, Rachael F Grace, Michele P Lambert, Candelaria O'Farrell, Melissa J Rose, Kristin A Shimano, Omar Niss, Cindy Neunert, Taizo A Nakano, Derek Macmath, Bogdan Dinu, Susan E Kirk, Ellis J Neufeld, Jenny M Despotovic, Michael E Scheurer, Amanda B Grimes

Center for Medical Ethics and Health Policy Staff Publications

Through the use of genetic sequencing, molecular variants driving autoimmunity are increasingly identified in patients with chronic and refractory immune cytopenias. With the goal of discovering genetic variants that predispose to pediatric immune thrombocytopenia (ITP) or increase risk for chronic disease, we conducted a genome-wide association study in a large multi-institutional cohort of pediatric patients with ITP. A total of 591 patients were genotyped using an Illumina Global Screening Array BeadChip. Six variants met genome-wide significance in comparison between children with ITP and a cohort of healthy children. One variant in NAV2 was inversely associated with ITP (adjusted odds ratio …