Health Policy Commons^™

What Is The Economic Benefit Of Annual Covid-19 Vaccination From The Adult Individual Perspective?, Sarah M Bartsch, Kelly J O'Shea, Colleen Weatherwax, Ulrich Strych, Kavya Velmurugan, Danielle C John, Maria Elena Bottazzi, Mustafa Hussein, Marie F Martinez, Kevin L Chin, Allan Ciciriello, Jessie Heneghan, Alexis Dibbs, Sheryl A Scannell, Peter J Hotez, Bruce Y Lee

Center for Medical Ethics and Health Policy Staff Publications

Background: With coronavirus disease 2019 (COVID-19) vaccination no longer mandated by many businesses/organizations, it is now up to individuals to decide whether to get any new boosters/updated vaccines going forward.

Methods: We developed a Markov model representing the potential clinical/economic outcomes from an individual perspective in the United States of getting versus not getting an annual COVID-19 vaccine.

Results: For an 18-49 year old, getting vaccinated at its current price ($60) can save the individual on average $30-$603 if the individual is uninsured and $4-$437 if the individual has private insurance, as long as the starting vaccine efficacy against severe …

Phase I Trial Of Gd2cart Cells Augmented With Constitutive Interleukin-7 Receptor For Treatment Of High-Grade Pediatric Cns Tumors, Frank Y Lin, Austin Stuckert, Candise Tat, Mark White, Lucia Ruggieri, Huimin Zhang, Birju Mehta, Natalia Lapteva, Zhuyong Mei, Angela Major, Sachin Thakkar, Thomas Shum, Kathan Parikh, Meng-Fen Wu, Holly B Lindsay, Lauren Scherer, Meghan Shekar, Patricia Baxter, Tao Wang, Bambi Grilley, Karen Moeller, John Hicks, Angshumoy Roy, Jamie Anastas, Fatema Malbari, Guillermo Aldave, Murali Chintagumpala, Susan Blaney, D Williams Parsons, Malcolm K Brenner, Helen E Heslop, Cliona M Rooney, Bilal Omer

Center for Medical Ethics and Health Policy Staff Publications

Purpose: T cells modified with chimeric antigen receptors (CARTs) have demonstrated efficacy for hematologic malignancies; however, benefit for patients with CNS tumors has been limited. To enhance T cell activity against GD2+ CNS malignancies, we modified GD2-directed CART cells (GD2.CARTs) with a constitutively active interleukin (IL)-7 receptor (C7R-GD2.CARTs).

Methods: Patients age 1-21 years with H3K27-altered diffuse midline glioma (DMG) or other recurrent GD2-expressing CNS tumors were eligible for this phase I trial (ClinicalTrials.gov identifier: NCT04099797). All subjects received standard-of-care adjuvant radiation therapy or chemotherapy before study enrollment. The first treatment cohort received GD2.CARTs alone (1 × 107 cells/m2), and …

Improving Patient Care: Expansion Of Access To Free Clinics, Anahis H. Davidian, Gail M. Bloom

Patient Experience Journal

Free clinics provide free or reduced-fee healthcare services for uninsured, underserved, and marginalized populations. Free clinics may be the only source of primary care for socioeconomically disadvantaged individuals lacking health insurance. However, consistently understaffed and underfunded free clinics are struggling to meet growing needs. The demand for services results in long waitlists with long wait times. Most free clinics rely on volunteer providers and staff due to limited financial resources. This case study proposes recommendations that can address the challenges of funding limitations while improving free clinics' ability to offer more accessible and equitable care to serve a greater proportion …

Phase Ii Study Of Vemurafenib In Children And Young Adults With Tumors Harboring Braf V600 Mutations: Nci-Cog Pediatric Match Trial (Apec1621) Arm G, Marie V Nelson, Aerang Kim, P Mickey Williams, Sinchita Roy-Chowdhuri, David R Patton, Brent D Coffey, Joel M Reid, Jin Piao, Lauren Saguilig, Todd A Alonzo, Stacey L Berg, Nilsa C Ramirez, Alok Jaju, Elizabeth Fox, Brenda J Weigel, Douglas S Hawkins, Margaret M Mooney, Naoko Takebe, James V Tricoli, Katherine A Janeway, Nita L Seibel, D Williams Parsons

Center for Medical Ethics and Health Policy Staff Publications

Background: This is a phase II subprotocol of the NCI-COG Pediatric MATCH study evaluating vemurafenib, a selective oral inhibitor of BRAF V600 mutated kinase, in patients with relapsed or refractory solid tumors harboring BRAF V600 mutations.

Methods: Patients received vemurafenib at 550 mg/m2 (maximum 960 mg/dose) orally twice daily for 28-day cycles until progression or intolerable toxicity. The primary aim was to determine the objective response rate and secondary objectives included estimating progression-free survival and assessing the tolerability of vemurafenib.

Results: Twenty-two patients matched to the subprotocol and 4 patients (18%) enrolled. Primary reasons for non-enrollment were ineligibility due to …

Policy Brief—Safeguarding Women's Health: Trends, Inequities, And Opportunities In Pakistan's Abortion And Postabortion Care Services, Population Council, Guttmacher

Safe Abortion and Postabortion Care

Pakistan is experiencing critical reproductive health issues driven by a high population growth rate of 2.55% per year, low contraceptive use (34% for all methods, 23.4% for modern methods), and a significant unmet need for family planning (17.3%). Low contraceptive use and high unmet need for family planning contribute to high rates of unintended pregnancies which often result in unsafe abortions and postabortion complications.

This policy brief presents the findings of a comprehensive study on abortion and postabortion care in Pakistan. The study was conducted in 2023 by the Population Council in partnership with the Guttmacher Institute. The study is …

Safeguarding Women's Health: Trends, Inequities, And Opportunities In Pakistan's Abortion And Post-Abortion Care Services, Ali M. Mir, Zeba Sathar, Iqbal Shah, Rehan M. Niazi, Tahira Parveen, Susheela Singh

Safe Abortion and Postabortion Care

This report presents the findings of a comprehensive study on abortion and post-abortion care in Pakistan, conducted in 2023 by the Population Council in partnership with the Guttmacher Institute. The study addresses a critical need for updated information on women's reproductive health in Pakistan, a country facing significant challenges including a high population growth rate (2.55% per annum), low contraceptive use (34% for any method, 23.4% for modern methods), and a high unmet need for family planning (17.3%). The study is the third of its kind since 2002, building on previous research conducted in 2002 and 2012. It comes at …

Recreational Cannabis In Louisiana: Anticipating Potential Risks For Motor Vehicle Safety In The Short And Long Term, Aimee H. Moles, Andrew Burns, Ashley Tillison, Austin L. Matthews

Reports

This document, titled Recreational Cannabis in Louisiana: Anticipating Potential Risks for Motor Vehicle Safety in the Short and Long Term, provides a comprehensive analysis of the potential impacts that cannabis legalization could have on road safety in Louisiana. The document is written to equip policymakers and concerned citizens with the necessary knowledge to navigate the complex landscape of cannabis legalization and its implications for public safety.

Key Objectives and Scope: The primary purpose of this document is to evaluate the potential risks associated with recreational cannabis legalization on motor vehicle safety, drawing on data and experiences from Canada and states …

Cerebrovascular Reactivity Mri As A Biomarker For Cerebral Small Vessel Disease–Related Cognitive Decline: Multi-Site Validation In The Markvcid Consortium, Peiying Liu, Zixuan Lin, Kaisha Hazel, George Pottanat, Cuimei Xu, Dengrong Jiang, Jay J. Pillai, Emma Lucke, Christopher E. Bauer, Brian T. Gold, Steven M. Greenburg, Karl G. Helmer, Kay Jann, Gregory Jicha, Joel Kramer, Pauline Maillard, Rachel M. Mulavelil, Pavel Rodriguez, Claudia L. Satizabal, Kristin Schwab, Sudha Seshadri, Herpreet Singh, Ángel G. Velarde Dediós, Danny J. J. Wang, Rita R. Kalyani, Abhay Moghekar, Paul B. Rosenberg, Sevil Yasar, Marilyn Albert, Hanzhang Lu

Neurology Faculty Publications

INTRODUCTION: Vascular contributions to cognitive impairment and dementia (VCID) represent a major factor in cognitive decline in older adults. The present study examined the relationship between cerebrovascular reactivity (CVR) measured by magnetic resonance imaging (MRI) and cognitive function in a multi-site study, using a predefined hypothesis.

METHODS: We conducted the study in a total of three analysis sites and 263 subjects. Each site performed an identical CVR MRI procedure using 5% carbon dioxide inhalation. A global cognitive measure of Montreal Cognitive Assessment (MoCA) and an executive function measure of item response theory (IRT) score were used as outcomes.

RESULTS: CVR …

Health Professional Regulation And Provision Of Quality Health Services; Cross Sectional Analysis Of Private Health Care Providers In Wajir County, Kenya, Ali Ahmed Mohamed Qadar, Wanja Mwaura-Tenambergen, Eunice Muthoni, Luke Wahome Kinyua

Population Health, East Africa

Background: Health professional regulatory bodies oversee and enforce standards in healthcare to safeguard patient safety and prevent harm. However, international consistency in these regulations remains limited. The Kenya health sector relies on various bodies to enforce standards among professionals and institutions, albeit constrained by financial and human resources that hinder effective oversight. This study aimed to assess how regulatory practicessuch as licensing, training oversight, inspection of practice, and quality assurance mechanisms- affect the quality of healthcare provided by private providers.

Methods: The study targeted 108 healthcare providers from 36 private health facilities, primarily nurses and clinical officers. A sample of …

Mda At Your Service: My License Expired, And I’M Overwhelmed, Kristin Johnson Dds

The Journal of the Michigan Dental Association

The Michigan Public Health Code allows a 60-day grace period for license renewal with late fees and CE requirements. For health insurance options, MDA Insurance provides assistance and quotes. Attend the MDA Health Insurance Seminar on Oct. 25 for more insights. Engage in organized dentistry via local society meetings, the MDA Leadership Forum, and the LEAD Program. MDA Insurance offers Medicare support, including educational events on Sept. 13 and 27. For more details, contact relevant MDA representatives.

Rural Oral Health Access Disparities In New York State, Renae Williams Atkinson Dmd, Ms, Stacy Mcilduff Cfre, Hayward Derek Horton Phd

The New York State Dental Journal

Disparities in access to dental care for those whose primary/only dental insurance is Medicaid is a known issue. The infamous case of 12-year-old Deamonte Driver from Maryland brought this great need for access to private dental care through Medicaid to the fore. Yet, to this date, there has been no resource to address this great need.

Dentists accepting Medicaid fall into two categories: those who practice in federally qualified health centers (FQHC), and those who practice privately. FQHCs are known anecdotally to have long waitlists, delaying access to needed care (as in the case of Driver). This is compounded by …

Disparities Surrounding The Availability Of Feminine Hygiene Products In The Workplace, Marlene Ventura

Electronic Theses, Projects, and Dissertations

Menstrual inequality in the workplace continues to exist, affecting financial welfare, mental health, physical health, and access to care. Women have been enduring disparities related to menstruation, including stigma, shame, and period poverty, which are often exacerbated in the workplace. This study aims to explore the experiences of women who do not have access to free feminine hygiene products in the workplace.

The researcher conducted one-to-one interviews in person with employed women (n=9). The questions were semi-structured and based on a survey with nineteen questions addressing areas of menstrual inequality in the workplace. Seven themes were identified: 1) work performance, …

Generating Clinical-Grade Gene-Disease Validity Classifications Through The Clingen Data Platforms, Matt W Wright, Courtney L Thaxton, Tristan Nelson, Marina T Distefano, Juliann M Savatt, Matthew H Brush, Gloria Cheung, Mark E Mandell, Bryan Wulf, T J Ward, Scott Goehringer, Terry O'Neill, Phil Weller, Christine G Preston, Ingrid M Keseler, Jennifer L Goldstein, Natasha T Strande, Jennifer Mcglaughon, Danielle R Azzariti, Ineke Cordova, Hannah Dziadzio, Lawrence Babb, Kevin Riehle, Aleksandar Milosavljevic, Christa Lese Martin, Heidi L Rehm, Sharon E Plon, Jonathan S Berg, Erin R Riggs, Teri E Klein

Center for Medical Ethics and Health Policy Staff Publications

Clinical genetic laboratories must have access to clinically validated biomedical data for precision medicine. A lack of accessibility, normalized structure, and consistency in evaluation complicates interpretation of disease causality, resulting in confusion in assessing the clinical validity of genes and genetic variants for diagnosis. A key goal of the Clinical Genome Resource (ClinGen) is to fill the knowledge gap concerning the strength of evidence supporting the role of a gene in a monogenic disease, which is achieved through a process known as Gene-Disease Validity curation. Here we review the work of ClinGen in developing a curation infrastructure that supports the …

How To Design Equitable Digital Health Tools: A Narrative Review Of Design Tactics, Case Studies, And Opportunities, Amy Bucher, Beenish M Chaudhry, Jean W Davis, Katharine Lawrence, Emily Panza, Manal Baqer, Rebecca T Feinstein, Sherecce A Fields, Jennifer Huberty, Deanna M Kaplan, Isabelle S Kusters, Frank T Materia, Susanna Y Park, Maura Kepper

Center for Medical Ethics and Health Policy Staff Publications

With a renewed focus on health equity in the United States driven by national crises and legislation to improve digital healthcare innovation, there is a need for the designers of digital health tools to take deliberate steps to design for equity in their work. A concrete toolkit of methods to design for health equity is needed to support digital health practitioners in this aim. This narrative review summarizes several health equity frameworks to help digital health practitioners conceptualize the equity dimensions of importance for their work, and then provides design approaches that accommodate an equity focus. Specifically, the Double Diamond …

Genomic Sequencing Research In Pediatric Cancer Care: Decision Making, Attitudes, And Perceived Utility Among Adolescents And Young Adults And Their Parents, Amanda M Gutierrez, Jill O Robinson, Hadley S Smith, Lauren R Desrosiers-Battu, Sarah R Scollon, Isabel Canfield, Rebecca L Hsu, Nicole M Schneider, D Williams Parsons, Sharon E Plon, Wendy Allen-Rhoades, Mary A Majumder, Janet Malek, Amy L Mcguire

Center for Medical Ethics and Health Policy Staff Publications

Purpose: Professional guidelines recommend engaging adolescents and young adults (AYAs) in medical decision making (DM), including whether to undergo genomic sequencing (GS). We explored DM around GS and attitudes after return of GS results among a diverse group of AYAs with cancer and their parents.

Methods: We surveyed AYAs with cancer (n = 75) and their parents (n = 52) 6 months after receiving GS results through the Texas KidsCanSeq study. We analyzed AYAs' DM role in GS research enrollment and their satisfaction with that role. We compared AYAs' and parents' self-reported understanding of, attitudes toward, and perceived utility of …

Measuring Perceived Utility Of Genomic Sequencing: Development And Validation Of The Genetic Utility (Gene-U) Scale For Pediatric Diagnostic Testing, Hadley Stevens Smith, Caryn Kseniya Rubanovich, Jill Oliver Robinson, Ariel N Levchenko, Sarah A Classen, Janet Malek, Barbara Biesecker, Kyle B Brothers, Benjamin S Wilfond, Christine Rini, Sara J Knight, Amy L Mcguire, Cinnamon S Bloss

Center for Medical Ethics and Health Policy Staff Publications

Purpose: Measuring the effects of genomic sequencing (GS) on patients and families is critical for translational research. We aimed to develop and validate an instrument to assess parents' perceived utility of pediatric diagnostic GS.

Methods: Informed by a 5-domain conceptual model, the study comprised 5 steps: (1) item writing, (2) cognitive testing, (3) pilot testing and item reduction, (4) psychometric testing, and (5) evaluation of construct validity. Parents of pediatric patients who had received results of clinically indicated GS participated in structured cognitive interviews and 2 rounds of surveys. After eliminating items based on theory and quantitative performance, we conducted …

Governing With Public Engagement: An Anticipatory Approach To Human Genome Editing, Dorit Barlevy, Eric Juengst, Jeffrey Kahn, Jonathan Moreno, Lauren Lambert, Alta Charo, Hervé Chneiweiss, Mahmud Farooque, David H Guston, Insoo Hyun, Paul S Knoepfler, Cynthia Selin, Rebecca Wilbanks, Manar Zaghlula, Christopher Thomas Scott

Center for Medical Ethics and Health Policy Staff Publications

In response to calls for public engagement on human genome editing (HGE), which intensified after the 2018 He Jiankui scandal that resulted in the implantation of genetically modified embryos, we detail an anticipatory approach to the governance of HGE. By soliciting multidisciplinary experts’ input on the drivers and uncertainties of HGE development, we developed a set of plausible future scenarios to ascertain publics values—specifically, their hopes and concerns regarding the novel technology and its applications. In turn, we gathered a subset of multidisciplinary experts to propose governance recommendations for HGE that incorporate identified publics’ values. These recommendations include: (1) continued …

Promoting Cultural Humility, Belonging, And Inclusion To Improve Well-Being Among Direct Care Staff In Oregon Assisted Living, Residential Care, And Memory Care Communities, 2024, Jacklyn Kohon, Dani Himes, Laura Rodriguez, Sarah Dys, Paula Carder, Diana Jacoby, Madeline Fox

Institute on Aging Publications

The voices and experiences of those working and living in assisted living, residential care, and memory care (AL/RC) settings in Oregon are highlighted in this study to understand cultural humility, belonging, inclusion, and intersectional experiences related to sustaining the workforce and promoting quality care. This qualitative study collected data through individual and focus group interviews with a total of 68 people, including 25 direct care staff, voice memos or interviews with 9 former direct care staff, interviews with 9 administrators, interviews with 7 management representatives (owner/operators, human resources specialists, directors of operations, among other titles), and interviews with 18 current …

Climate And Extreme Weather Event Impacts On Administrators, Direct Care Staff, And Residents In Oregon Assisted Living, Residential Care, And Memory Care Communities, 2024, Dani Himes, Jacklyn Kohon, Madeline Fox, Laura Rodriguez, Sarah Dys, Diana Jacoby, Paula Carder

Institute on Aging Publications

This brief report on AL/RC staff and resident experiences with climate events highlights the voices of AL/RC direct care staff, former direct care staff, residents, administrators, and management representatives to promote well-being in these care settings. This study can inform Oregon’s efforts to support long-term care workforce readiness for future climate emergencies and inform future quantitative data collection on AL/RC and other long-term care workers, including those employed in home health agencies, nursing facilities, and adult foster homes.

Expanding A Behavioral View On Digital Health Access: Drivers And Strategies To Promote Equity, Maura M Kepper, Lauren A Fowler, Isabelle S Kusters, Jean W Davis, Manal Baqer, Sara Sagui-Henson, Yunyu Xiao, Adati Tarfa, Jean C Yi, Bryan Gibson, Kristin E Heron, Nicole M Alberts, Marissa Burgermaster, Veronica Ps Njie-Carr, Lisa M Klesges

Center for Medical Ethics and Health Policy Staff Publications

The potential and threat of digital tools to achieve health equity has been highlighted for over a decade, but the success of achieving equitable access to health technologies remains challenging. Our paper addresses renewed concerns regarding equity in digital health access that were deepened during the COVID-19 pandemic. Our viewpoint is that (1) digital health tools have the potential to improve health equity if equitable access is achieved, and (2) improving access and equity in digital health can be strengthened by considering behavioral science-based strategies embedded in all phases of tool development. Using behavioral, equity, and access frameworks allowed for …