Health Policy Commons^™

Decentralized Clinical Trials For Medications To Reduce The Risk Of Dementia: Consensus Report And Guidance, Leanne Howard, Carla Abdelnour, Erin Abner, Ricardo F. Allegri, Hiroko H. Dodge, Serge Gauthier, Camilla M. Hoyos, Gregory Jicha, Patrick G. Kehoe, Catherine J. Mummery, Adesola Ogunniyi, Nikolaos Scarmeas, Xiaoying Chen, Jodie R. Titiner, Christopher R. Weber, Ruth Peters

Neurology Faculty Publications

INTRODUCTION: Recent growth in the functionality and use of technology has prompted an increased interest in the potential for remote or decentralized clinical trials in dementia. There are many potential benefits associated with decentralized medication trials, but we currently lack specific recommendations for their delivery in the dementia field.

METHODS: A modified Delphi method engaged an expert panel to develop recommendations for the conduct of decentralized medication trials in dementia prevention. A working group of researchers and clinicians with expertise in dementia trials further refined the recommendations.

RESULTS: Overall, the recommendations support the delivery of decentralized trials in dementia prevention …

Examining Dietary Disparities And Associated Factors Among Young Children Across Diverse Racial, Ethnic And Immigrant Households In Nebraska, Naveta Bhatti

College of Education and Human Sciences: Dissertations, Theses, and Student Research

Early childhood is a crucial stage for developing eating behaviors which in turn plays a major role in determining health outcomes. Assessing children’s diet plays a crucial role in tackling the obesity epidemic. One of the ways to assess children’s dietary intake is by evaluating their dietary quality. Dietary quality refers to the overall healthfulness and nutritional value of an individual's diet, considering the combination of foods consumed over time. Research has consistently demonstrated that a high-quality diet is associated with a reduced risk of several health issues, such as all-cause mortality, cardiovascular disease incidence or mortality, cancer incidence or …

Lethal Phenotypes In Mendelian Disorders, Pilar Cacheiro, Samantha Lawson, Ignatia B Van Den Veyver, Gabriel Marengo, David Zocche, Stephen A Murray, Michael Duyzend, Peter N Robinson, Damian Smedley

Center for Medical Ethics and Health Policy Staff Publications

Purpose: Existing resources that characterize the essentiality status of genes are based on either proliferation assessment in human cell lines, viability evaluation in mouse knockouts, or constraint metrics derived from human population sequencing studies. Several repositories document phenotypic annotations for rare disorders; however, there is a lack of comprehensive reporting on lethal phenotypes.

Methods: We queried Online Mendelian Inheritance in Man for terms related to lethality and classified all Mendelian genes according to the earliest age of death recorded for the associated disorders, from prenatal death to no reports of premature death. We characterized the genes across these lethality categories, …

A Risk Is Not A Harm: Abortion Exceptions In State Laws, Trevor M Bibler, Alison Suen

Center for Medical Ethics and Health Policy Staff Publications

This letter responds to the article "Beneath the Sword of Damocles: Moral Obligations of Physicians in a Post-Dobbs Landscape," by Anne Drapkin Lyerly, Ruth R. Faden, and Michelle M. Mello, in the May-June 2024 issue of the Hastings Center Report.

Trans-Ancestral Genetic Risk Factors For Treatment-Related Type 2 Diabetes Mellitus In Survivors Of Childhood Cancer, Cindy Im, Achal Neupane, Jessica L Baedke, Brian Lenny, Angela Delaney, Stephanie B Dixon, Eric J Chow, Sogol Mostoufi-Moab, Tianzhong Yang, Melissa A Richard, M Monica Gramatges, Philip J Lupo, Noha Sharafeldin, Smita Bhatia, Gregory T Armstrong, Melissa M Hudson, Kirsten K Ness, Leslie L Robison, Yutaka Yasui, Carmen L Wilson, Yadav Sapkota

Center for Medical Ethics and Health Policy Staff Publications

Purpose: Type 2 diabetes mellitus (T2D) is a prevalent long-term complication of treatment in survivors of childhood cancer, with marked racial/ethnic differences in burden. In this study, we investigated trans-ancestral genetic risks for treatment-related T2D.

Patients and methods: Leveraging whole-genome sequencing data from the St Jude Lifetime Cohort (N = 3,676, 304 clinically ascertained cases), we conducted ancestry-specific genome-wide association studies among survivors of African and European genetic ancestry (AFR and EUR, respectively) followed by trans-ancestry meta-analysis. Trans-/within-ancestry replication including data from the Childhood Cancer Survivor Study (N = 5,965) was required for prioritization. Three external general population T2D polygenic …

The Road To Tailored Adjuvant Chemotherapy For All Four Non-Pancreatic Periampullary Cancers: An International Multimethod Cohort Study, Bas A Uijterwijk, Daniël H Lemmers, Michele Ghidini, Johanna W Wilmink, Alberto Zaniboni, Giuseppe Kito Fusai, Alessandro Zerbi, Bas Groot Koerkamp, Misha Luyer, Poya Ghorbani, Roberto Salvia, Steven White, Benedetto Ielpo, Brian K P Goh, Ugo Boggi, Geert Kazemier, Michael G House, Vasileios K Mavroeidis, Bergthor Björnsson, Michele Mazzola, Mario Serradilla, Dimitris Korkolis, Adnan Alseidi, Keith J Roberts, Zahir Soonawalla, Patrick Pessaux, William E Fisher, Sharnice Koek, Tara S Kent, Miljana Vladimirov, Louisa Bolm, Nigel Jamieson, Raffaele Dalla Valle, Jorg Kleeff, Alessandro Mazzotta, Miguel Angel Suarez Muñoz, Santiago Sánchez Cabús, Chad G Ball, Adam C Berger, Clarissa Ferarri, Marc G Besselink, Mohammed Abu Hilal, International Study Group On Non-Pancreatic Periampullary Cancer (Isgaca)

Center for Medical Ethics and Health Policy Staff Publications

Background: Despite differences in tumour behaviour and characteristics between duodenal adenocarcinoma (DAC), the intestinal (AmpIT) and pancreatobiliary (AmpPB) subtype of ampullary adenocarcinoma and distal cholangiocarcinoma (dCCA), the effect of adjuvant chemotherapy (ACT) on these cancers, as well as the optimal ACT regimen, has not been comprehensively assessed. This study aims to assess the influence of tailored ACT on DAC, dCCA, AmpIT, and AmpPB.

Patients and methods: Patients after pancreatoduodenectomy for non-pancreatic periampullary adenocarcinoma were identified and collected from 36 tertiary centres between 2010 - 2021. Per non-pancreatic periampullary tumour type, the effect of adjuvant chemotherapy and the main relevant regimens …

Post-Trial Responsibilities In Pragmatic Clinical Trials: Fulfilling The Promise Of Research To Drive Real-World Change, Stephanie R Morain, P Pearl O'Rourke, Joseph Ali, Vasiliki Rahimzadeh, Devon K Check, Hayden B Bosworth, Jeremy Sugarman

Center for Medical Ethics and Health Policy Staff Publications

While considerable scholarship has explored responsibilities owed to research participants at the conclusion of explanatory clinical trials, no guidance exists regarding responsibilities owed at the conclusion of a pragmatic clinical trial (PCT). Yet post-trial responsibilities in PCTs present distinct considerations from those emphasized in existing guidance and prior scholarship. Among these considerations include the responsibilities of the healthcare delivery systems in which PCTs are embedded, and decisions about implementation for interventions that demonstrate meaningful benefit following their integration into usual care settings-or deimplementation for those that fail to do so. In this article, we present an overview of prior scholarship …

Rethinking Medical Quality Training During Residency, Salih Selek

Teaching in Clinics

A brief editorial on medical quality training

2024 Uthealth & Memorial Hermann Quality Symposium Abstracts, Salih Selek

Teaching in Clinics

Every year, the UTHealth McGovern Medical School and Memorial Hermann-Texas Medical Center jointly organize a Quality Symposium, where oral and poster presentations spotlight the outstanding efforts in quality improvement initiatives ongoing at both institutions. Sixty-three teams dedicated to Quality Improvement were chosen to present their projects during the afternoon Poster Session. The abstracts included in this compilation offer a glimpse into the remarkable Quality Improvement endeavors showcased at the 2024 Quality Symposium.

[2024 Honorable Mention] Hasta Que El Cuerpo Aguante, Brisa Rosiles

Ethnic Studies Research Paper Award

The focus of this project revolves around a critical examination of the alarming occurrences of heat stroke-related deaths among field workers in California, with a specific emphasis on cases documented in the Salinas Valley. The core of my artistic expression lies in a digital painting that captures the reality of a laborer enduring the devastating effects of heat stroke in the agricultural fields.

A Phase 2 Clinical Trial To Evaluate The Safety, Reactogenicity, And Immunogenicity Of Different Prime-Boost Vaccination Schedules Of 2013 And 2017 A(H7n9) Inactivated Influenza Virus Vaccines Administered With And Without As03 Adjuvant In Healthy Us Adults, Christina A Rostad, Robert L Atmar, Emmanuel B Walter, Sharon Frey, Jeffery L Meier, Amy C Sherman, Lilin Lai, Rachel Tsong, Carol M Kao, Vanessa Raabe, Hana M El Sahly, Wendy A Keitel, Jennifer A Whitaker, Michael J Smith, Kenneth E Schmader, Geeta K Swamy, Getahun Abate, Patricia Winokur, Wendy Buchanan, Kaitlyn Cross, Ashley Wegel, Yongxian Xu, Inci Yildirim, Satoshi Kamidani, Nadine Rouphael, Paul C Roberts, Mark J Mulligan, Evan J Anderson

Center for Medical Ethics and Health Policy Staff Publications

Introduction: A surge of human influenza A(H7N9) cases began in 2016 in China from an antigenically distinct lineage. Data are needed about the safety and immunogenicity of 2013 and 2017 A(H7N9) inactivated influenza vaccines (IIVs) and the effects of AS03 adjuvant, prime-boost interval, and priming effects of 2013 and 2017 A(H7N9) IIVs.

Methods: Healthy adults (n = 180), ages 19-50 years, were enrolled into this partially blinded, randomized, multicenter phase 2 clinical trial. Participants were randomly assigned to 1 of 6 vaccination groups evaluating homologous versus heterologous prime-boost strategies with 2 different boost intervals (21 vs 120 days) and 2 …

Supporting Ontario Public Health Units To Address Adverse Childhood Experiences In Pandemic Recovery Planning: A Priority-Setting Exercise, Kimberly B Harding, Erica Di Ruggiero, Erick Gonzalez, Amanda Hicks, Daniel W Harrington, Sarah Carsley

Faculty, Staff and Student Publications

BACKGROUND: Adverse childhood experiences (ACEs) are potentially traumatic exposures experienced during childhood, for example, neglect. There is growing evidence that the coronavirus disease 2019 (COVID-19) pandemic and related socioeconomic conditions contributed to an increased risk of ACEs. As public health programs/services are re-evaluated and restored following the state of emergency, it is important to plan using an ACEs-informed lens. The aim of this study was to identify and prioritize initiatives or activities that Public Health Ontario (PHO) could undertake to support Ontario public health units' work towards ACEs-informed pandemic recovery plans.

METHODS: The Child Health and Nutrition Research Initiative method …

Equity In Access For Veterans In The Va Community Care Program, Baligh R. Yehia, Said A. Ibrahim

Department of Medicine Faculty Papers

No abstract provided.

Pm25, Vegetation Density, And Childhood Cancer: A Case-Control Registry-Based Study From Texas 1995–2011, Lindsay A Williams, David Haynes, Jeannette M Sample, Zhanni Lu, Ali Hossaini, Laura A Mcguinn, Thanh T Hoang, Philip J Lupo, Michael E Scheurer

Center for Medical Ethics and Health Policy Staff Publications

Background: Air pollution is positively associated with some childhood cancers, whereas greenness is inversely associated with some adult cancers. The interplay between air pollution and greenness in childhood cancer etiology is unclear. We estimated the association between early-life air pollution and greenness exposure and childhood cancer in Texas (1995 to 2011).

Methods: We included 6101 cancer cases and 109 762 controls (aged 0 to 16 years). We linked residential birth address to census tract annual average fine particulate matter < 2.5 µg/m³ (PM2.5) and Normalized Difference Vegetation Index (NDVI). We estimated odds ratios (ORs) and 95% confidence intervals (CIs) between PM2.5/NDVI interquartile range increases and cancer. We assessed statistical interaction between PM2.5 and NDVI (likelihood ratio tests).

Results: Increasing residential early-life PM2.5 exposure was associated with all childhood cancers (OR = 1.10, 95% CI = 1.06 to 1.15), …

The Cost Of Long-Term Care In The Mountain West, 2023, Madison Dwyer, Freddy Nie, Annie Vong, Caitlin J. Saladino, William E. Brown Jr.

Health

This fact sheet examines data on the cost of long-term care for the Mountain West states of Arizona, Colorado, Nevada, New Mexico, and Utah from the Genworth “Cost of Care Survey.” Data on long-term care includes home health care, adult day health care facilities, licensed assisted living facilities, and certified and licensed nursing homes.

Developing An Ethics And Policy Framework For Psychedelic Clinical Care: A Consensus Statement, Amy L Mcguire, I Glenn Cohen, Dominic Sisti, Matthew Baggott, Yuria Celidwen, Nese Devenot, Sabrina Gracias, Charles Grob, Ifetayo Harvey, Brent Kious, Mason Marks, Michael Mithoefer, Elizabeth Nielson, Dost Öngür, Alexandra Pallas, Andrew Peterson, Eduardo E Schenberg, Paul Summergrad, Brett Waters, Monnica T Williams, David B Yaden

Center for Medical Ethics and Health Policy Staff Publications

Importance: As government agencies around the globe contemplate approval of the first psychedelic medicines, many questions remain about their ethical integration into mainstream medical practice.

Objective: To identify key ethics and policy issues related to the eventual integration of psychedelic therapies into clinical practice.

Evidence review: From June 9 to 12, 2023, 27 individuals representing the perspectives of clinicians, researchers, Indigenous groups, industry, philanthropy, veterans, retreat facilitators, training programs, and bioethicists convened at the Banbury Center at Cold Spring Harbor Laboratory. Prior to the meeting, attendees submitted key ethics and policy issues for psychedelic medicine. Responses were categorized into 6 …

Determining Factors For Improved Uptake Of Harm Reduction Services In The United States: A Study Of Inclusive, Culturally Sensitive Messaging, Lauretta Ekanem Omale

Dissertations

Harm reduction refers to public health policies and programs aimed at decreasing the adverse consequences associated with drug use. While harm reduction services (e.g., syringe exchange programs) can mitigate health risks, marginalized groups face barriers to service access and utilization, partially due to ineffective messaging approaches that fail to align with cultural values and experiences. A one-size-fits-all approach to messaging can negatively impact service utilization, health outcomes, and health disparities. Ineffective communication can lead to poor adherence to treatment, poorer health outcomes, and increased adverse events.

Culturally insensitive communication contributes to stigma, mistrust, and lack of perceived relevance, discouraging service …

Essays In Applied Microeconomics, Ege Aksu

Dissertations, Theses, and Capstone Projects

This dissertation consists of two chapters that investigate the effect of public health policies on health outcomes.

The first chapter evaluates the impact of the extensive health care reforms enacted between 2003–2013 under the Health Transformation Program (HTP) in Turkey on maternal and infant health outcomes for the poor. By focusing on a specific insurance program (Green Card) expansion that was a part of HTP, I explore changes in infant survival, fertility, and children’s vaccination status. Before 2004, all public health insurance beneficiaries (the control group) were covered for outpatient services, including prenatal and postnatal doctor visits, gestational diabetes screenings, …

Why Does The Cost Of Employer-Sponsored Coverage Keep Rising?, Salpy Kanimian, Vivian Ho

Center for Medical Ethics and Health Policy Staff Publications

Over the past 25 years, the gap between the increase in health insurance costs and workers' wages has significantly expanded. This trend has led to significant concerns about healthcare affordability, with surveys revealing conflicting opinions regarding whether hospitals or health insurance companies bear the blame for escalating costs. To better understand these dynamics, we examined consumer price indices for health insurance, hospital services, and professional services from 2006 to 2023 using Bureau of Labor Statistics data. Our analysis shows that the hospital price index rose steadily between 2006 and 2023, faster than insurance premiums or professional services. To examine whether …

Latin American Trans-Ancestry Initiative For Ocd Genomics (Latino): Study Protocol, James J Crowley, Carolina Cappi, Marcos E Ochoa-Panaifo, Renee M Frederick, Minjee Kook, Andrew D Wiese, Diana Rancourt, Elizabeth G Atkinson, Paola Giusti-Rodriguez, Jacey L Anderberg, Latin American Trans‐Ancestry Initiative For Ocd Genomics, Brazilian Obsessive‐Compulsive Spectrum Disorder Working Group, Jonathan S Abramowitz, Victor R Adorno, Cinthia Aguirre, Gilberto S Alves, Gustavo S Alves, Naeshia Ancalade, Alejandro A Arellano Espinosa, Paul D Arnold, Daphne M Ayton, Izabela G Barbosa, Laura Marcela Barón Castano, Cynthia N Barrera, María Celeste Berardo, Dayan Berrones, John R Best, Tim B Bigdeli, Christie L Burton, Joseph D Buxbaum, Jennifer L Callahan, Maria Cecília B Carneiro, Sandra L Cepeda, Evelyn Chazelle, Jessica M Chire, Macarena Churruca Munoz, Pamela Claisse Quiroz, Journa Cobite, Jonathan S Comer, Daniel L Costa, Jennifer Crosbie, Victor O Cruz, Guillermo Dager, Luisa F Daza, Anabel De La Rosa-Gómez, Daniela Del Río, Fernanda Z Delage, Carolina B Dreher, Lucila Fay, Tomas Fazio, Ygor A Ferrão, Gabriela M Ferreira, Edith G Figueroa, Leonardo F Fontenelle, Diego A Forero, Daniele T H Fragoso, Bharathi S Gadad, Sheldon R Garrison, Andres González, Laura D Gonzalez, Marco A González, Polaris Gonzalez-Barrios, Wayne K Goodman, Dorothy E Grice, Jerry Guintivano, Daniel G Guttfreund, Andrew G Guzick, Matthew W Halvorsen, Joseph D Hovey, Hailiang Huang, Jonathan Irreño-Sotomonte, Reinhard Janssen-Aguilar, Matias Jensen, Alexandra Z Jimenez Reynolds, Joali Alexandra Juárez Lujambio, Nasim Khalfe, Madison A Knutsen, Caleb Lack, Nuria Lanzagorta, Monicke O Lima, Melanie O Longhurst, David A Lozada Martinez, Elba S Luna, Andrea H Marques, Molly S Martinez, Maria De Los Angeles Matos, Caitlyn E Maye, Joseph F Mcguire, Gabriela Menezes, Charlene Minaya, Tomás Miño, Sara M Mithani, Circe Montes De Oca, Alonso Morales-Rivero, Maria E Moreira-De-Oliveira, Olivia J Morris, Sandra I Muñoz, Zainab Naqqash, Ambar A Núñez Bracho, Belinda E Núñez Bracho, Maria Corina Ochoa Rojas, Luis A Olavarria Castaman, Trinidad Olivos Balmaceda, Iliana Ortega, Darpan I Patel, Ainsley K Patrick, Mariel Paz Y Mino, Jose L Perales Orellana, Bárbara Perdigão Stumpf, Tamara Peregrina, Tania Pérez Duarte, Kelly L Piacsek, Maritza Placencia, María Belén Prieto, Lucas C Quarantini, Yana Quarantini-Alvim, Renato T Ramos, Iaroslava C Ramos, Vanessa R Ramos, Kesley A Ramsey, Elise V Ray, Margaret A Richter, Bradley C Riemann, Juan C Rivas, Maria C Rosario, Camilo J Ruggero, Angel A Ruiz-Chow, Alejandra Ruiz-Velasco, Melisa N Sagarnaga, Aline S Sampaio, Leonardo C Saraiva, Russell J Schachar, Sophie C Schneider, Ethan J Schweissing, Laura D Seligman, Roseli G Shavitt, Keaton J Soileau, S Evelyn Stewart, Shaina B Storch, Emily R Strouphauer, Vissente Tapia Cuevas, Kiara R Timpano, Beatriz Treviño-De La Garza, Alexie Vallejo-Silva, Javier Vargas-Medrano, María I Vásquez, Guadalupe Vidal Martinez, Saira A Weinzimmer, Mauricio A Yanez, Gwyneth Zai, Lina M Zapata-Restrepo, Luz M Zappa, Raquel M Zepeda-Burgos, Anthony W Zoghbi, Euripedes C Miguel, Carolyn I Rodriguez, Mayra C Martinez Mallen, Pablo R Moya, Tania Borda, María Beatriz Moyano, Manuel Mattheisen, Stacey Pereira, Gabriel Lázaro-Muñoz, Karen G Martinez-Gonzalez, Michele T Pato, Humberto Nicolini, Eric A Storch

Center for Medical Ethics and Health Policy Staff Publications

Obsessive-compulsive disorder (OCD) is a debilitating psychiatric disorder. Worldwide, its prevalence is ~2% and its etiology is mostly unknown. Identifying biological factors contributing to OCD will elucidate underlying mechanisms and might contribute to improved treatment outcomes. Genomic studies of OCD are beginning to reveal long-sought risk loci, but >95% of the cases currently in analysis are of homogenous European ancestry. If not addressed, this Eurocentric bias will result in OCD genomic findings being more accurate for individuals of European ancestry than other ancestries, thereby contributing to health disparities in potential future applications of genomics. In this study protocol paper, we …