Health Policy Commons^™

Medication Assisted Treatment: Prescription Drug And Opioid Addiction Expansion Project, Mary Lindsey Smith Phd, Katharine Knight Mph, Mark Richards Bs, Tyler Egeland Ba, Evelyn Ali Bs

Substance Use Research & Evaluation

Greater Portland Health (GPH) in collaboration with Preble Street Resource Center was awarded a Medication Assisted Treatment: Prescription Drug & Opioid Addiction (MOUD-PDOA) grant from SAMHSA. The GPH MOUD-PDOA project will include a mixed-methods evaluation led by Catherine E. Cutler Institute. The evaluation team will build knowledge and provide feedback to inform the implementation and refinement of the GPH MOUD-PDOA Program.

Evaluation Goals:

• Document program strategies and identify barriers and facilitators to implementation
• Examine the efficacy of using a continuum of treatment services to increase access to MOUD among vulnerable populations in underserved communities
• Assess the impact of the intervention …

Nursing Abroad: A Comparison Of Healthcare In Italy, Sweden, And The Us, Sadie Stark

The Eleanor Mann School of Nursing Undergraduate Honors Theses

No healthcare system is perfect, nor does one system work for all populations. History and culture have dictated the mindset of people for generations. It is the ever-changing mindset of patients and providers that will continue to expand and improve international healthcare by first changing daily practices. Nursing in Italy, Sweden, and the United States look very similar but also have a number of differences. Each country’s healthcare system works for its population, but efforts for international collaboration could still prove beneficial. Whether it be universal or private, centralized or localized, a patient centered focus is the driving force behind …

Staff Matters: What Will Be The Impact Of Changes To Michigan’S New Paid Sick Leave Law?, Jodi Schafer Sphr, Shrm-Scp

The Journal of the Michigan Dental Association

Michigan's paid sick leave law has seen several changes in recent years, and the latest updates, if upheld, will go into effect in February 2023. The original ballot-initiated law requires most employers to provide paid sick leave to employees. Employers need to be proactive in understanding the potential impact of these changes, including accrual rates, usage limits, notice requirements, and supporting documentation. It's crucial to review current leave policies and prepare for compliance if the law takes effect.

Headquarters Report: Mda Strategic Plan: In The Rear View Mirror And Around The Curve, Karen Burgess Cae

The Journal of the Michigan Dental Association

The Association Executive Director's year-end report discusses the accomplishments and challenges of the MDA's 2021-25 Strategic Plan. Member value remains high, as indicated by a Net Promoter Score of 43 and positive feedback on benefits like TDSC.com. However, younger practitioners are less engaged due to pandemic-related challenges. Member engagement saw a successful in-person Annual Session and increased online engagement. Organizational sustainability remains strong, but efforts are focused on maintaining membership participation. Diversity, equity, and inclusion initiatives, including a collaborative website, made significant progress. Advocacy efforts resulted in Medicaid reform and defeating restrictive bills. The report concludes by emphasizing the evolving …

Dentistry And The Law: Employee Vs. Independent Contractor, Dan Schulte Jd

The Journal of the Michigan Dental Association

This month’s Dentistry and the Law column discusses hiring a dentist as an employee or an independent contractor. Employing a dentist as an independent contractor offers advantages such as avoiding compliance with various employment laws and not having to withhold taxes. However, there is uncertainty regarding whether tax and other authorities will recognize the independent contractor relationship. Factors like supervision and control play a significant role in this determination. To mitigate uncertainty, practices can contract with an entity owned by the dentist, providing a potential solution. Legal counsel is recommended for setting up such arrangements.

Lack Of Consensus Among Healthcare Professionals At A Large Academic Medical Center On The Use Of Exome Sequencing For Prenatal Diagnosis, Kylie Johnson, Hadi Erfani, Mohamad Ali Maktabi, Ignatia Van Den Veyver, Salma Nassef

Center for Medical Ethics and Health Policy Staff Publications

Prenatal exome sequencing (ES) is increasingly used for prenatal diagnosis because emerging data indicate it has incremental diagnostic benefit in pregnancies with fetal anomalies without identified genetic abnormalities by karyotyping and chromosomal microarray analysis. The aim of this study was to evaluate the medical community's attitude toward the clinical utility and use of exome sequencing for prenatal diagnosis and to address differences in attitudes and responses by type of practitioner, level of training, and years passed since last full-time training. We analyzed the answers of 109 trainees and professionals in the fields of genetic counseling, laboratory science, and medicine to …

Prenatal Phenotyping Of Fetal Tubulinopathies: A Multicenter Retrospective Case Series, Bobby K Brar, Marisa Gilstrop Thompson, Neeta L Vora, Kelly Gilmore, Karin Blakemore, Kristen A Miller, Jessica Giordano, Andreas Dufke, Beatrix Wong, Samantha Stover, Billie Lianoglou, Ignatia Van Den Veyver, Esther Dempsey, Mara Rosner, Karen Chong, David Chitayat, Teresa N Sparks, Mary E Norton, Ronald Wapner, Kristin Baranano, Angie C Jelin, Fetal Sequencing Consortium

Center for Medical Ethics and Health Policy Staff Publications

Objective: Tubulinopathies refer to conditions caused by genetic variants in isotypes of tubulin resulting in defective neuronal migration. Historically, diagnosis was primarily via postnatal imaging. Our objective was to establish the prenatal phenotype/genotype correlations of tubulinopathies identified by fetal imaging.

Methods: A large, multicenter retrospective case series was performed across nine institutions in the Fetal Sequencing Consortium. Demographics, fetal imaging reports, genetic screening and diagnostic testing results, delivery reports, and neonatal imaging reports were extracted for pregnancies with a confirmed molecular diagnosis of a tubulinopathy.

Results: Nineteen pregnancies with a fetal tubulinopathy were identified. The most common prenatal imaging findings …

Effect Of Problem-Solving Treatment On Self-Reported Disability Among Veterans With Gulf War Illness: A Randomized Clinical Trial, Lisa M Mcandrew, Karen S Quigley, Shou-En Lu, David Litke, Joseph F Rath, Gudrun Lange, Susan L Santos, Nicole Anastasides, Beth Ann Petrakis, Lauren Greenberg, Drew A Helmer, Wilfred R Pigeon

Center for Medical Ethics and Health Policy Staff Publications

Importance: Few evidence-based treatments are available for Gulf War illness (GWI). Behavioral treatments that target factors known to maintain the disability from GWI, such as problem-solving impairment, may be beneficial. Problem-solving treatment (PST) targets problem-solving impairment and is an evidence-based treatment for other conditions.

Objective: To examine the efficacy of PST to reduce disability, problem-solving impairment, and physical symptoms in GWI.

Design, setting, and participants: This multicenter randomized clinical trial conducted in the US Department of Veterans Affairs compared PST with health education in a volunteer sample of 511 Gulf War veterans with GWI and disability (January 1, 2015, to …

Phase I Car-T Clinical Trials Review, Shaun Bulsara, Mengfen Wu, Tao Wang

Center for Medical Ethics and Health Policy Staff Publications

Background/aim: Chimeric antigen receptor (CAR) T cells with tumor specificity are being increasingly investigated. Phase I trials are the first step of testing for safety of novel CAR-T therapy to determine the maximum tolerated dose (MTD). Several dose escalation methods have been developed over time including rule-based, model-based, and model-assisted designs. The goal of this project is to overview the phase I designs used in current CAR-T trials.

Materials and methods: We searched PubMed for peer-reviewed literature published between January 1, 2015 and December 31, 2021. The search was limited to human studies in the English language using the keywords …

Malnutrition Vaccines For An Imminent Global Food Catastrophe, Peter J Hotez

Center for Medical Ethics and Health Policy Staff Publications

Together with climate change, both the geopolitical events in Ukraine and social disruptions in supply chains from the COVID-19 pandemic could produce global food shortages or even mass starvation events. Promising new interventions include vaccines to prevent infectious causes of malnutrition or infections disproportionately causing death among the malnourished.

Clinical And Demographic Factors Contributing To Asparaginase-Associated Toxicities In Children With Acute Lymphoblastic Leukemia, Priyadarshani Dharia, Michael D Swartz, M Brooke Bernhardt, Han Chen, M Monica Gramatges, Philip J Lupo, Austin L Brown, Michael E Scheurer

Center for Medical Ethics and Health Policy Staff Publications

A total of 548 patients (age range: 1-22 years, 60.4% Hispanic, 55.8% male) diagnosed with acute lymphoblastic leukemia were reviewed for pegaspargase-associated hypersensitivity (14.8%), hyperbilirubinemia (9.7%), venous thromboembolism (VTE, 9.7%), and pancreatitis (5.3%). Odds ratios (OR) and 95% confidence intervals (CI) evaluated associations between clinical factors and each toxicity, cumulative number of toxicities, and toxicity clusters identified using k-mode analysis. Most (68.9%) did not experience any toxicity, 24.6% experienced one toxicity, and 6.3% two or more. Age >10 years was associated with hyperbilirubinemia (OR = 3.83; 95% CI: 1.64-8.95), pancreatitis (OR = 3.72; 95% CI: 1.29-10.68), VTE (OR = 4.65; …

Germline Genetic And Treatment-Related Risk Factors For Diabetes Mellitus In Survivors Of Childhood Cancer: A Report From The Childhood Cancer Survivor Study And St Jude Lifetime Cohorts, Melissa A Richard, Sogol Mostoufi-Moab, Nisha Rathore, Jessica Baedke, Austin L Brown, Stephen J Chanock, Danielle N Friedman, M Monica Gramatges, Rebecca M Howell, Kala Y Kamdar, Wendy M Leisenring, Lillian R Meacham, Lindsay M Morton, Kevin Oeffinger, Leslie L Robison, Yadav Sapkota, Charles A Sklar, Gregory T Armstrong, Smita Bhatia, Philip J Lupo

Center for Medical Ethics and Health Policy Staff Publications

Purpose: To characterize germline genetic risk factors of diabetes mellitus among long-term survivors of childhood cancer.

Methods: Adult survivors of childhood cancer from the Childhood Cancer Survivor Study (CCSS) Original Cohort (n = 5,083; 383 with diabetes) were used to conduct a discovery genome-wide association study. Replication was performed using the CCSS Expansion (n = 2,588; 40 with diabetes) and the St Jude Lifetime (SJLIFE; n = 3,351; 208 with diabetes) cohorts. Risk prediction models, stratified on exposure to abdominal radiation, were calculated using logistic regression including attained age, sex and body mass index, diagnosis, alkylating chemotherapy, age at cancer …

Incidence Of An Insulin-Requiring Hyperglycemic Syndrome In Sars-Cov-2-Infected Young Individuals: Is It Type 1 Diabetes?, Massimo Pietropaolo, Peter Hotez, Nick Giannoukakis

Center for Medical Ethics and Health Policy Staff Publications

Pancreatic ACE2 receptor expression, together with increased prevalence of insulin-requiring hyperglycemia in patients with coronavirus disease 2019 (COVID-19), suggested that severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pancreatic infection might trigger a β-cell-selective inflammation precipitating autoimmune type 1 diabetes (T1D). We examined T1D incidence in patients with COVID-19 inside a large, global population using a "big data" approach. The incidence in 0-30-year-old patients with confirmed COVID-19 over an ∼15-month period from the beginning of the COVID-19 pandemic was compared with an age-matched population without COVID-19 inside the TriNetX COVID-19 Research Network (>80 million deidentified patient electronic medical records globally). …

Quality Of Life Of Hypertensive Patients Undergoing Chronic Disease Management Program During The Covid-19 Pandemic, Widya Astuty Lolo, Gayatri Citraningtyas, Deby Afriani Mpila, Heri Wijaya, Sandeep Poddar

Kesmas

The COVID-19 pandemic has restricted some common activities for hypertensive patients undergoing the Chronic Disease Management Program/Program Pengelolaan Penyakit Kronis in primary health care, decreasing the quality of life. This study aimed to measure the quality of life of hypertensive patients undergoing the Chronic Disease Management Program at primary health care of Manado City, North Sulawesi Province, Indonesia, during the COVID-19 pandemic and determine the factors influencing hypertension such as sex, age, education, employment status, monthly income and duration of hypertension. This cross-sectional study was carried out on 150 hypertensive patients randomly sampled at primary health care from June to …

The Potential Of Private Health Insurance Ownership Based On The 2018-2020 National Socioeconomic Survey Data, Arief Rosyid Hasan, Adang Bachtiar, Cicilya Candi

Kesmas

In 2014, the Indonesian Government introduced a social security program in the health sector. However, Indonesia’s out-of-pocket expenses remain high due to a lack of public interest in National Health Insurance services. Financing expensive health services with high out-of-pocket expenses has the potential to cause poverty. Private health insurance is considered a solution to this problem. This study aimed to determine the socioeconomic factors of private health insurance ownership and its potential in Indonesia. This study used secondary data from the 2018, 2019, and 2020 National Socioeconomic Surveys. Logistic regression analysis showed that the variables related to private health insurance …

Long-Term Care In The United States: History, Financing, And Directions For Reform, George A. (Sandy) Mackenzie

Upjohn Press

This book is a concise survey of the development of U.S. long-term care and its financing, with comparisons with other rich countries. It also includes a brief comparative account of the impact of the COVID-19 pandemic in the United States and several other countries. The study finds much that is amiss with American long-term care and proposes three sets of progressively more ambitious reforms.

Financial Well-Being Of Frontline Healthcare Workers: The Importance Of Employer Benefits, Mathieu Despard, Sophia Fox-Dichter, Haotian Zheng, Grace Anderson, Olivia Borland, Kourtney Gilbert

Social Policy Institute Research

Frontline healthcare workers – especially direct care workers (DCWs), such as home health aides, struggle due to low pay, lack of benefits, and difficult working conditions. The need for these workers is growing. Unless frontline healthcare jobs improve, positions may be difficult to fill, and care for vulnerable members of society may be compromised.

In this study, we surveyed 2,321 frontline healthcare workers and conducted in-depth interviews with 30 of these workers concerning pay, benefits, work conditions, and financial well-being. Key survey findings included:

• Only 39% of workers were eligible for at least four out of five major benefits (e.g., …

Implementing Just Climate Adaptation Policy: An Analysis Of Recognition, Framing, And Advocacy Coalitions In Boston, U.S.A., Jeffrey T. Malloy, Catherine Ashcraft, Paul Kirshen, Thomas G. Safford, Semra Aytur, Shannon H. Rogers

Faculty Publications

Cities face intersectional challenges implementing climate adaptation policy. This research contributes to scholarship dedicated to understanding how policy implementation affects socially vulnerable groups, with the overarching goal of promoting justice and equity in climate policy implementation. We apply a novel framework that integrates social justice theory and the advocacy coalition framework to incrementally assess just climate adaptation in Boston, Massachusetts in the United States. Boston made an ambitious commitment to address equity as part of its climate planning and implementation efforts. In this paper, we evaluate the first implementation stage over the period 2016–2019 during which Boston developed coastal resilience …

Air Quality In The Mountain West, 2018-2020, Zachary Billot, Zachary Walusek, Caitlin J. Saladino, William E. Brown Jr.

Environment

This fact sheet examines the state of air quality, including ozone levels and particle pollution, throughout the Mountain West from 2018 to 2020. Data from the American Lung Association “State of the Air” report is used to determine the quality of air in the Mountain West states of Arizona, Colorado, Nevada, New Mexico, and Utah.

Telerehabilitation: Future Of Phase Ii Cardiac Rehabilitation: Review Of Preliminary Outcomes, Mon S Bryant, Savitri E Fedson, Alexander Schutz, Lorraine D Cornwell, Amir Sharafkhaneh, Bandi Venkata

Center for Medical Ethics and Health Policy Staff Publications

In this brief communication, we reported Telehealth Home-Based Cardiac Rehabilitation (CR) program structure and preliminary outcomes from patients that completed a 12-week program after coronary artery bypass graft surgery (CABG). We aim to advocate the use of Telerehabilitation as a Phase II CR in patients immediately after the CABG. This approach was innovative and encouraging because the patients were still in subacute phase. The program can serve as a continuation of care for the patients after being discharged from a hospital while regaining their functional ability at home. Our preliminary outcomes demonstrated improvements in resting heart rate, activity level, nutrition …