Health Policy Commons^™

Leveraging Clinical Trial Populations And Data From The Children's Oncology Group For Cancer Survivorship Research, Eric J Chow, Lena E Winestone, Philip J Lupo, Lisa R Diller, Tara O Henderson, Nina S Kadan-Lottick, Jennifer M Levine, Kirsten K Ness, Smita Bhatia, Saro H Armenian

Center for Medical Ethics and Health Policy Staff Publications

Children and adolescents diagnosed with cancer can now expect an average 85% 5-year overall survival, with significant improvements in longer-term morbidity and mortality reported over the past several decades. However, the long-term impact of therapeutic agents and modalities introduced in recent years remains unclear and will require dedicated follow-up in the years ahead. The Children's Oncology Group (COG), a part of the NCI's National Clinical Trials Network, with over 200 sites across North America and beyond, enrolls more than 10,000 patients onto research protocols annually, inclusive of first-line clinical trials and nontherapeutic studies. COG provides a platform to conduct survivorship …

Adult Day Services In Maine: Benefits, Challenges, And Opportunities, Elizabeth Gattine Jd, Eileen Griffin Jd, Kimberly I. Snow Mhsa, Ba

Disability & Aging

In Maine and nationally, adult day services tend to be underfunded and underutilized compared to other types of long term services and supports (LTSS). In part, investment in adult day services is hampered by a lack of standardized data collection and limited research on issues of accessibility, cost-effectiveness, and the impact of adult day services on the broader health system. Lack of uniformity in state regulatory frameworks for licensing, program design, service delivery, and other administrative requirements further complicates cross-state comparisons. Considering these limitations, a key goal of this report is to provide a more detailed and comprehensive understanding of …

Recommendations For Whole Genome Sequencing In Diagnostics For Rare Diseases, Erika Souche, Sergi Beltran, Erwin Brosens, John W Belmont, Magdalena Fossum, Olaf Riess, Christian Gilissen, Amin Ardeshirdavani, Gunnar Houge, Marielle Van Gijn, Jill Clayton-Smith, Matthis Synofzik, Nicole De Leeuw, Zandra C Deans, Yasemin Dincer, Sebastian H Eck, Saskia Van Der Crabben, Meena Balasubramanian, Holm Graessner, Marc Sturm, Helen Firth, Alessandra Ferlini, Rima Nabbout, Elfride De Baere, Thomas Liehr, Milan Macek, Gert Matthijs, Hans Scheffer, Peter Bauer, Helger G Yntema, Marjan M Weiss

Center for Medical Ethics and Health Policy Staff Publications

In 2016, guidelines for diagnostic Next Generation Sequencing (NGS) have been published by EuroGentest in order to assist laboratories in the implementation and accreditation of NGS in a diagnostic setting. These guidelines mainly focused on Whole Exome Sequencing (WES) and targeted (gene panels) sequencing detecting small germline variants (Single Nucleotide Variants (SNVs) and insertions/deletions (indels)). Since then, Whole Genome Sequencing (WGS) has been increasingly introduced in the diagnosis of rare diseases as WGS allows the simultaneous detection of SNVs, Structural Variants (SVs) and other types of variants such as repeat expansions. The use of WGS in diagnostics warrants the re-evaluation …

Vaccine-Linked Chemotherapy With A Low Dose Of Benznidazole Plus A Bivalent Recombinant Protein Vaccine Prevents The Development Of Cardiac Fibrosis Caused By Trypanosoma Cruzi In Chronically-Infected Balb/C Mice, Victor Manuel Dzul-Huchim, Maria Jesus Ramirez-Sierra, Pedro Pablo Martinez-Vega, Miguel Enrique Rosado-Vallado, Victor Ermilo Arana-Argaez, Jaime Ortega-Lopez, Fabian Gusovsky, Eric Dumonteil, Julio Vladimir Cruz-Chan, Peter Hotez, María Elena Bottazzi, Liliana Estefania Villanueva-Lizama

Center for Medical Ethics and Health Policy Staff Publications

Background: Chagas disease (CD) is caused by Trypanosoma cruzi and affects 6-7 million people worldwide. Approximately 30% of chronic patients develop chronic chagasic cardiomyopathy (CCC) after decades. Benznidazole (BNZ), one of the first-line chemotherapy used for CD, induces toxicity and fails to halt the progression of CCC in chronic patients. The recombinant parasite-derived antigens, including Tc24, Tc24-C4, TSA-1, and TSA-1-C4 with Toll-like receptor 4 (TLR-4) agonist-adjuvants reduce cardiac parasite burdens, heart inflammation, and fibrosis, leading us to envision their use as immunotherapy together with BNZ. Given genetic immunization (DNA vaccines) encoding Tc24 and TSA-1 induce protective immunity in mice and …

Will Anti-Vaccine Activism In The Usa Reverse Global Goals?, Peter J Hotez

Center for Medical Ethics and Health Policy Staff Publications

In the time of the COVID-19 pandemic, anti-vaccine activism in the USA accelerated, amplified and formed an alliance with political groups and even extremists. An organized, well-funded and empowered anti-science movement now threatens to spill over and threaten all childhood immunizations in the USA and globally.

An Ultra-Brief Screening Scale For Pediatric Obsessive-Compulsive Disorder: The Oci-Cv-5, Amitai Abramovitch, Jonathan S Abramowitz, Dean Mckay, Heining Cham, Kennedy S Anderson, Lara J Farrell, Daniel A Geller, Gregory L Hanna, Sharna Mathieu, Joseph F Mcguire, David R Rosenberg, S Evelyn Stewart, Eric A Storch, Sabine Wilhelm

Center for Medical Ethics and Health Policy Staff Publications

Background: Obsessive-compulsive disorder (OCD) is an often disabling and chronic condition that is normally assessed using diagnostic interviews or lengthy self-report questionnaires. This makes routine screening in general health settings impractical, and as a result OCD is often under-(or mis-)recognized. The present study reports on the development of an ultra-brief version of the Obsessive-Compulsive Inventory-Child Version (OCI-CV) which may be administered routinely as a screener for pediatric OCD.

Method: A total of 489 youth diagnosed with OCD, 259 non-clinical controls, and 299 youth with other disorders completed the OCI-CV and other indices of psychopathology. Using item analyses, we extracted five …

High Prevalence Of Osteopathy In Chronic Pancreatitis: A Cross-Sectional Analysis From The Proceed Study, Phil A Hart, Dhiraj Yadav, Liang Li, Savi Appana, William Fisher, Evan Fogel, Chris E Forsmark, Walter G Park, Stephen Pandol, Mark D Topazian, Stephen K Van Den Eden, Santhi Swaroop Vege, David Bradley, Jose Serrano, Darwin L Conwell

Center for Medical Ethics and Health Policy Staff Publications

Background & aims: Chronic pancreatitis (CP) is associated with osteopathy (osteoporosis or osteopenia). However, existing literature is mostly limited to retrospective or administrative studies that have not clearly defined the prevalence and risk factors. Our aim was to identify patient- and disease-related associations with osteopathy in a prospective cohort study of CP.

Methods: We studied 282 subjects with definitive CP enrolled in the PROCEED study who had a baseline dual-energy X-ray absorptiometry (DXA) scan. Osteopenia and osteoporosis were defined using the lowest T-scores. Clinical data were collected using standardized case report forms. Comparisons were performed with a multivariate logistic regression …

Rates Of Laboratory Adverse Events By Course In Paediatric Leukaemia Ascertained With Automated Electronic Health Record Extraction: A Retrospective Cohort Study From The Children’S Oncology Group, Tamara P Miller, Kelly D Getz, Yimei Li, Biniyam G Demissei, Peter C Adamson, Todd A Alonzo, Evanette Burrows, Lusha Cao, Sharon M Castellino, Marla H Daves, Brian T Fisher, Robert Gerbing, Robert W Grundmeier, Edward M Krause, Judy Lee, Philip J Lupo, Karen R Rabin, Mark Ramos, Michael E Scheurer, Jennifer J Wilkes, Lena E Winestone, Douglas S Hawkins, M Monica Gramatges, Richard Aplenc

Center for Medical Ethics and Health Policy Staff Publications

Background: Adverse events are often misreported in clinical trials, leading to an incomplete understanding of toxicities. We aimed to test automated laboratory adverse event ascertainment and grading (via the ExtractEHR automated package) to assess its scalability and define adverse event rates for children with acute myeloid leukaemia and acute lymphoblastic leukaemia.

Methods: For this retrospective cohort study from the Children's Oncology Group (COG), we included patients aged 0-22 years treated for acute myeloid leukaemia or acute lymphoblastic leukaemia at Children's Healthcare of Atlanta (Atlanta, GA, USA) from Jan 1, 2010, to Nov 1, 2018, at the Children's Hospital of Philadelphia …

Change During Cognitive And Exposure Phases Of Cognitive-Behavioral Therapy For Autistic Youth With Anxiety Disorders, Andrew G Guzick, Sophie C Schneider, Philip C Kendall, Jeffrey J Wood, Connor M Kerns, Brent J Small, Ye Eun Park, Sandra L Cepeda, Eric A Storch

Center for Medical Ethics and Health Policy Staff Publications

Objective: To evaluate improvement during the (a) cognitive and (b) exposure therapy phases of cognitive-behavioral therapy (CBT) for autistic youth with anxiety disorders.

Method: Participants were 148 autistic youth (aged 7-13; 77% male; 64% White) with clinically significant anxiety who were randomized to standard or adapted CBT. Clinician-rated anxiety severity was recorded at each appointment. Trajectories of change during (a) the cognitive phase and (b) the exposure phase of treatment were analyzed using piecewise multilevel modeling.

Results: Compared to the psychoeducation and cognitive therapy phases, the exposure phase corresponded with significantly more rapid symptom reduction, b = -.11, 95% CI …

Spatial Analysis For Enhancing The Use Of Health Data Availability From Different Sources To Help The Decision-Making Process, Tris Eryando

Kesmas

Spatial analysis in public health has become a common method used by researchers to understand the distribution of public health aspects related to the surrounding environment. It can also be used to analyze individual information in the form of a dot and the location or line of aggregated information in a specific area of study. Another benefit is the possibility of using different data sources to be analyzed in one statistical model analysis, as long as the identification area is sufficiently clear as a key variable. Spatial analysis can show an object's distribution on a locational map and explain the …

Sars-Cov-2 Antibody Seroprevalence In Jakarta, Indonesia, Iwan Ariawan, Hafizah Jusril, Muhammad N Farid, Pandu Riono, Wiji Wahyuningsih, Widyastuti Widyastuti, Dwi Oktavia T L Handayani, Endang Sri Wahyuningsih, Rebekka Daulay, Retno Henderiawati, Safarina G. Malik, Rintis Noviyanti, Leily Trianty, Nadia Fadila, Khin Saw Aye Myint, Frilasita A. Yudhaputri, Neeraja Venkateswaran, Kodumudi Venkateswaran, Venkatachalam Udhayakumar, William A. Hawley, Juliette Morgan, Paul M. Pronyk

Kesmas

The SARS-CoV-2 transmission dynamics in low- and middle-income countries remain poorly understood. This study aimed to estimate the SARS-CoV-2 antibodies seroprevalence in Jakarta, Indonesia, and to increase knowledge of SARS-CoV-2 transmission in urban settings. A population-based serosurvey among individuals aged one year or older was conducted in Jakarta. Employing a multistage sampling design, samples were stratified by district, slum, and non-slum residency, sex, and age group. Blood samples were tested for IgG against three different SARS-CoV-2 antigens. Seroprevalence was estimated after applying sample weights and adjusting for cluster characteristics. In March 2021, this study collected 4,919 respondents. The weighted estimate …

A Stunting Prevention Risk Factors Pathway Model For Indonesian Districts/Cities With A Stunting Prevalence Of ≥30%, Nina Fentiana, Endang L. Achadi, Besral Besral, Abram Kamiza, Trini Sudiarti

Kesmas

The prevalence of stunting in Indonesian children aged 0-23 months is a public health problem caused by direct and indirect factors. This study aimed to discover the path of the relationship between various risk factors and the stunting prevalence of ≥30% in 165 districts/cities in Indonesia. Data were obtained from the 2018 National Basic Health Research, National Socioeconomic Survey, and the Statistics Indonesia with a cross-sectional approach. The secondary data on stunting and risk factors were aggregated at the district/city level from individual data; children aged 0-23 months. The path analysis used to determine a stunting prevention model showed that …

Determinants Of Type 2 Diabetes Mellitus Among Passive Smokers, Adinda Rahma Triyaniarta, Santi Martini, Kurnia Dwi Artanti, Sri Widati, Rizma Dwi Nastiti

Kesmas

Type 2 diabetes mellitus (T2DM) leads to complications of other diseases. The modifiable risk factors for T2DM are overweight, physical activity, hypertension, unhealthy diet, and smoking. This study aimed to analyze determinants of T2DM incidence in passive smokers among various factors. This study was conducted at Hospital X in Surabaya City, East Java Province, Indonesia, from September 2019 to April 2020. The variables were univariate, bivariate, and multivariate. Case samples were T2DM patients and passive smokers, while control samples were non-T2DM patients and passive smokers, with 52 respondents per group, of 104 total respondents. Variables statistically significant related to the …

The Effect Of Health Promotion Program On Perceived Self-Efficacy And Self-Care Practices Among Elderly With Multimorbidity In Chiang Mai, Thailand, Jukkrit Wungrath, Nuttida Khumai, Phinphot Phrommasen

Kesmas

Multimorbidity in the elderly is a major public health issue with serious consequences. This study investigated the effects of health promotion programs on perceived self-efficacy and self-care practices among the elderly with multimorbidity using a quasi-experimental study design from February to July 2021. The study samples were the elderly from Doi Saket District, Chiang Mai Province, Thailand, selected by a multistage random sampling technique. The experimental and control groups each comprised 40 elderlies with multimorbidity. All elderly participants took part in a 12-week health promotion program. The perceived self-efficacy and self-care practices of the study samples were assessed using interviews, …

Predictors Of Anxiety Toward Covid-19 Delta Variant: A Cross- Sectional Study Among Healthcare Providers In Java And Bali, Indonesia, I Ketut Swarjana, I Gede Putu Darma Suyasa, I Kadek Nuryanto

Kesmas

Health facilities are experiencing overcapacity, oxygen scarcity, and a limited number of healthcare providers due to the coronavirus disease 2019 (COVID-19), thus impacted on anxiety. This study aimed to determine predictors of anxiety among healthcare providers toward the Delta variant of COVID-19 in Indonesia. A cross-sectional study was conducted with 371 healthcare providers in Java and Bali Islands, and the snowball sampling technique was used. Data were collected using a questionnaire and distributed through social media (WhatsApp), then analyzed using univariate analysis, bivariate analysis (Chi-square test), and multivariate analysis (multiple logistic regression). The results showed that 81 (21.8%) respondents experienced …

Perspectives On Reproductive Health Education Among Javanese Parents, Bagoes Widjanarko, Ratih Indraswari, Aditya Kusumawati, Novia Handayani

Kesmas

This study aimed to investigate the perspectives of reproductive health education among Javanese parents of children aged 9-11 years. This cross-sectional study was conducted with 12,306 parents in Semarang City, Central Java Province, Indonesia, using a purposive sampling technique. Some parents agreed that reproductive health education at home was unnecessary (29.5%), taboo (45%), difficult (73.1%), and awkward (41.5%). Most parents (72.7%) were not transparent in providing reproductive health information to their children by using other terms to name the genitals, considering the politeness aspect. Good practices of providing reproductive health information are slightly more common in mothers (54.2%), unemployed parents …

Spatial Analysis Of Seven Islands In Indonesia To Determine Stunting Hotspots, Tiopan Sipahutar, Tris Eryando, Meiwita Budiharsana

Kesmas

Indonesia is a vast country struggling to reduce its stunting prevalence. Hence, identifying priority areas is urgent. In determining areas to prioritize, one needs to consider geographical issues, particularly correlations among areas. This study aimed to discover whether stunting prevalence in Indonesia occurs randomly or in clusters; and, if it occurs in clusters, which areas are the hotspots. This ecological study used aggregate data from the 2018 National Basic Health Research and Poverty Data and Information Report from the Statistics Indonesia. This study analyzed 514 districts/cities across 34 provinces on seven main islands in Indonesia. The method used was the …

Model Autonomy Of Self-Finance Management For Primary Health Care To Enhance Workers’ Satisfaction, Ahmad Jet Alamin, Ossama Issac, Lina Teo, Atikah Adyas

Kesmas

This study aimed to find an appropriate model of autonomous self-finance management in primary health care (PHC) to enhance workers' satisfaction. This was a cross-sectional study in which data were collected through self-administered questionnaires from 204 workers in ten Regional Public Service Agency for Primary Health Care (RPSAPHC)/Badan Layanan Umum Daerah Pusat Kesehatan Masyarakat (BLUD Puskesmas) in Tangerang District, Banten Province, Indonesia using the partial least squares and structural equation model (PLS-SEM). A total of 73 indicators were used to examine the PHC transformation process to enhance workers' satisfaction. The indicators were grouped into three variables depending on workers' satisfaction: …

“High Spending, Poor Productivity Gains!” Assessing Public Health System (In)Efficiency And Hospital Performance In The State Of Kuwait: Would More Private Delivery Improve Healthcare?, Aljawhara Alsabah

NYMC Student Theses and Dissertations

The healthcare sector in the State of Kuwait has been nurtured for many decades by the government, where the majority of health services in the country are controlled by the Ministry of Health (MoH). Although healthcare services in public sector hospitals are at highly subsidized rates, causing private sector involvement in healthcare to be considerably low, the growing demands for private delivery of care burgeoned participation of private hospitals in Kuwait, and improving hospital efficiency and productivity is more critical and timelier than ever. This dissertation aims to analyze public health system efficiency and hospital performance in the State of …

Allowing Cities To Mandate Employer Paid Sick Leave Could Reduce Deaths Among Working-Age Adults, Douglas A. Wolf, Jennifer Karas Montez, Shannon M. Monnat

Population Health Research Brief Series

Paid sick leave is good for health, yet there is no federal paid sick leave mandate, and U.S. states are increasingly preempting their city and county governments from mandating employer paid sick leave. This brief describes how working-age (ages 25-64) mortality rates from several external causes of premature death (suicide, homicide, drug overdose, alcohol poisoning, and transport accidents) from 1999 to 2019 may have been lower if states had not preempted cities and counties from mandating paid sick leave. The authors find that working-age mortality rates could have been over 7.5% lower in 2019 in cities and counties that were …