Health Policy Commons^™

Medical Ethics: How Resource Distribution Affects The Decision Making Of Doctors In Rural India: An Explorative And Comparative Study In Jamkhed, Maharashtra, Jared Yee

Independent Study Project (ISP) Collection

Using rural Mahrasthra as a case study, I was able to explore the medical ethics and common dilemmas that occur in Rural India. Through a collection of interviews and articles, I was able to piece together my understanding of some common ethical challenges that India faces, emphasizing ones that were unique to the location and circumstance. Using observations I made through my work in the hospital, I learned that limited resources effects all sides of ethics in the medical field, with a signficinant effect on economics, hospital structure, and clinical protocol. In an attempt to source the aspects of Indian …

Analysis Of The Need For Legal Protection For Doctors In Teleconsultation Services Towards The Covid-19 Endemic In Indonesia, Mila Fitriana, Anhari Achadi

Journal of Indonesian Health Policy and Administration

Teleconsultation is a form of telemedicine that has developed rapidly during the COVID-19 pandemic. Clinical teleconsultation provides remote clinical consultation services to assist in establishing a diagnosis, and/or providing treatment considerations/advice. There are several issues in telemedicine, including ethical and legal issues. This study aims to find ethical and legal issues related to teleconsultation services after the COVID-19 pandemic. This research uses normative legal research methods. The laws and regulations that are reviewed by the researcher are those that are still valid in the Republic of Indonesia until June 2022. Researchers compare teleconsultation regulations and laws that were in effect …

Analysis Of Factors Related To Intention-To-Use Telemedicine Services (Teleconsultation) In Jabodetabek Residents During The Covid-19 Pandemic In 2021, Isna Mutiara Salsabila, Kurnia Sari

Journal of Indonesian Health Policy and Administration

The emergence of COVID-19 pandemic has made it difficult for people to access health services. According to JKN statistics, FKTP visits was decreased from 337.69 million (2019) to 193.03 (2021). Teleconsultation, a type of telemedicine, could be the right solution so that people can still access the health services they need and protect themselves from the spread of COVID-19. There was an increase in the use of several teleconsultation applications in Indonesia during pandemic, from 4 million to more than 15 million people. However, this rate is only 7.63% of the internet users and 5.6% of the total population of …

Analysis Of Prolanis Policy Implementation During The Covid-19 Pandemic In 2021, D.Fitria Sari Firdaus, Mardiati Nadjib

Journal of Indonesian Health Policy and Administration

Data from Basic Health Research (Riskesdas) in 2018 shows that Diabetes and Hypertension dominate chronic diseases. The Director of BPJS Kesehatan has issued Circular No. 14 of 2020 concerning health services for national health insurance participants during the COVID-19 prevention period, especially Prolanis. The policy contains an appeal to postpone the provision of services in the form of mass gathering activities such as Prolanis Gymnastics, Club Education, and and other activities. Hence, this research is needed to describe the implementation of Prolanis policies during the COVID-19 Pandemic. The study used a descriptive research design with qualitative methods and George C. …

Description Study Of Pandeglang Community Knowledge On Natural Disasters And Government Policies Related To Natural Disaster Preparedness In 2022, Novi Anggraini Ginting, Wiku Bakti Bawono Adisasmito

Journal of Indonesian Health Policy and Administration

Pandeglang Regency, which is a disaster-prone area, requires people who have sufficient knowledge to create community preparedness in dealing with disasters and can assist in the disaster mitigation process. This study aims to find out how the community's knowledge and community preparedness related to natural disasters and what efforts have been made by the government to improve the readiness of the people of Pandeglang Regency. This research method is descriptive and quantitative with 451 respondents. The results of the study showed that the people of Pandeglang Regency still did not know correctly the different types of threats or types of …

Service Of People With Psychiatric Problems (Odmk) At The Pasar Baru Health Center And Pabuaran Tumpeng Health Center In Tangerang City In 2022: A Comparative Study, Mentari Kirana Firdaus, Masyitoh Basabih

Journal of Indonesian Health Policy and Administration

Mental health is one of the global health issues with cases that continue to increase every year. In 2019, psychiatric problems were the second leading cause of disability worldwide with a total of 970 million cases. This research is a comparative study that aims to determine the difference between ODMK services at Pasar Baru Health Center and Pabuaran Tumpeng Health Center. This research uses a qualitative approach with a case study method, data collection is done through in-depth interviews and document review. The variables analyzed include input, process, and output. The results of the study found that in the input …

Observational Study Of The Clinical Performance Of A Public-Private Partnership National Referral Hospital Network In Lesotho: Do Improvements Last Over Time?, Nancy A. Scott, Jeanette L. Kaiser, Brian W. Jack, Elizabeth L. Nkholongo, Allison Juntunen, Tshema Nash, Mayowa Alade, Taryn Vian

Nursing and Health Professions Faculty Research and Publications

Public-private partnerships (PPP) may increase healthcare quality but lack longitudinal evidence for success. The Queen ‘Mamohato Memorial Hospital (QMMH) in Lesotho is one of Africa’s first healthcare PPPs. We compare data from 2012 and 2018 on capacity, utilization, quality, and outcomes to understand if early documented successes have been sustained using the same measures over time. In this observational study using administrative and clinical data, we assessed beds, admissions, average length of stay (ALOS), outpatient visits, and patient outcomes. We measured triage time and crash cart stock through direct observation in 2013 and 2020. Operational hospital beds increased from 390 …

Democratizing The Economy Or Introducing Economic Risk? Gig Work During The Covid-19 Pandemic, Daniel Auguste, Stephen Roll, Mathieu Despard

Social Policy Institute Research

Though the growth of the gig economy has coincided with increased economic precarity in the new economy, we know less about the extent to which gig work (compared with other self-employment arrangements and non-gig work) may fuel economic insecurity among American households. We fill this gap in the literature drawing on a sample of 4,756 workers from a unique national survey capturing economic hardships among non-standard workers like app-and platform-based gig and other self-employed workers during the COVID-19 pandemic. Results from generalized boosted regression modeling, utilizing machine learning to account for potential endogeneity, demonstrated that gig workers experienced significantly greater …

Considering The Genetic Architecture Of Hypoplastic Left Heart Syndrome, John W Belmont

Center for Medical Ethics and Health Policy Staff Publications

Hypoplastic left heart syndrome (HLHS) is among the most severe cardiovascular malformations and understanding its causes is crucial to making progress in prevention and treatment. Genetic analysis is a broadly useful tool for dissecting complex causal mechanisms and it is playing a significant role in HLHS research. However, unlike classical Mendelian disorders where a relatively small number of genes are largely determinative of the occurrence and severity of the disease, the picture in HLHS is complex. De novo single-gene and copy number variant (CNV) disorders make an important contribution, but there is emerging evidence for causal contributions from lower penetrance …

Usage And Impact Of Benefits Among Frontline Healthcare Workers, Mathieu Despard

Social Policy Institute Research

We completed a study about frontline healthcare workers – the benefits they get through work and how they are doing financially. This brief provides highlights from our survey to 2,321 workers and interviews with 30 workers.

“The More People’S Stories That We Learn, The More We Can Wrap Around Our Support”: How Postoperative Bariatric Surgery Patients Use Online Communities, Breisha George

Health Sciences Student Scholarship

Bariatric surgery (also called weight loss surgery) is often thought of as a one-day medical procedure. However, after surgery, there are long-term physical and psychological changes that each patient manages. The goal of this study was to gain deeper insights into how a patient navigates their postoperative experience after bariatric surgery, specifically examining their use of online bariatric communities. Ten semi-structured interviews were conducted, transcribed, and thematically analyzed. Three major themes were identified: (1) Mental Health, (2) Belonging to Community, (3) Support. Each theme incudes several sub-themes, showcasing a range of helpful and harmful experiences from engaging with these online …

Toward Informatics-Enabled Preparedness For Natural Hazards To Minimize Health Impacts Of Climate Change, Jimmy Phuong, Naomi O. Riches, Luca Calzoni, Gora Datta, Deborah Duran, Asiyah Yu Lin, Ramesh P. Singh, Anthony E. Solomonides, Noreen Y. Whysel, Ramakanth Kavuluru

Publications and Research

Natural hazards (NHs) associated with climate change have been increasing in frequency and intensity. These acute events impact humans both directly and through their effects on social and environmental determinants of health. Rather than relying on a fully reactive incident response disposition, it is crucial to ramp up preparedness initiatives for worsening case scenarios. In this perspective, we review the landscape of NH effects for human health and explore the potential of health informatics to address associated challenges, specifically from a preparedness angle. We outline important components in a health informatics agenda for hazard preparedness involving hazard-disease associations, social determinants …

Covid-19 And Children, Carl A Pierce, Kevan C Herold, Betsy C Herold, Janet Chou, Adrienne Randolph, Binita Kane, Sammie Mcfarland, Deepti Gurdasani, Christina Pagel, Peter Hotez, Sarah Cobey, Scott E Hensley

Center for Medical Ethics and Health Policy Staff Publications

There has been substantial research on adult COVID-19 and how to treat it. But how do severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections afflict children? The COVID-19 pandemic has yielded many surprises, not least that children generally develop less severe disease than older adults, which is unusual for a respiratory disease. However, some children can develop serious complications from COVID-19, such as multisystem inflammatory syndrome in children (MIS-C) and Long Covid, even after mild or asymptomatic COVID-19. Why this occurs in some and not others is an important question. Moreover, when children do contract COVID-19, understanding their role in …

Air Quality And Cancer Prevalence Trends Across The Sub-Saharan African Regions During 2005–2020, Omolola Okunromade, Jingjing Yin, Clara Ray, Atin Adhikari

Health Policy & Community Health: Faculty Publications

Poor air quality and environmental pollution remain some of the main etiological factors leading to cancers and cancer-related deaths worldwide. As a result of human activities, deleterious airborne chemicals can be dispersed not only in the environment but also released in occupational environments and industrial areas. Air pollutants and cancer links are now established through various oxidative stress-related mechanisms and related DNA damages. Generally, ambient and indoor air pollutants have been understudied in sub-Saharan Africa (SSA) compared to other regions in the world. Our study not only highlights the deleterious effects of air pollutants in these developing countries, but it …

Targeting Glycans For Car Therapy: The Advent Of Sweet Cars, Zoe Raglow, Mary Kathryn Mckenna, Challice L Bonifant, Wenjing Wang, Marina Pasca Di Magliano, Johannes Stadlmann, Josef M Penninger, Richard D Cummings, Malcolm K Brenner, David M Markovitz

Center for Medical Ethics and Health Policy Staff Publications

Chimeric antigen receptor (CAR) T cell therapy has created a paradigm shift in the treatment of hematologic malignancies but has not been as effective toward solid tumors. For such tumors, the primary obstacles facing CAR T cells are scarcity of tumor-specific antigens and the hostile and complex tumor microenvironment. Glycosylation, the process by which sugars are post-translationally added to proteins or lipids, is profoundly dysregulated in cancer. Abnormally glycosylated glycoproteins expressed on cancer cells offer unique targets for CAR T therapy as they are specific to tumor cells. Tumor stromal cells also express abnormal glycoproteins and thus also have the …

Can Statins Lessen The Burden Of Virus Mediated Cancers?, Eva H Clark, Sarah T Ahmed, Elaine Chang, Elizabeth Y Chiao, Donna L White

Center for Medical Ethics and Health Policy Staff Publications

Background: Oncogenic viruses, including hepatitis B virus (HBV), hepatitis C virus (HCV), human papillomavirus (HPV), Epstein Barr virus (EBV), and Kaposi Sarcoma Herpes virus (KSHV) contribute to a significant proportion of the world's cancers. Given the sizeable burden of virus mediated cancers, development of strategies to prevent and/or treat these cancers is critical. While large population studies suggest that treatment with hydroxymethylglutaryl-CoA reductase inhibitors, commonly known as statins, may reduce the risk of many cancer types including HBV/HCV related hepatocellular carcinoma, few studies have specifically evaluated the impact of statin use in populations at risk for other types of virus …

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 …

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 …