By gaining new knowledge, and sharing what we learn through a wide range of publications, the CHI Center team is strengthening community health, primary care, system dynamics, and more.
CHI Center Publications - January 1, 2025 – April 29, 2026
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| Title: Effectiveness of Music Therapy on Utilization Outcomes among Surgical Patients with Mental Health Conditions: A Propensity-Score Matched Cohort Study |
| Author(s): Rodgers-Melnick, SN (Rodgers-Melnick, Samuel N.); Love, TE (Love, Thomas E.); Koroukian, SM (Koroukian, Siran M.); Gunzler, D (Gunzler, Douglas); Beno, M (Beno, Mark); Razzak, R (Razzak, Rab); Dusek, JA (Dusek, Jeffery A.); Rose, J (Rose, Johnie) |
| Source: JOURNAL OF INTEGRATIVE AND COMPLEMENTARY MEDICINE DOI: 10.1177/27683605261444109 Early Access Date: APR 2026 Published Date: 2026 APR 20 |
| Abstract: Background: Music interventions can be beneficial for reducing post-operative pain and opioid exposure, but few studies have investigated music therapy (MT)'s real-world effects on utilization outcomes. This study examined characteristics associated with receiving MT and its impacts on length of stay (LOS) and opioid utilization among surgical patients with mental health and/or substance use disorders (MSUD). Methods: A retrospective cohort study was conducted of 4239 inpatients (267 MT, 3972 usual care) with MSUD who underwent surgery between August 2020 and July 2023. A propensity score for receiving MT accounting for sociodemographics, pain, hospital services, and multiple comorbidities was used to create a matched cohort. The effects of MT on log-transformed LOS and mean morphine milligram equivalents (MME)/day were estimated. Results: Among patients receiving MT, the median (IQR) time to MT referral was 80.43 (39.27-179.31) hours (h). Patients received 3 (2-4) MT interventions, representing exposure on 18.18% (11.32%-29.81%) of admitted days. Covariates associated with receiving MT (adjusted odds ratio [95% CI]) included receiving palliative care (3.57 [2.02, 6.25]) and having a trauma/stress disorder (2.93 [2.00, 4.24]), anxiety (1.51 [1.11, 2.06]), heart failure (1.63 [1.05, 2.51]), a more resource-intensive admission (1.55 [1.08, 2.23]), and more opioids administered by 48 h (1.19 [1.04, 1.37]). In the analysis of 251 matched pairs, MT's estimated effect on log-transformed outcomes was 1.42 [1.27, 1.58] for LOS and 0.95 [0.75, 1.19] for MME/day. Conclusion: Patients with MSUD who undergo surgery and receive MT are more medically complex and thus may have prolonged LOS compared with those receiving usual care. Receiving MT on 18.18% of admitted days does not meaningfully impact opioid utilization within this population. Findings inform factors that may influence the decision to refer MT. LOS effects should be interpreted with caution given the inability to account for some factors that influence LOS. |
| PubMed ID: 42009620 |
| Title: Prognostic Value of MammaPrint in Diverse Populations: Evaluating Racial Disparities in Breast Cancer Outcomes |
| Author(s): Abou Zeidane, R (Abou Zeidane, Reine); Lichtman-Mikol, S (Lichtman-Mikol, Samuel); Pisano, C (Pisano, Courtney); Hauk, B (Hauk, Benjamin); Sun, YL (Sun, Yilun); Rana, PS (Rana, Priyanka S.); Lopez-Flores, C (Lopez-Flores, Citlally); McBean, BN (McBean, Breanna N.); Jungles, KM (Jungles, Kassidy M.); Lal, T (Lal, Trisha); Mehta, N (Mehta, Nihit); Bomeisl, P (Bomeisl, Philip); Amin, AL (Amin, Amanda L.); Montero, AJ (Montero, Alberto J.); Koroukian, S (Koroukian, Siran); Rose, J (Rose, Johnie); Lyons, J (Lyons, Janice); Speers, CW (Speers, Corey W.) |
| Source: JCO PRECISION ONCOLOGY Volume: 10 Article Number: e2500926 DOI: 10.1200/PO-25-00926 Published Date: 2026 APR |
| Abstract: PURPOSE MammaPrint (MP), a 70-gene expression profile assay, informs treatment decisions in early-stage breast cancer by classifying patients into high or low risk of recurrence categories. However, racial disparities in breast cancer outcomes necessitate an evaluation of MP's prognostic utility across diverse populations. This study explores differences in MP scores and associated outcomes among women of various racial backgrounds. MATERIALS AND METHODS We retrospectively analyzed women with early-stage breast cancer who underwent MP testing (2013-2023) at University Hospitals Seidman Cancer Center. Patients were stratified by self-reported race and MP scores (high v low risk). Clinical outcomes, including recurrence-free survival (RFS) and overall survival (OS), were compared using Kaplan-Meier and Cox proportional hazards models. RESULTS Among 1,349 women, 15.7% were African American (AA), 83.4% White, 0.6% Asian, and 0.3% from other racial groups. Overall, 64.7% had low-risk and 35.3% had high-risk scores. AA women had a significantly higher proportion of high-risk MP scores compared with White women (49.1% v 32.7%). Although the 5-year RFS rates were comparable between AA and White women (76.5% v 77.2%), the 5-year OS rates were slightly lower for AA women compared with White women (77.8% v 78.2%). MP remained prognostic for RFS at 3, 5, and 10 years regardless of race. Multivariable analysis revealed no significant differences in OS (hazard ratio [HR], 0.94 [95% CI, 0.47 to 1.89]; P = .866) or RFS (HR, 0.83 [95% CI, 0.43 to 1.59]; P = .572) between AA and White women after adjusting for MP risk groups and other clinical factors. High-risk MP scores were associated with worse OS (HR, 3.06 [95% CI, 1.64 to 5.70]; P < .001) and RFS (HR, 2.68 [95% CI, 1.55 to 4.62]; P < .001) compared with low-risk scores. Other factors associated with worse RFS and OS were tumor size, nodal involvement, and age. Interaction models indicated no difference is OS or RFS in AA women and White women with either low-risk or high-risk MP, respectively. CONCLUSION Despite AA women exhibiting a higher proportion of high-risk MP scores, survival outcomes were comparable with those of White women. These findings underscore MP's consistent prognostic performance across racial groups but further highlight the need to address additional clinical and social determinants influencing breast cancer outcomes beyond genomic risk alone. |
| PubMed ID: 41955550 |
| Title: Spatial Access to Cancer Care Providers in National Cancer Institute-Designated Cancer Center Catchment Areas |
| Author(s): Buchalter, RB (Buchalter, R. Blake); Rose, J (Rose, Johnie); Dalton, JE (Dalton, Jarrod E.); Gunsalus, PR (Gunsalus, Paul R.); Khorana, AA (Khorana, Alok A.); Schmit, SL (Schmit, Stephanie L.) |
| Source: JCO CLINICAL CANCER INFORMATICS Volume: 10 Article Number: e2500166 DOI: 10.1200/CCI-25-00166 Published Date: 2026 MAR |
| Abstract: PURPOSE Access to care is an important component of cancer center catchment area (CA) analytics, where CAs are defined as the geographic scope of cancer center operations. Spatial access to care is one piece of the access to care continuum that is useful for quantifying population travel to health care providers. As no studies have comprehensively calculated CA spatial access to providers, we examined access to oncology, cancer care, and primary care providers for all 65 National Cancer Institute-designated cancer center CAs in the 48 contiguous US states. METHODS We used the 2024 end-of-year Centers for Medicare and Medicaid Services National Downloadable File and the enhanced two-step floating CA method to compute spatial accessibility. We stratified analyses by cancer center, census division, 2020 urban/rural status, 2023 area deprivation, and cancer center type, and produced select CA maps. RESULTS Census tracts in the Montefiore Einstein Comprehensive Cancer Center CA had the highest oncology and cancer care spatial access, while the Masonic Cancer Center had the highest primary care spatial access. New Jersey, New York, and Pennsylvania CAs had the highest oncology and cancer care spatial access (P < .001), while midwestern CAs had the highest primary care spatial access (P < .001). Across area deprivation index quartiles and all provider groupings, urban tracts had higher spatial access than rural tracts (P < .001). Comprehensive cancer centers had higher spatial access to oncology and primary care than noncomprehensive cancer centers (P < .001), while noncomprehensive cancer centers had higher spatial access to cancer care providers (P < .001). CONCLUSION We observed significant differences in CA spatial access to oncology, cancer care, and primary care by region, urban/rural status, socioeconomic position, and cancer center type. |
| PubMed ID: 41886708 |
| Title: Weighting by Income Probabilities as a Novel Approach to Quantifying Differences in the Burden of Cancer by Income: A Case Study of Colorectal Cancer in Ohio |
| Author(s): Kim, U (Kim, Uriel); Koroukian, S (Koroukian, Siran); Rose, J (Rose, Johnie) |
| Source: JCO CLINICAL CANCER INFORMATICS Volume: 10 Article Number: e2500171 DOI: 10.1200/CCI-25-00171 Published Date: 2026 MAR |
| Abstract: PURPOSE Population-based cancer registries are a key data resource for catchment area informatics, but their utility for quantifying differences in cancer burden by socioeconomic status is limited. Here, we describe an approach that estimates cancer incidence along income gradients, leveraging a newly validated method called weighting by income probabilities (WIP). METHODS We estimated income-specific colorectal cancer incidence, stratified by sex and race/ethnicity, in a catchment area (Ohio) as a case study. Income-specific numerator data (number of cancer cases per income bracket) were estimated using WIP, whereas denominators (population at risk by income bracket) were derived from US Census data. RESULTS In the case study of the 52,257 patients with invasive colorectal cancer diagnosed in the catchment area of Ohio between 2010 and 2019, lower income was generally associated with higher incidence rates, except in non-Hispanic (NH) White female individuals. The highest incidence was observed in NH Black male individuals at 0-149% of the Federal Poverty Level, with 113.7 cases per 100,000 (95% CI, 99.6 to 129.3) in 2010-2012, compared with 57.8 (95% CI, 54.7 to 61.2) in their NH White counterparts. Sensitivity analyses showed that income-specific incidence statistics were robust to sources of error in numerator and denominator estimation, with incidence estimates varying by no more than 1.98% from the reference estimates. CONCLUSION The approach described here accurately estimates cancer incidence along income gradients and can be expanded to estimate income-specific survival and mortality. The case study of colorectal cancer in Ohio demonstrates important insights into the burden of cancer by income. These granular income-specific data can enhance our understanding of the relationship between cancer burden and socioeconomic status and inform cancer surveillance, prevention, and control efforts. |
| PubMed ID: 41881063 |
| Title: The Association of County-level Structural Racism with Risk Factors for Negative Maternal Health and Birth Outcomes among Non-Hispanic Black People of Childbearing Age |
| Author(s): Baltrus, P (Baltrus, Peter); Li, CH (Li, Chaohua); McDonald, A (McDonald, Adenike); Mussington, T (Mussington, Tyra); Douglas, M (Douglas, Megan); Gaglioti, A (Gaglioti, Anne); Dean, LT (Dean, Lorraine T.); Daugherty, GB (Daugherty, Geoff B.); Hernandez-Green, ND (Hernandez-Green, Natalie D.) |
| Source: JOURNAL OF RACIAL AND ETHNIC HEALTH DISPARITIES DOI: 10.1007/s40615-026-02849-8 Early Access Date: FEB 2026 Published Date: 2026 FEB 21 |
| Abstract: Introduction Place-based measures of structural racism have shown adverse relationships with maternal health outcomes. Pre-existing conditions like diabetes, hypertension, and depression contribute to Black-White maternal health disparities. This study investigates the association between county-level structural racism (CSR) and these conditions among non-Hispanic Black women of reproductive age. Methods We analyzed data from women of reproductive age in the 2011-2012 Behavioral Risk Factor Surveillance System (BRFSS). CSR was measured using a validated multi-indicator construct examined by quartile. Depression, diabetes, and hypertension were self-reported. Individual and county-level covariates were obtained from BRFSS and the 2010 US Census. We conducted multilevel logistic regression models. Results Women in the highest CSR quartile counties showed the highest depression prevalence and lowest hypertension prevalence. While initial analysis showed no significant associations between CSR and diabetes or hypertension, the fully adjusted model revealed women in the highest CSR quartile had significantly higher odds of diabetes [OR = 1.33(1.00-1.78)] and depression [AOR = 1.50(1.19-1.90)]. Conclusions This study expands understanding of county-level structural racism's relationship with chronic health conditions affecting Black women's maternal health outcomes. Findings suggest that CSR is an important factor to consider in potential interventions to address maternal health disparities among NHB birthing parents. |
| PubMed ID: 41723299 |
| Title: Higher socioeconomic status and physician accessibility linked to more early-stage but not fewer late-stage melanoma diagnoses |
| Author(s): Dong, WC (Dong, Weichuan); Kim, U (Kim, Uriel); Montgomery, B (Montgomery, Brock); Lal, T (Lal, Trisha); Liu, LB (Liu, Lingbo); Kakish, H (Kakish, Hanna); Rose, J (Rose, Johnie); Koroukian, SM (Koroukian, Siran M.); Bordeaux, JS (Bordeaux, Jeremy S.); Rothermel, LD (Rothermel, Luke D.); Hoehn, R (Hoehn, Richard s) |
| Source: CLINICAL AND EXPERIMENTAL DERMATOLOGY DOI: 10.1093/ced/llaf546 Early Access Date: FEB 2026 Published Date: 2026 FEB 4 |
| Abstract: Background Socioeconomic status (SES) and physician accessibility, key proxies for skin cancer screening uptake, can influence melanoma diagnosis, but their impact on reducing advanced-stage diagnoses remains unclear.Objectives To examine how SES and physician accessibility relate to the incidence of early- and late-stage melanoma across neighbourhoods in Ohio (USA).Methods This cross-sectional study analysed individuals with newly diagnosed cancer cases from the Ohio Incidence Surveillance System (2011-2020), aggregated into 259 neighbourhoods (derived from 2952 census tracts), and estimated neighbourhood-level, stage-specific incidence rates. Correlation and geospatial analyses explored dose-response relationships between SES, physician accessibility and stage-specific melanoma incidence. Classification and regression tree (CART) and logistic regression further examined these associations.Results Higher SES and physician accessibility were significantly associated with increased early-stage melanoma incidence but not with late-stage incidence. Affluent city suburbs with high physician accessibility had the highest early-stage incidence (median 20.2 per 100 000), whereas rural areas experiencing socioeconomic disadvantage (defined as below the median level of SES) and with low physician accessibility had the lowest (median 14.4 per 100 000). CART identified five neighbourhood profiles of early-stage melanoma. A nearly 100-fold difference in the odds of high early-stage incidence was observed between the high-risk and low-risk neighbourhoods. No significant results were observed for late-stage incidence in correlation analysis, CART or logistic regression.Conclusions Areas with high healthcare access measures experience increased early-stage melanoma incidence. However, this does not correspond to a reduction in late-stage incidence. The absence of a clear association between late-stage incidence and these screening proxies highlights the need for further research into the biology and progression of advanced-stage melanoma tumours, as well as the effectiveness of current screening methods in detecting the condition in such patients. Higher socioeconomic status and greater physician accessibility - proxies for skin cancer screening uptake - were associated with increased early-stage melanoma incidence but not with reduced late-stage incidence across neighbourhoods in Ohio (USA). Specifically, neighbourhoods with higher education attainment, lower uninsured rates and lower poverty rates had nearly 100 times higher odds of high early-stage incidence, yet their late-stage incidence remained similar. The lack of association between screening proxies and late-stage incidence raises questions about the effectiveness of widespread melanoma screening in preventing advanced disease. |
| PubMed ID: 41388790 |
| Title: Implementing a Precision Medicine Thoracic Service Using In-House Reflex Testing in a Large Academic-Community Practice |
| Author(s): Bruno, DS (Bruno, Debora S.); Mirsky, MM (Mirsky, Matthew M.); Donner, AL (Donner, Andrea L.); Kopp, SR (Kopp, Shelby R.); Jani, M (Jani, Mehul); Mneimneh, W (Mneimneh, Wadad); Yoest, JM (Yoest, Jennifer M.); Margevicius, SP (Margevicius, Seunghee P.); Shanahan, J (Shanahan, John); Fu, PF (Fu, Pingfu); Hsu, ML (Hsu, Melinda L.); Wang, Q (Wang, Qian); Chiec, LS (Chiec, Lauren S.); Dutcher, GA (Dutcher, Giselle A.); Cho, S (Cho, Sean); Dowlati, A (Dowlati, Afshin); Rose, J (Rose, Johnie); Sadri, N (Sadri, Navid) |
| Source: CHEST Volume: 169 Issue: 1 Pages: 280-290 DOI: 10.1016/j.chest.2025.07.4095 Early Access Date: JAN 2026 Published Date: 2026 JAN |
| Abstract: BACKGROUND: Broad genomic testing is necessary to treat patients with stage IV non-small cell lung cancer (NSCLC). This article describes a NSCLC precision medicine service at an academic-community practice and provides model-based estimates of the impact of a similar intervention. RESEARCH QUESTION: Will implementation of a precision medicine service increase NSCLC next-generation sequencing (NGS) rates, improve testing turnaround times (TATs), and increase rates of actionable genomic alterations (AGAs)? STUDY DESIGN AND METHODS: The Precision Medicine Thoracic (PREDICT) service consists of: (1) system-wide reflex testing of patients with stage IV NSCLC by in-house solid tumor NGS-focused assay and programmed cell death ligand 1 (PD-L1) testing; (2) nurse navigator oversight; (3) the molecular tumor board; and (4) an integrated information portal (Onco-Tracker) for real-time updates on sample processing, results, and treatment recommendations by the molecular tumor board. A decision analytic model compared 4 strategies: PREDICT vs standard care (send-out sequencing and PD-L1 testing), and sequencing of all patients with stage IV NSCLC vs patients with non-squamous histology findings only. RESULTS: From January 2016 to December 2018, a total of 626 retrospective patients with stage IV NSCLC were eligible. In the 17 months following the launch of PREDICT, 290 prospective patients were identified. NGS testing rates increased significantly (91.3% vs 60.8%; P < .0001) after PREDICT, whereas TATs from biopsy date were significantly shorter for both NGS (12 vs 18 days; P < .0001) and PD-L1 (7 vs 10 days; P < .0001). AGAs were identified in 29.3% of prospective patients vs 22% of the retrospective cohort (P = .0172). Targeted therapy use increased from 6.8% to 10.6% (P = .048). The decision analytic model predicted superior survival with the PREDICT initiative across all patients, resulting in the highest rates of AGA identification and lowest chemotherapy utilization rates in the first-line setting. INTERPRETATION: Implementation of a precision medicine service for stage IV NSCLC comprising reflex testing, nurse navigation, a molecular tumor board, and an information portal at a combined academic-community practice led to higher NGS testing rates and shorter TATs. The result was identification of more actionable mutations and higher rates of first-line targeted therapy utilization. Decision analytic modeling suggests the superiority of this initiative across all patients. |
| PubMed ID: 40912295 |
| Title: Life is Larger Than Science |
| Author(s): Gotler, RS (Gotler, Robin S.); Steiner, M (Steiner, Melanie) |
| Source: ANNALS OF FAMILY MEDICINE Volume: 24 Issue: 1 Pages: 1-2 DOI: 10.1370/afm.250740 Published Date: 2026 JAN-FEB |
| PubMed ID: 41587852 |
| Title: A Novel Evaluation of Patient Socioeconomic Characteristics That Predict Clinical Trial Enrollment |
| Author(s): Dong, WC (Dong, Weichuan); Shoag, J (Shoag, Jamie); Lal, T (Lal, Trisha); Kyasaram, RK (Kyasaram, Ravi K.); Bruno, DS (Bruno, Debora S.); Rose, J (Rose, Johnie); Koroukian, SM (Koroukian, Siran M.); Vu, L (Vu, Long); Shanahan, JP (Shanahan, John P.); Hoehn, RS (Hoehn, Richard S.) |
| Source: JOURNAL OF THE NATIONAL COMPREHENSIVE CANCER NETWORK Volume: 24 Issue: 1 Article Number: 257092 DOI: 10.6004/jnccn.2025.7092 Published Date: 2026 JAN |
| Abstract: Background: Clinical trial participation offers patients with cancer access to cutting-edge therapies and generates critical evidence that informs and improves future cancer treatment guidelines. However, disparities in trial enrollment hinder inclusivity and limit the generalizability of trial findings. This study investigates patient-specific factors influencing therapeutic trial enrollment to identify and address barriers to equitable participation. Methods: This retrospective cohort study included patients with cancer aged 18 to 75 years diagnosed between 2018 and 2021 at a regional hospital system in Northeast Ohio. Patients' electronic medical records were linked to the individual-level LexisNexis Social Determinants of Health data. Propensity score matching was performed to balance trial and nontrial patients with respect to age, biological sex, and cancer type. Key predictors of trial enrollment were identified using a systematic variable selection process, the Boruta machine learning algorithm, and stepwise logistic regression. Geographic variation in enrollment were examined at the ZIP code level. Results: Among 12,630 patients with cancer, 649 (5.1%) participated in treatment-related trials. After 1:7 propensity score matching, the Boruta algorithm identified income, property ownership, and household factors as the strongest predictors of enrollment, whereas race/ethnicity, college attendance, and distance to closest relatives were less influential. Logistic regression revealed that non-Hispanic Black individuals (odds ratio [OR], 0.70; 95% CI, 0.54-0.89) and those in other minority groups (OR, 0.57; 95% CI, 0.36-0.88) were less likely to enroll compared with non-Hispanic White individuals. After adjusting for income, non-Hispanic Black race was no longer significant (OR, 0.85; 95% CI, 0.64-1.11). Higher estimated income was associated with increased enrollment (up to 67% higher odds), whereas patients insured through Medicaid were 29% less likely to enroll than those with private insurance (OR, 0.71; 95% CI, 0.53-0.93). Conclusions: Findings from this study suggest that financial resources may play a greater role in clinical trial enrollment than traditional demographic characteristics. Improving equity in trial enrollment and enhancing the generalizability of trial findings will likely require increased financial and structural support for diverse and vulnerable patient populations. J Natl Compr Canc Netw 2026;24(1):e257092 doi:10.6004/jnccn.2025.7092 |
| PubMed ID: 41671439 |
| Title: Beyond screening: neighborhood-level factors associated with colorectal cancer stage at diagnosis |
| Author(s): Lal, T (Lal, Trisha); Chakraborty, NN (Chakraborty, Natalie N.); Koroukian, S (Koroukian, Siran); Rose, J (Rose, Johnie); Dong, WC (Dong, Weichuan); Hoehn, RS (Hoehn, Richard S.) |
| Source: CANCER CAUSES & CONTROL Volume: 37 Issue: 1 Article Number: 14 DOI: 10.1007/s10552-025-02082-4 Published Date: 2025 DEC 27 |
| Abstract: PurposeWhile increasing colorectal cancer (CRC) screening uptake is a major public health goal, it remains unclear whether screening rates consistently translate to high earlier-stage diagnosis at the community level. This study examined the relationship between screening and early stage CRC diagnosis, identifying barriers that may disrupt this pathway.MethodsWe used census-tract-level data on CRC patients diagnosed between 2010 and 2019 in the Ohio Cancer Incidence Surveillance System, linked to community-level screening estimates from CDC PLACES (2018). Census tracts were grouped into sociodemographically similar communities using the Max-p regionalization method. We applied geographic weighted regression (GWR) to assess spatial variation in the screening-early diagnosis relationship and used the Variable Selection Using Random Forest (VSURF) algorithm to identify key predictors of early stage diagnosis. Linear regression models evaluated associations between predictors, screening, and early stage diagnosis.Results2,952 census tracts were aggregated into 869 communities for analysis. Higher screening rates were not consistently associated with early stage diagnosis, as revealed by GWR, which showed significant regional variation. VSURF identified structural factors, rather than screening uptake, as top predictors of early stage diagnosis. In multivariable models, uninsurance (beta - 0.29) and public transportation dependence (beta - 0.31) were associated with lower early stage diagnosis, while the screening rate was not independently associated.ConclusionsStructural barriers may disrupt the screening-to-diagnosis pathway at the community level. Our findings underscore the importance of investing in follow-up infrastructure, including navigation and transportation, to ensure that screening achieves its goal of early detection. |
| PubMed ID: 41455016 |
| Title: Leveraging Community-Based System Dynamics to Understand Long Covid Disparities in African American Communities: A Model for Health Equity Research |
| Author(s): Evans, CR (Evans, Chad R.); Echols, MR (Echols, Melvin R.); Martin, D (Martin, D.); Taylor, HA (Taylor, H. A.); Washington, JA (Washington, James A.); Gbinigie, O (Gbinigie, Olusola); Gaglioti, AH (Gaglioti, Anne H.); Wright, W (Wright, Wendi); Hovmand, P (Hovmand, Peter) |
| Source: HEALTH EXPECTATIONS Volume: 28 Issue: 6 Article Number: e70516 DOI: 10.1111/hex.70516 Published Date: 2025 DEC 15 |
| Abstract: Background Long Covid disproportionately affects African American communities, exacerbating pre-existing health disparities and systemic barriers to care. Conventional public health interventions often fail to address the complex systemic issues at play due to a lack of grounding in community-certified knowledge about the broader societal context that produces the disparities and in which the interventions must operate. New methods are needed to elicit community perspectives on living with long Covid.Methods This study employed Community-Based System Dynamics (CBSD) workshops, conducted in hybrid formats (online and in-person), to engage African American communities impacted by long Covid. Participants included affected individuals, healthcare professionals and systems researchers.Results The workshops yielded system dynamics causal loop diagrams that illustrate the multifaceted societal context and impact of long Covid. Community-driven insights led to the identification of targeted interventions and informed a comprehensive action plan designed to address specific health system barriers and enhance community resilience.Conclusions CBSD workshops proved effective in fostering significant community engagement and empowerment, presenting a replicable model for gaining a deeper understanding of the socio-cultural context that underlies complex health disparities. These findings suggest that incorporating community-sourced societal context knowledge and system dynamics modelling and analysis can substantially enhance public health strategies for managing long Covid.Patient or Public Contribution People with lived experience of long Covid were actively involved throughout all phases of this study. Participants contributed to the design and facilitation of Community-Based System Dynamics (CBSD) workshops, helped construct and refine causal loop diagrams based on their experiences, and generated action ideas for future interventions. Their insights shaped both the structure and content of the system models and directly informed the interpretation of results. Several participants also reviewed and provided feedback on early drafts of the manuscript to ensure the findings reflected their perspectives and priorities. |
| PubMed ID: 41395800 |
| Title: Association between County Health Rankings Factors and County-level Genitourinary Cancer Mortality |
| Author(s): Badreddine, J (Badreddine, Jad); Kim, E (Kim, Erin); Tang, S (Tang, Stephen); Rhodes, S (Rhodes, Stephen); Davis, L (Davis, Laura); Hartman, H (Hartman, Holly); Cullen, J (Cullen, Jennifer); Rose, J (Rose, Johnie); Vince, R (Vince, Randy) |
| Source: JOURNAL OF RACIAL AND ETHNIC HEALTH DISPARITIES DOI: 10.1007/s40615-025-02764-4 Early Access Date: DEC 2025 Published Date: 2025 DEC 4 |
| Abstract: Objectives To explore the association between County Health Ranking (CHR) factors, county-level demographics, and county-level age-adjusted genitourinary (GU) cancer mortality rates. Materials and Methods This population-based study used county-level data from the US and CHR program. CHR bases county-level scoring on four factors: health behaviors, clinical care, social and economic factors, and physical environment-higher values per factor signify a better score. The relationship between county-level factors, demographics, and age-adjusted GU-cancer mortality rates was analyzed with linear mixed-effects models. We included interaction terms between the county-level factors and the proportion of Black residents. Results County-level variables associated with lower age-adjusted GU-cancer mortality rates included larger population (beta/SD increase: - 0.64; 95% CI, - 0.82 to - 0.4, P < 0.001), positive health behaviors (- 0.58; 95% CI, - 0.83 to - 0.33, P < 0.001), and clinical care (- 0.21; 95% CI, - 0.41 to - 0.01, P = 0.04). A higher proportion of Black residents was associated with increasing age-adjusted GU-cancer mortality rate (0.52; 95% CI, 0.28-0.75, P < 0.001). Interaction terms demonstrated a relationship between clinical care and age-adjusted GU-cancer mortality rates that was attenuated by the proportion of Black residents (interaction-beta: 0.24; 95% CI, 0.06-0.42, P = 0.01). Follow-up analysis of clinical care demonstrated that quality of care, not access, was associated with decreased mortality rates. Conclusion The beneficial association between better clinical care and decreased age-adjusted GU-cancer mortality rates was modulated by the proportion of Black residents and appears due to the healthcare access sub-component. These findings suggest that having healthcare resources within a county does not ensure equitable access to high-quality healthcare, specifically for Black residents. |
| PubMed ID: 41343003 |
| Title: National trends in emergency and non-emergency colorectal cancer resections across the COVID-19 pandemic |
| Author(s): Lal, T (Lal, Trisha); Kang, CO (Kang, Christine O.); Liu, FZ (Liu, Fangzhou); Cabulong, A (Cabulong, Alexander); Hoehn, RS (Hoehn, Richard S.); Rose, J (Rose, Johnie); Koroukian, SM (Koroukian, Siran M.) |
| Source: SURGICAL ONCOLOGY INSIGHT Volume: 3 Issue: 1 Article Number: 100197 DOI: 10.1016/j.soi.2025.100197 Early Access Date: DEC 2025 Published Date: 2026 MAR |
| Abstract: The enclosed information is STRICTLY CONFIDENTIAL and is intended for the use of the addressee only. University Hospitals and its affiliates disclaim any responsibility for unauthorized disclosure of this information to anyone other than the addressee. Federal and Ohio law protect patient medical information, including psychiatric_disorders, (H.I.V) test results, A.I.Ds-related conditions, alcohol, and/or drug_dependence or abuse disclosed in this email. Federal regulation (42 CFR Part 2) and Ohio Revised Code section 5122.31 and 3701.243 prohibit disclosure of this information without the specific written consent of the person to whom it pertains, or as otherwise permitted by law. |
| Title: Cost Burden of End of Life Care Across Gradients of Cognitive Impairment Among Nursing Home Residents with Cancer |
| Author(s): Vu, L (Vu, Long); Koroukian, S (Koroukian, Siran); Rose, J (Rose, Johnie); Warner, D (Warner, David); Douglas, S (Douglas, Sara); Schiltz, N (Schiltz, Nicholas) |
| Source: INNOVATION IN AGING Meeting Abstract: igaf122.26 Volume: 9 Special Issue: SI DOI: 10.1093/geroni/igaf122.2605 Published Date: 2025 DEC Supplement: _2 |
| Title: Impact of Hormone Therapy on Sexual Function in Menopausal Women: A Cross-Sectional Analysis of Cosmos Data |
| Author(s): Pope, R (Pope, Rachel); Ganesh, P (Ganesh, Prakash); Marino, J (Marino, Jean); Myers, A (Myers, Anna) |
| Source: MENOPAUSE-THE JOURNAL OF THE MENOPAUSE SOCIETY Meeting Abstract: P-142 Volume: 32 Issue: 12 Published Date: 2025 DEC |
| Title: BREATHTAKING BENEFITS? GLUCAGON-LIKE PEPTIDE-1 RECEPTOR AGONISTS IMPACT ON ASTHMA EXACERBATIONS |
| Author(s): Krishnan, V (Krishnan, Vidya); Conklin, D (Conklin, Danette); Pawar, O (Pawar, Omkar); Ganesh, P (Ganesh, Prakash) |
| Source: CHEST Volume: 168 Issue: 4 Pages: 5645A-5645A DOI: 10.1016/j.chest.2025.07.3155 Early Access Date: NOV 2025 Published Date: 2025 OCT Supplement: S |
| Title: Integration of social marketing and system dynamics modeling to address health disparities: an academic-community partnership case study |
| Author(s): Biroscak, BJ (Biroscak, Brian J.); Khaliq, M (Khaliq, Mahmooda); Schneider, T (Schneider, Tali); Dash-Pitts, L (Dash-Pitts, Lolita); Loi, CXA (Aguado Loi, Claudia Ximena); Ewing, AP (Ewing, Aldenise Phylicia); Hovmand, PS (Hovmand, Peter S.); Bryant, CA (Bryant, Carol A.); Parvanta, C (Parvanta, Claudia) |
| Source: JOURNAL OF SOCIAL MARKETING Volume: 15 Issue: 4 Pages: 579-600 DOI: 10.1108/JSOCM-02-2025-0025 Early Access Date: NOV 2025 Published Date: 2025 DEC 3 |
| Abstract: PurposeThe purpose of this innovative case study research was to integrate community-based social marketing and system dynamics modeling to address colorectal cancer screening disparities. The resulting framework, Community-Based Prevention Marketing (CBPM) for Systems Change, was designed to build academic-community partners' social marketing and systems thinking capacities, for designing, implementing and evaluating multilevel prevention strategies.Design/methodology/approachThis case study used a CBPM framework, integrating participatory system dynamics modeling to design, implement and evaluate a multilevel intervention. Implementation of group modeling techniques during the workshops with a cancer community coalition guided development of causal loop diagrams, leverage points identification and intervention scenarios to enhance colorectal cancer screening rates in a specific US community. Refinement of qualitative and quantitative models emerged and were refined through integration of community wisdom, secondary data and rich discussions when applying systems thinking visualization tools.FindingsThe participatory system dynamics modeling process was valued by the partners. However, there was a mismatch between the community partners' expectations for quick results and the longer timelines suggested by the simulation modeling. The difference between what the partners hoped to achieve and what the simulations revealed led them to question the utility of the simulation modeling. As a result, they decided to continue developing and implementing the social marketing strategy without further using the simulation tools. Anticipation of such an outcome should be incorporated when designing systems thinking approaches with community organizations.Originality/valueTo the best of the authors' knowledge, this is the first social marketing application integrating participatory system dynamics simulation modeling and community-based social marketing. Findings suggest that the two orientations, a marketing orientation and systems thinking orientation can inform shared decision-making. Yet, more real-world applications are needed to facilitate shared learning among social marketing researchers, practitioners and clients. |
| Title: System Dynamics Modeling for Managing Capacity and Demand for Human Services |
| Author(s): Biroscak, BJ (Biroscak, Brian J.) |
| Source: SYSTEMIC PRACTICE AND ACTION RESEARCH Volume: 38 Issue: 4 Article Number: 29 DOI: 10.1007/s11213-025-09739-w Published Date: 2025 NOV 11 |
| Abstract: The effective delivery of human services is frequently hampered by complex challenges related to managing both service capacity (e.g., facilities, labor) and fluctuating demand (e.g., community members in need). This persistent mismatch, acutely observed in critical areas such as domestic violence (DV) programs, leads to unmet needs and significant service system strain. While existing approaches address aspects of this problem, they often struggle to capture the dynamic, interconnected nature of these challenges and the underlying system structures that drive observed trends. This paper proposed system dynamics (SD) modeling, a computer-aided methodology for understanding temporal patterns and providing strategic decision support, as a powerful approach to enhance human services management through improved capacity and demand alignment. SD offers a unique ability to shift from an event-oriented perspective to a systems-orientation, revealing endogenous feedback mechanisms and accumulations that conventional methods often overlook. DV programs are presented as a compelling case for this application due to their critical role in supporting persons in crisis and programs' ongoing struggle with demand exceeding available capacity. By demonstrating the potential of SD in this specific context, the paper highlights a generalizable framework for other human services organizations to better manage complex service delivery challenges. |
| Title: Expanding diagnostic testing for drug-resistant tuberculosis in high burden settings: a cost-effectiveness analysis |
| Author(s): Getchell, M (Getchell, Marya); Ansah, JP (Ansah, John Pastor); Lim, D (Lim, Dodge); Basilio, R (Basilio, Ramon); Tablizo, F (Tablizo, Francis); Corpuz, C (Corpuz, Carmen); Matchar, D (Matchar, David) |
| Source: BMC PUBLIC HEALTH Volume: 25 Issue: 1 Article Number: 3795 DOI: 10.1186/s12889-025-24934-z Published Date: 2025 NOV 5 |
| Abstract: BackgroundNew and effective tools for detecting drug-resistant tuberculosis (DR-TB) include GeneXpert XDR and targeted Next Generation Sequencing (tNGS). However, data on their implementation in high TB-burden settings is limited. We aimed to determine cost-effectiveness of different strategies using GeneXpert XDR or tNGS for DR-TB detection in high TB-burden, low-resource settings.MethodsA dynamic simulation model was calibrated to WHO-reported TB data for Philippines and Thailand. Intervention scenarios for expanded diagnostic testing of drug-resistance were simulated for 2025 - 2035. Health benefits were estimated using disability-adjusted life years. Cost-effectiveness was calculated from a health system perspective using country-level TB diagnosis and treatment costs. Analyses include incremental cost-effectiveness ratios (ICERs) and incremental net monetary benefit (INMB).ResultsImplementing GeneXpert XDR or tNGS for DR-TB detection improves TB health outcomes. Scenarios using GeneXpert XDR are more likely to be cost-effective than scenarios using tNGS. Interventions targeting previously treated cases reduce costs but also reduce health benefits. Testing all TB cases with GeneXpert XDR is cost-effective (Philippines ICER = $1,808, INMB = $210M; Thailand ICER = $5,251, INMB = $26M) with a 1 x GDP willingness-to-pay threshold (WTP). Targeting GeneXpert XDR to previously treated cases is also cost-effective (Philippines ICER = $1,288, INMB = $52M; Thailand ICER = $3,667, INMB = $9.2M) but results in lower INMB. tNGS is cost-effective at higher WTP.InterpretationIn high TB-burden countries, GeneXpert XDR is cost-effective as an additional DR-TB diagnostic test. tNGS is not cost-effective for routine clinical DR-TB testing but has potential for application to high-risk populations, especially with introduction of new TB treatment regimens. |
| PubMed ID: 41194030 |
| Title: A cross-sectional assessment of US cancer diagnoses during the COVID-19 pandemic |
| Author(s): Burus, T (Burus, Todd); Kim, U (Kim, Uriel); Rose, J (Rose, Johnie); Koroukian, SM (Koroukian, Siran M.); Kuhs, KAL (Kuhs, Krystle A. Lang) |
| Source: CANCER EPIDEMIOLOGY Volume: 99 Article Number: 102944 DOI: 10.1016/j.canep.2025.102944 Early Access Date: OCT 2025 Published Date: 2025 DEC |
| Abstract: Background: Disruptions to cancer diagnoses were widely reported in the US during the early COVID-19 pandemic. Whether any cases remained unaccounted-for by the end of the pandemic has not been fully assessed. Methods: We collected data on invasive cancer diagnoses occurring among individuals aged 20-89 years between January 2020 and December 2022 from the Surveillance, Epidemiology, and End Results database. Expected cancer case counts and incidence rates with 95 % credibility intervals (95 %CrIs) were estimated for 2020-2022 from pre-pandemic trends (2005-2019) using Bayesian Age-Period-Cohort models. We compared observed rates with expected rates, and estimated unaccounted-for cases. Additional site-, stage-, and subgroup-specific analyses were performed. Results: Among 2260,704 cancer cases diagnosed in 2020-2022, the observed incidence rate was 595.5 per 100,000 persons (95 %CI, 594.7-596.2), which was 6.7 % lower than the expected rate of 638.1 (95 %CrI, 620.1-656.1) and corresponded to 160,475 fewer-than-expected cases (95 %CrI, 99,777-221,174). Annual observed rates were significantly lower than expected in 2020 (565.8 vs. 630.7), with recovery in 2021 and 2022, though not enough to overcome the existing case deficit. Incidence rates for persons aged >= 65 years, nonmetropolitan residents, and non-Hispanic White individuals, as well as site-specific rates for lung and kidney cancers and non-Hodgkin lymphoma, remained below expected levels beyond 2020. Early-stage colorectal cancer diagnoses were 14.2 % lower than expected over the period. Conclusion: While annual cancer incidence rates returned to expected levels by the end of the COVID-19 pandemic, substantial numbers of unaccounted-for cases remained, raising concerns for future increases in cancer morbidity and mortality. |
| PubMed ID: 41108855 |
| Title: Timing of neurorehabilitation and subsequent Alzheimer's disease risk in patients with moderate to severe traumatic brain injury: A nationwide retrospective cohort study in the United States |
| Author(s): Kennemer, AA (Kennemer, Austin A.); Gao, ZX (Gao, Zhenxiang); Davis, PB (Davis, Pamela B.); Kaelber, DC (Kaelber, David C.); Xu, R (Xu, Rong) |
| Source: JOURNAL OF ALZHEIMERS DISEASE Volume: 108 Issue: 3 Pages: 1155-1165 DOI: 10.1177/13872877251385262 Early Access Date: OCT 2025 Published Date: 2025 DEC |
| Abstract: Background Traumatic brain injury (TBI) is associated with an increased risk of Alzheimer's disease (AD). It is unknown if prompt neuro-rehabilitative treatment following moderate or severe TBI mitigates this risk compared with delayed treatment. Objective To determine whether immediate neuro-rehabilitative treatment following moderate or severe TBI reduces the risk of AD and related cognitive outcomes compared with delayed treatment. Methods We conducted a retrospective cohort using the TriNetX Analytics Platform, which includes health records from over 100 million US patients. Adults aged 50-90 years with moderate or severe TBI were included if they received immediate treatment (within 1 week) or delayed treatment (>1 week). Outcomes were AD risk at 3- and 5-year follow-up, with additional outcomes of mild cognitive impairment (MCI), dementia, and AD-related medication prescriptions. Cox proportional hazards models were applied to propensity score-matched cohorts, and hazard ratios (HRs) with 95% confidence intervals (CIs) were calculated. Results Of 37,081 eligible patients, 17,636 remained after propensity score matching. Immediate treatment was associated with lower AD risk compared with delayed treatment (HR, 0.59; 95% CI, 0.41-0.86 at 3 years; HR, 0.70; 95% CI, 0.52-0.94 at 5 years). Similar risk reductions were observed for MCI, dementia, and AD-related medication use. Conclusions Immediate treatment following moderate or severe TBI was associated with significantly reduced risk of AD and related cognitive decline. These findings suggest that prompt intervention may mitigate long-term neurodegenerative consequences of TBI. |
| PubMed ID: 41069042 |
| Title: Harnessing Artificial Intelligence for Obesity Care: A Systematic Review of AI-Enabled Behavioral Coaching Platforms, Outcomes, and Ethical Implications |
| Author(s): Hallock, R (Hallock, Rajiev); Mehta, N (Mehta, Nihit); Patel, N (Patel, Niki); Ganesan, N (Ganesan, Niteesh); Kang, C (Kang, Christine); Pulis, M (Pulis, Melissa); Rose, J (Rose, Johnie) |
| Source: CURRENT CARDIOVASCULAR RISK REPORTS Volume: 19 Issue: 1 Article Number: 24 DOI: 10.1007/s12170-025-00776-7 Published Date: 2025 OCT 1 |
| Abstract: Purpose of ReviewArtificial intelligence (AI) enabled behavioral health coaching has emerged as a potential solution for managing obesity and related complications. This review aims to evaluate the effectiveness, engagement, and ethical implications of AI-enabled behavioral coaching platforms in the management of obesity.Recent FindingsOur search identified 21 relevant studies. Of these, 8 were randomized controlled trials and 13 were observational studies (including pretest-protest, longitudinal, retrospective cohort and single-arm intervention studies). AI-based platforms were associated with clinically significant weight loss (ranging from - 0.8 kg to - 13.9% of baseline weight), systolic blood pressure reductions up to - 18.6 mmHg, improvements in HbA1c (up to - 1.2% points) and LDL cholesterol (up to - 66.6 mg/dL). Engagement levels were high, with retention rates ranging from 57 to 92%, particularly in hybrid models combining AI with human coaching. Ethical concerns reported included algorithmic opacity, lack of cultural tailoring, and unequal access due to technological barriers.SummaryAI-driven behavioral coaching platforms demonstrate promising effectiveness in obesity and cardiometabolic risk management, with outcomes comparable to traditional lifestyle interventions. However, ethical limitations, short study durations, and variability in design highlight the need for longer-term, diverse, and ethically grounded research. Future studies should emphasize algorithm transparency, data governance, equitable access, and integration into routine clinical care. |
| Title: Associations of selective serotonin reuptake inhibitors and long COVID risk in patients with depression: a retrospective cohort study |
| Author(s): Gao, ZX (Gao, Zhenxiang); Tabernacki, T (Tabernacki, Tomasz); Davis, PB (Davis, Pamela B.); Kaelber, DC (Kaelber, David C.); Xu, R (Xu, Rong) |
| Source: INFECTION Volume: 54 Issue: 1 Pages: 203-211 DOI: 10.1007/s15010-025-02648-z Early Access Date: SEP 2025 Published Date: 2026 FEB |
| Abstract: PurposeTo evaluate the potential of selective serotonin reuptake inhibitors (SSRIs) in reducing the risk of long COVID in patients with depression.MethodsThis retrospective cohort study analyzed U.S. electronic health records from TriNetX platform to compare the risk of long COVID among adults with depression who were prescribed SSRIs versus non-SSRI antidepressants between March 2020 and December 2022. The main outcome was the long COVID diagnosis. As a sensitivity analysis, CDC-defined long COVID symptoms were used as alternative outcomes. Cox proportional hazards models were used to assess outcomes occurring 3-6 and 3-12 months after the index SARS-CoV-2 infection, with hazard ratios (HRs) and 95% confidence intervals (CIs) calculated.ResultsAfter propensity score matching, the study included 31,264 patients, and the risk of long COVID diagnosis was significantly lower in the SSRI cohort compared to the matched non-SSRI antidepressant cohort, with hazard ratios of 0.57 (95% CI: 0.44-0.73) for the 3-6-month period and 0.59 (95% CI: 0.49-0.72) for the 3-12-month period. Sensitivity analyses in matched cohorts of 17,100 patients showed that SSRI use was associated with a significantly reduced risk of long COVID symptoms, consistent across symptom categories and pandemic periods.ConclusionsIn adult patients with depression, SSRIs compared with non-SSRI antidepressants were associated with a lower risk of long COVID. These results offer preliminary evidence that SSRIs may help prevent long COVID in high-risk populations and warrant further preclinical and clinical investigation. |
| PubMed ID: 40996671 |
| Title: Neighborhood multi-modal spatial access to primary care is associated with improved colorectal cancer screening in NCI-designated cancer center catchment areas |
| Author(s): Buchalter, RB (Buchalter, R. Blake); Wang, CZ (Wang, Changzhen); Gunsalus, PR (Gunsalus, Paul R.); Dalton, JE (Dalton, Jarrod E.); Rose, J (Rose, Johnie); Schmit, SL (Schmit, Stephanie L.) |
| Source: CANCER EPIDEMIOLOGY BIOMARKERS & PREVENTION Volume: 34 Issue: 9 Special Issue: SI Pages: A95-A95 DOI: 10.1158/1538-7755.DISP25-A095 Published Date: 2025 SEP 18 |
| Title: Impact of sociodemographic, clinical, and intervention characteristics on pain intensity within a single music therapy session |
| Author(s): Rodgers-Melnick, SN (Rodgers-Melnick, Samuel N.); Gunzler, D (Gunzler, Douglas); Love, TE (Love, Thomas E.); Koroukian, SM (Koroukian, Siran M.); Beno, M (Beno, Mark); Dusek, JA (Dusek, Jeffery A.); Rose, J (Rose, Johnie) |
| Source: JOURNAL OF PAIN Volume: 36 Article Number: 105556 DOI: 10.1016/j.jpain.2025.105556 Early Access Date: SEP 2025 Published Date: 2025 NOV |
| Abstract: Several studies support the efficacy of music therapy (MT) for reducing pain, but few have examined which interventions are most effective or which patients are more likely to respond. This study investigated which sociodemographic, clinical, and intervention characteristics are associated with clinically significant reductions in pain intensity (0-10 numeric rating scale reduction >= 2 units) within a single MT session. We conducted a retrospective review of 2039 MT sessions provided across a large health system among 1203 adult patients reporting pre-session pain >= 4/10, a complete post-session pain score, and a complete pre-session stress score. We employed a multivariable logistic mixed effects model to evaluate binary pain reduction response (>= 2 units vs. < 2 units) where patients were considered nested within therapists. The model included a fixed covariate for MT intervention type: receptive only, recreative (i.e., singing or active instrument play), compositional/creative (e. g., songwriting), or music-assisted relaxation and imagery (MARI). Covariates in the model associated with higher adjusted odds ratios (aOR [95% CI]) included (1) recreative (1.37 [1.00, 1.86]) and MARI (1.48 [1.01, 2.17]) MT interventions as compared to receptive; (2) 15-minute increases in session length (1.40 [1.22, 1.61]); (3) 1-unit increases in pre-session pain (1.19 [1.11, 1.28]), (4) 5-unit increases in Elixhauser comorbidity count (1.29 [1.05, 1.60); and (5) a documented MT session goal of pain management (3.58, [2.64, 4.86]). MT interventions involving singing, active instrument play, and relaxation/imagery may be more effective for reducing pain intensity than interventions only involving live or recorded music among patients with high pre-session pain. Perspective: This study examined factors associated with meaningful reductions in pain (0-10 numeric rating scale reduction >= 2 units) within a single music therapy session. Among hospitalized patients, interventions involving singing, active instrument play, and relaxation/imagery may be more effective for reducing pain than interventions only involving live or recorded music. |
| PubMed ID: 40945641 |
| Title: Beyond the Discharge Summary: 10 Critical Considerations for Primary Care Physicians Managing Postdischarge Care |
| Author(s): Morikawa, MJ (Morikawa, Masahiro J.); Ganesh, PP (Ganesh, Prakash P.) |
| Source: SOUTHERN MEDICAL JOURNAL Volume: 118 Issue: 9 Pages: 618-621 DOI: 10.14423/SMJ.0000000000001865 Published Date: 2025 SEP |
| PubMed ID: 41032273 |
| Title: Charting Suicide Risk in Latina Adolescents: A Qualitative System Dynamics Approach |
| Author(s): Gulbas, LE (Gulbas, Lauren E.); Hovmand, PS (Hovmand, Peter S.); Calzada, EJ (Calzada, Esther J.); Hausmann-Stabile, C (Hausmann-Stabile, Carolina); Kim, SY (Kim, Su Yeong); Zayas, LH (Zayas, Luis H.) |
| Source: CULTURAL DIVERSITY & ETHNIC MINORITY PSYCHOLOGY DOI: 10.1037/cdp0000772 Early Access Date: AUG 2025 Published Date: 2025 AUG 11 |
| Abstract: Objectives: Suicide risk among Latina adolescents is shaped by dynamic interactions among emotional, behavioral, and sociocultural factors. This study develops a causal feedback theory to illustrate how these factors reinforce or mitigate suicide risk over time. Method: Using grounded theory analysis, we analyzed qualitative interviews with 60 Latina adolescents (ages 11-19) recruited from New York City: 30 with a history of suicide attempts and 30 with no reported history of suicidal behaviors. Participants varied by Hispanic cultural group, place of birth, and documentation status. Results: Our feedback theory is organized around seven categories: cognitive vulnerabilities, avoidant coping, high-risk behaviors, family conflict, social support, cultural socialization, and ethnic identity. A reinforcing loop of cognitive vulnerabilities, avoidant coping, high-risk behaviors, and family conflict was more common among adolescents who had attempted suicide. In contrast, social support, cultural socialization, and ethnic identity functioned as protective mechanisms that disrupted risk loops among those without suicidal behaviors. These findings suggest that while risk factors increase the likelihood of suicidal thoughts and behaviors, access to protective resources can interrupt risk trajectories and promote resilience. Conclusions: This study highlights the importance of culturally responsive suicide prevention strategies that strengthen social support, cultural socialization, and ethnic pride. By modeling suicide risk as a dynamic system, these findings provide new insights for intervention efforts tailored to the experiences of Latina adolescents. |
| PubMed ID: 40788715 |
| Title: Identifying patients with mild cognitive impairment at high risk of transitioning to Alzheimer's disease using routinely collected data |
| Author(s): Katabathula, S (Katabathula, Sreevani); Gurney, M (Gurney, Mark); Perry, G (Perry, George); Davis, PB (Davis, Pamela B.); Xu, R (Xu, Rong) |
| Source: JOURNAL OF ALZHEIMERS DISEASE Volume: 108 Issue: 1_SUPPL Pages: S334-S343 DOI: 10.1177/13872877251351622 Early Access Date: JUN 2025 Published Date: 2025 NOV Supplement: 1_SUPPL |
| Abstract: Background: Mild cognitive impairment (MCI) is a heterogeneous condition with variable progression to Alzheimer's disease (AD). Identifying MCI individuals at high risk for progression typically requires cerebrospinal fluid (CSF) biomarkers, magnetic resonance imaging (MRI), which are costly and invasive. Objective: This study aimed to develop a cost-effective approach using routinely collected clinical data to identify a subgroup of MCI individuals at high risk for AD progression. Methods Analyses were conducted using the UK Biobank dataset, focusing on 1019 participants identified: as having MCI, using the ICD-10 code F06.7 (mild neurocognitive disorder due to known physiological condition) in the absence of a dedicated diagnostic code for MCI. Participants (mean age = 71.7 years; 44% women) were characterized using routinely recorded demographic, comorbidity, and lifestyle data. A mixed-data clustering model was applied to classify individuals into subgroups. Clinical relevance of each cluster was evaluated using Kaplan-Meier survival analysis of MCI-to-AD progression over an average follow-up of 4.5 years.Results Three subtypes were identified with distinct progression risks: high-risk (HR), medium-risk (MR), and low-risk (LR). The HR subtype had significantly higher prevalence of hypertension (98%), cardiovascular disease (89%), diabetes (48%), and high cholesterol (67%) than MR and LR (p < 0.05). The HR group was younger on average but had greater comorbidity burden and higher likelihood of AD progression. Conclusions: This study demonstrates the feasibility of using routinely collected data to identify high-risk MCI individuals. This approach offers a practical preliminary screening tool to prioritize individuals for targeted interventions and further specialized assessments. |
| PubMed ID: 40560182 |
| Title: Associations of semaglutide with Alzheimer's disease-related dementias in patients with type 2 diabetes: A real-world target trial emulation study |
| Author(s): Wang, W (Wang, William); Davis, PB (Davis, Pamela B.); Qi, X (Qi, Xin); Gurney, M (Gurney, Mark); Perry, G (Perry, George); Volkow, ND (Volkow, Nora D.); Kaelber, DC (Kaelber, David C.); Xu, R (Xu, Rong) |
| Source: JOURNAL OF ALZHEIMERS DISEASE Volume: 106 Issue: 4 Pages: 1509-1522 DOI: 10.1177/13872877251351329 Early Access Date: JUN 2025 Published Date: 2025 AUG |
| Abstract: Background Almost half of the dementia cases are preventable. Semaglutide treats several medical conditions that are risk factors for dementia. Objective We aim to investigate if semaglutide is associated with a decreased risk of dementia. Methods We conducted emulation target trials based on a nationwide population-based database of patient electronic health records (EHRs) in the US among 1,710,995 eligible patients with type 2 diabetes (T2D) comparing semaglutide with other antidiabetic medications. First-time diagnosis of Alzheimer's disease-related dementia (ADRD) including vascular dementia, frontotemporal dementia, Lewy body dementia and other dementias were examined using Cox proportional hazards and Kaplan-Meier survival analyses during a 3-year follow-up. Models were adjusted by propensity-score matching. Results We show that semaglutide was associated with a significantly reduced risk of overall ADRD incidence with a hazard ratio ranging from 0.54 (0.49-0.59) compared with insulin, 0.67 (0.61-0.74) compared with metformin, to 0.80 (0.72-0.89) compared with older generation glucagon-like peptide-1 agonists (GLP-1RAs). The association varied for specific dementia types, with significantly reduced risk of vascular dementia and no evidence of associations with frontotemporal and Lewy body dementias. Conclusions These findings provide evidence supporting protective effects of semaglutide on dementias in patients with T2D. Future works are needed to establish the causal relationships through randomized clinical trials and to characterize the underlying mechanisms. |
| PubMed ID: 40552638 |
| Title: Implications of Primary Care Scenarios for the 'Performance' of Chronic Care Delivery in Switzerland: A Systems Modelling View |
| Author(s): Ansah, JP (Ansah, John P.); Duminy, L (Duminy, Lize); Schoenenberger, L (Schoenenberger, Lukas); Blankart, CR (Blankart, Carl Rudolf); Nicolet, A (Nicolet, Anna); Matchar, DB (Matchar, David Bruce) |
| Source: SYSTEMS RESEARCH AND BEHAVIORAL SCIENCE Volume: 43 Issue: 1 Pages: 306-315 DOI: 10.1002/sres.3171 Early Access Date: JUN 2025 Published Date: 2026 JAN |
| Abstract: Switzerland and most high-income countries are confronted with a growing number of people with chronic conditions who must be treated by healthcare systems that are designed to provide acute care predominantly. A widely supported solution is strengthening the primary care sector to better meet these increasingly complex healthcare needs. We used system dynamics to develop a computer simulation model of the driving factors and their connections to the quadruple aim of Switzerland's chronic care. The model served as an exploratory scenario analysis tool. A critical insight from the scenario analysis is that the capacity of the primary care sector can only be enduringly enhanced if the workforce is expanded and resources are shifted from inpatient and specialist care to primary care. This study should help policymakers better understand fundamental structural mechanisms and cause-effect relationships arising from changes to primary care. |
| Title: Association of Medicaid expansion with colon cancer care: treatment patterns and survival in non-metastatic cases from state registry-claims data |
| Author(s): Eom, KY (Eom, Kirsten Y.); Dong, WC (Dong, Weichuan); Hoehn, RS (Hoehn, Richard S.); Albert, JM (Albert, Jeffrey M.); Kim, U (Kim, Uriel); Cooper, G (Cooper, Gregory); Rose, J (Rose, Johnie); Tsui, J (Tsui, Jennifer); Koroukian, SM (Koroukian, Siran M.) |
| Source: CANCER CAUSES & CONTROL Volume: 36 Issue: 10 Pages: 1263-1274 DOI: 10.1007/s10552-025-01983-8 Early Access Date: JUN 2025 Published Date: 2025 OCT |
| Abstract: PurposeDespite growing research on Medicaid expansion's impact on cancer outcomes, there remains a critical need for a more nuanced understanding of how expansion affects cancer care and survival. This study assesses whether Medicaid expansion was associated with improved receipt of standard treatment, timely treatment initiation, and overall survival among colon cancer patients, while examining the specific factors influencing these outcomes.MethodsUsing Ohio's state cancer registry linked with Medicaid records, we analyzed 688 Medicaid-enrolled patients with non-metastatic colon cancer diagnosed between May 2011 and December 2017. We employed multivariable Poisson and Cox proportional hazard regression analyses to evaluate the impact of Medicaid expansion on treatment and survival outcomes, controlling for individual- and area-level factors.ResultsWe observed no significant changes in the likelihood of receipt of standard treatment or timely treatment initiation post-expansion vs. pre-expansion, and no significant differences in these outcomes by Medicaid eligibility criteria post-expansion. However, we observed significantly improved survival (hazard ratio, HR 0.49 [0.28, 0.88]) among patients who became newly eligible for Medicaid under the ACA vs. pre-expansion. Patients enrolled emergently (shortly after/upon diagnosis) were more likely to receive standard treatment (risk ratio, RR 1.14 [1.02, 1.27]).ConclusionsOur findings provide nuanced insights into Medicaid expansion's impact on colon cancer care, showing that while expansion did not affect treatment measures, it improved survival among newly eligible patients. Higher standard treatment likelihood among emergently enrolled patients suggests complex post-expansion care dynamics. Further research should investigate mechanisms underlying improved survival and develop interventions to enhance treatment quality alongside observed survival benefits. |
| PubMed ID: 40549121 |
| Title: Long-Range Forecasting for Emergency Care Systems in a Highly Dynamic Setting: A Singapore Case Study |
| Author(s): Siddiqui, FJ (Siddiqui, Fahad Javaid); Kumar, A (Kumar, Ashish); Ansah, JP (Ansah, John P.); Yuan, G (Yuan, Guo); Liu, ZH (Liu, Zhenghong); Malhotra, R (Malhotra, Rahul); Ong, MEH (Ong, Marcus Eng Hock); Lam, SSW (Lam, Sean Shao Wei) |
| Source: JOURNAL OF THE AMERICAN COLLEGE OF EMERGENCY PHYSICIANS OPEN Volume: 6 Issue: 4 Article Number: 100184 DOI: 10.1016/j.acepjo.2025.100184 Early Access Date: MAY 2025 Published Date: 2025 AUG |
| Abstract: Objectives: In aging societies such as Singapore, emergency care systems (ECSs) face the challenge of ever-increasing demand for urgent care. The uncertainties around population aging are compounded by the downstream effects of population health interventions. We forecast the demand for ECS use in Singapore, in terms of emergency department length of stay (ED-LOS) hours per person per year, until 2050, with and without the effects of a major intervention that enhances the role of primary and community care. Methods: Using a system dynamics simulation model, we applied age-specific emergency department usage rates-derived from our analysis of 1,736,405 attendances in a large tertiary hospital and stratified by acuity-to an age-stratified population forecast. We simulated a baseline and 4 intervention scenarios based on different efficacy-time and effect size levels. Results: In the baseline scenario, median ED-LOS increased from 580 hours per 1000 residents per year in 2010 to 644 hours per 1000 residents in 2050. Median ED-LOS increased from 276 to 372 hours per 1000 residents per year for high-acuity patients, whereas it decreased from 302 to 274 hours per 1000 residents per year for low-acuity patients. Under all intervention scenarios, low-acuity ECS use per person decreased, caused by "decanting" of this patient group to primary care. However, high-acuity ECS use per person increased because of longevity. Conclusions: In the long term, an overall increase in ECS demand is driven by an increase in high-acuity use; population health interventions can further exacerbate the high-acuity burden. Our work casts light on the relatively less-studied dynamics of long-term ECS demand. |
| PubMed ID: 40510827 |
| Title: Psychiatric outcomes after mild concussion by treatment timing and age |
| Author(s): Kennemer, AA (Kennemer, Austin A.); Gao, ZX (Gao, Zhenxiang); Wang, LD (Wang, Lindsey); Davis, PB (Davis, Pamela B.); Kaelber, DC (Kaelber, David C.); Xu, R (Xu, Rong) |
| Source: JOURNAL OF PSYCHIATRIC RESEARCH Volume: 187 Pages: 233-237 DOI: 10.1016/j.jpsychires.2025.05.017 Early Access Date: MAY 2025 Published Date: 2025 JUL |
| Abstract: Previous guidance for mild concussion treatment has recommended physical and cognitive rest. However, it remains unknown if patients who received treatment at different times had differential neuropsychiatric outcomes. We examined if patients who received immediate treatment less than one week after a mild concussion had a different risk for subsequent depression or anxiety compared with those who received delayed treatment greater than one week after the event, stratified by age groups. This multicenter retrospective cohort study used the TriNetX Analytics platform to access de-identified electronic health records of over 100 million patients, including both inpatient and outpatient visits, from 60 healthcare organizations across the United States. A total of 9881 patients with a diagnosis of mild concussion either received either immediate treatment, defined as within 1 week (n = 4053), or delayed treatment, defined as 1 week to 6 months (n = 5828) following the diagnosis of mild concussion. Each group was stratified by age:<= 25, 26-64, and 65+ years. Patients who received early treatment had significantly lower risk of depression and anxiety compared with propensity-score matched patients who received delayed treatment during a 5-year follow-up after mild TBI diagnosis, with hazard ratios (HRs) of 0.74 (95 % CI, 0.65-0.84) and 0.75 (95 % CI, 0.68-0.84), respectively. These results are consistent across age groups, with strongest reduction in older adults aged 65 years and older. These findings suggest that timely treatment for concussion may mitigate subsequent adverse psychiatric outcomes. |
| PubMed ID: 40382945 |
| Title: Effectiveness and Safety of Respiratory Syncytial Virus Vaccine for US Adults Aged 60 Years or Older |
| Author(s): Fry, SE (Fry, Sarah E.); Terebuh, P (Terebuh, Pauline); Kaelber, DC (Kaelber, David C.); Xu, R (Xu, Rong); Davis, PB (Davis, Pamela B.) |
| Source: JAMA NETWORK OPEN Volume: 8 Issue: 5 Article Number: e258322 DOI: 10.1001/jamanetworkopen.2025.8322 Published Date: 2025 MAY 9 |
| Abstract: Importance Respiratory syncytial virus (RSV) is associated with hospitalization and death among older adults. Characterizing the safety and effectiveness of recently introduced vaccines against RSV is critical. Objective To assess the safety and effectiveness of vaccines against RSV and the major adverse events among patients aged 60 years or older during the 2023-2024 RSV season. Design, Setting, and Participants In this study using a data platform containing electronic health records for more than 270 million patients across the US, a test-negative case-control design was used to estimate vaccine effectiveness (VE), and a self-controlled case series of vaccine recipients was included to estimate vaccine-associated adverse events. Records from participants aged 60 years or older with acute respiratory infection (ARI) and testing for RSV between October 1, 2023, and April 30, 2024, were included in the VE study. For vaccine safety analysis, all participants aged 60 years or older who received the RSV vaccine from July 1, 2023, to June 30, 2024 were included. Data were analyzed from August 2024 to March 2025. Main Outcomes and Measures Cases were those patients who tested positive for RSV, and controls were those who tested negative for RSV. Patients were classified as vaccinated if the vaccine was received at least 14 days before testing. VE against RSV-associated ARI diagnosis, emergency department or urgent care visits, or hospitalizations was estimated using (1 - odds ratio) x 100%. Excess risks of immune thrombocytopenic purpura and Guillain-Barr & eacute; syndrome diagnosis for 6 weeks after vaccine administration were calculated. Results Of 787 822 patients tested for RSV, 53 963 were positive (733 859 were controls); 1318 cases (2.4%) and 66 928 controls (9.1%) were vaccinated. Overall, VE was 75.1% (95% CI, 73.6%-76.4%) against ARI and was similar for age groups of 60 to 74 years and 75 years or older and against urgent care visits or hospitalizations. Immunocompromised patients had a VE from 67.0% (95% CI, 62.6%-70.9%) for patients aged 60 to 74 years to 73.1% (95% CI, 69.9%-76.0%) for those aged 75 years or older, and the lowest VE (ie, from 29.4% [95% CI, 3.5%-48.4%] for patients aged 60-74 years to 44.4% [95% CI, 1.0%-68.8%] for those aged >= 75 years) was for a subgroup of patients who received stem cell transplants. Among 4 746 518 vaccine recipients, no excess risk of immune thrombocytopenic purpura diagnosis was detected. An excess of 5.2 cases (RSVPreF3+AS01) or 18.2 cases (RSVPreF) of Guillain-Barr & eacute; syndrome were diagnosed per 1 000 000 doses of RSV vaccine administered. Conclusions and Relevance VE for the RSV protein subunit vaccine in this case-control study was similar to the VE in clinical trials. The VE for immunocompromised patients was mildly (overall) to moderately (for stem cell transplant recipients) diminished. Risk of immune thrombocytopenic purpura after vaccination was not elevated, but the risk of Guilain-Barre syndrome was statistically significantly elevated in patients who received the RSVPreF vaccine but not in those who received RSVPreF+AS01 vaccine, although the risk was small. These observations should inform clinicians' choices and patient instructions. |
| PubMed ID: 40343698 |
| Title: EARLY ONSET PROSTATE CANCER: A COMPLEX INTERPLAY BETWEEN RACE, POVERTY, AND INCIDENCE |
| Author(s): Davis, LE (Davis, Laura E.); Liu, FZ (Liu, Fangzhou); Dong, WC (Dong, Weichuan); Rose, J (Rose, Johnie); Koroukian, S (Koroukian, Siran); Vince, R (Vince, Randy) |
| Source: JOURNAL OF UROLOGY Meeting Abstract: PD18-08 Volume: 213 Issue: 5S DOI: 10.1097/01.JU.0001109928.76203.bd.08 Published Date: 2025 MAY Supplement: 5 |
| Title: Moving Closer to Personalized Cancer Prevention Strategies by Assessing Comorbidity and Multimorbidity |
| Author(s): Koroukian, SM (Koroukian, Siran M.); Kim, U (Kim, Uriel); Rose, J (Rose, Johnie) |
| Source: JAMA NETWORK OPEN Volume: 8 Issue: 4 Article Number: e253476 DOI: 10.1001/jamanetworkopen.2025.3476 Published Date: 2025 APR 7 |
| PubMed ID: 40193080 |
| Title: A conceptual system dynamics model of social determinants of health (SDoH) and its impact on population health |
| Author(s): Ansah, JP (Ansah, John P.); Salazar, R (Salazar, Robinson); Elamin, A (Elamin, Amal) |
| Source: JOURNAL OF PUBLIC HEALTH RESEARCH Volume: 14 Issue: 2 Article Number: 22799036251347035 DOI: 10.1177/22799036251347035 Published Date: 2025 APR |
| Abstract: Background: This paper primarily aims to construct a conceptual model of social determinants of health (SDoH), which will serve as a vital tool for identifying the feedback mechanisms that influence population health outcomes. Additionally, it seeks to simulate both the immediate and long-term effectiveness of proposed SDoH interventions on population health.Design and methods: We developed a system dynamics model of SDoH based on literature review and insights from community health experts. This model enables us to simulate the effectiveness of proposed interventions on population health, using CVD as a representative example of health outcomes.Results: The model results highlight a promising approach for enhancing population health. The neighborhood intervention stands out among the various interventions, demonstrating the most significant impact on health compared to other individual interventions. This finding underscores the potential of neighborhood-focused strategies in improving overall population health.Conclusion: This paper provides a clear explanation and causal framework for why investing in programs that enhance SDoH can improve population health. It introduces a powerful tool such as a causal map of SDoH, enabling policymakers and stakeholders to gain a more profound, dynamic understanding of the relationship between SDoH and health outcomes. This knowledge may help to make informed decisions and implement effective interventions. |
| PubMed ID: 40521180 |
| Title: Comparing Breast Cancer Treatment Outcomes Between Fee-for-Service and Medicare Advantage |
| Author(s): Shearn-Nance, G (Shearn-Nance, Galen); Sachdev, RR (Sachdev, Rishi R.); Vu, L (Vu, Long); Dong, WC (Dong, Weichuan); Montero, AJ (Montero, Alberto J.); Koroukian, SM (Koroukian, Siran M.); Rose, J (Rose, Johnie) |
| Source: AMERICAN JOURNAL OF MANAGED CARE Volume: 31 Issue: 4 Pages: 190-196 DOI: 10.37765/ajmc.2025.89720 Published Date: 2025 APR |
| Abstract: OBJECTIVES: Medicare Advantage (MA) enrollment has increased over the past 2 decades. We compare receipt of standard treatment, time to treatment initiation (TTI), and overall survival (OS) between fee-for-service (FFS) Medicare and MA for women in Ohio with breast cancer. STUDY DESIGN: Retrospective cohort. METHODS: We used Ohio cancer registry data linked with Medicare enrollment files to identify women diagnosed between 2011 and 2016 with local-or regional-stage breast cancer. We evaluated the association between FFS or MA and each outcome, adjusting for age, race, marital status, county type, neighborhood poverty level, stage, hormone receptor status, and dual Medicare-Medicaid enrollment. Standard treatment was mastectomy or breast-conserving surgery plus radiotherapy; chemotherapy for regional disease; and hormone therapy if hormone receptor positive. RESULTS: A total of 12,349 patients met inclusion criteria (6801 FFS; 5548 MA). No difference was found in receipt of standard treatment between FFS and MA patients (adjusted OR [AOR], 0.99; 95% CI, 0.91-1.08) or between Black and White patients (AOR, 1.14; 95% CI, 0.94-1.40); however, Black patients with FFS had lower odds of standard treatment (AOR for interaction, 0.75; 95% CI, 0.57-0.99). We detected no difference in TTI (adjusted HR [AHR], 0.98; 95% CI, 0.94-1.01) or OS (AHR, 1.03; 95% CI, 0.92-1.15) between FFS and MA patients, and we found no significant interaction between MA status and race for OS or TTI. CONCLUSIONS: MA enrollment was not independently associated with standard treatment, TTI, or OS after cancer diagnosis. Further work is needed to understand why Black patients with FFS Medicare were less likely to receive standard treatment. |
| PubMed ID: 40227399 |
| Title: Developing Group Model-Building Workshops for Children's Healthy Living Food Systems |
| Author(s): Hovmand, PS (Hovmand, Peter S.); Franck, K (Franck, Karen); Butel, J (Butel, Jean); Galbreath, J (Galbreath, Jennifer); Esquivel, M (Esquivel, Monica); Coleman, P (Coleman, Patricia); Aflague, T (Aflague, Tanisha); Shallcross, L (Shallcross, Leslie); Ogland-Hand, C (Ogland-Hand, Callie); Oshiro, J (Oshiro, Jordan); Belyeu-Camacho, T (Belyeu-Camacho, Tayna); Sikes, A (Sikes, Amelia); Novotny, R (Novotny, Rachel) |
| Source: CURRENT DEVELOPMENTS IN NUTRITION Volume: 9 Issue: 4 Article Number: 104583 DOI: 10.1016/j.cdnut.2025.104583 Early Access Date: MAR 2025 Published Date: 2025 APR |
| Abstract: This article reports on the development of group model-building workshops for understanding children's nutrition and health as a complex adaptive system. A community-based system dynamics approach was used to conduct workshops in 5 United States-Affiliated Pacific jurisdictions as part of the Children's Healthy Living Food Systems project from October 2022 to March 2023. Workshops were cofacilitated by local teams using a facilitation guide with a series of structured small-group exercises or "scripts" and evaluated using a pre-post participant survey. Products generated through these workshops included causal maps of the food systems driving child nutrition and health and prioritized action ideas that can be used to inform program design, planning, and implementation of local initiatives. Workshop evaluation highlights the robustness of workshops across jurisdictions, cultural contexts, and varied experiences of facilitation teams. Implications for the future development of group model-building facilitation guides and child nutrition are discussed. |
| PubMed ID: 40212831 |
| Title: Beyond Rugged Individualism?: Exploring the Resilience of Black Entrepreneurs to Chronic Racism |
| Author(s): Nurse, S (Nurse, Saran); Dasent, K (Dasent, Kisha); Rivera, A (Rivera, Alex); Ansah, JP (Ansah, John Pastor); Black, J (Black, Janine) |
| Source: JOURNAL OF MANAGEMENT STUDIES Volume: 63 Issue: 1 Special Issue: SI Pages: 162-194 DOI: 10.1111/joms.13211 Early Access Date: MAR 2025 Published Date: 2026 JAN |
| Abstract: This study investigates how the resilience process unfolds for Black entrepreneurs in the context of chronic racism, employing a novel qualitative approach that combines Group Model Building (GMB) and semi-structured interviews with 49 Black entrepreneurs. Drawing on the socio-ecological theory of resilience and leveraging Critical Race Theory (CRT), the research finds that resilience, shaped by the persistent nature of racism, requires ongoing adaptation rather than a return to a pre-adversity state. This continuous adaptation can lead to the depletion of coping resources. The study also illustrates how internal and external coping mechanisms interact, showing that over-reliance on internal coping mechanisms arises due to insufficient institutional and social support. Our research contributes to the literature on Black entrepreneurship, resilience, and race in entrepreneurship, while offering a comprehensive policy approach to both support and empower Black entrepreneurs. We advocate for decolonizing research practices that not only study but actively benefit the communities involved, fostering engaged and transformative scholarship. |
| Title: Socioeconomic Differences in Navigating Access to Lung Transplant |
| Author(s): Lehr, CJ (Lehr, Carli J.); Mourany, L (Mourany, Lyla); Gunsalus, P (Gunsalus, Paul); Rose, J (Rose, Johnie); Valapour, M (Valapour, Maryam); Dalton, JE (Dalton, Jarrod E.) |
| Source: JAMA NETWORK OPEN Volume: 8 Issue: 3 Article Number: e250572 DOI: 10.1001/jamanetworkopen.2025.0572 Published Date: 2025 MAR 13 |
| Abstract: Importance Inequitable access to transplant in the US is well recognized, yet the nature and extent of upstream disparities in care prior to transplant are unknown. Objective To understand patterns of referral for lung transplant by race, ethnicity, and neighborhood-level socioeconomic status. Design, Setting, and Participants This retrospective cohort study included adults aged 18 to 80 years with obstructive and restrictive lung disease from a single large-volume transplant center in Cleveland, Ohio, who were diagnosed between January 1, 2006, and May 11, 2023. Exposures Neighborhood resources. Main Outcomes and Measures The main outcome was the transition to the next stage of the transplant care continuum, death, or a lapse in care. Cause-specific Cox proportional hazards regression models were used to account for death as a competing risk, adjusting for age at index encounter (respective to each cohort), diagnosis, and sex as covariates. Results This study included 30 050 patients with obstructive and restrictive lung disease with primary care encounters (mean [SD] age, 65 [13] years; 56.1% female), 73 817 with a pulmonary medicine encounter, 4198 undergoing lung transplant evaluation, and 1378 on the lung transplant waiting list. In a multivariable model including age, diagnosis, sex, area deprivation index, and race and ethnicity (including 3.3% Hispanic, 15.2% non-Hispanic Black, and 81.5% non-Hispanic White individuals), patients residing in the least-resourced neighborhoods were 97% more likely to die without transitioning to pulmonary medicine (hazard ratio [HR], 1.97 [95% CI, 1.78-2.17]), 90% more likely to die prior to lung transplant evaluation (HR, 1.90 [95% CI, 1.77-2.04]), 40% more likely to die prior to placement on the waiting list (HR, 1.40 [95% CI, 1.11-1.76]), and 97% more likely to die prior to transplant (HR, 1.97 [95% CI, 1.18-3.29]) compared with patients residing in the most-resourced neighborhoods. These patients were also 13% less likely to transition to pulmonary medicine (HR, 0.87 [95% CI, 0.82-0.92]) and 45% less likely to be placed on the waiting list (HR, 0.55 [95% CI, 0.44-0.68]) despite a 69% increased likelihood of transplant evaluation (HR, 1.69 [95% CI, 1.36-2.09]). While non-Hispanic Black patients had lower risks of death across all stages of care, they experienced a 39% lower likelihood of proceeding to lung transplant evaluation (HR, 0.61 [95% CI, 0.51-0.74]). Racial differences in the cumulative incidence of waiting list placement were found, but differences were not consistent across levels of neighborhood resources. Conclusions and Relevance In this retrospective cohort study of patients diagnosed with restrictive and obstructive pulmonary disease, increased mortality risks and decreased likelihood of care escalations for patients who were socioeconomically disadvantaged and for racial and ethnic minority patients were found. These results suggest potential interventions for advancing equitable access to lung transplant. |
| PubMed ID: 40080022 |
| Title: The community health worker model for cardiovascular kidney metabolic syndrome: A new paradigm for high value care |
| Author(s): Rajagopalan, S (Rajagopalan, Sanjay); Adarquah-Yiadom, J (Adarquah-Yiadom, Jeshurun); Mcclain, F (Mcclain, Fonda); Ansah, JP (Ansah, John Pastor); Osborne, H (Osborne, Heidi); Nicholson, K (Nicholson, Kimberly); Landskroner, Z (Landskroner, Zoe); Mountain, K (Mountain, Kyia); Eaton, E (Eaton, Elke); Porges, J (Porges, Jodi); Horvitz, R (Horvitz, Rita); Neeland, IJ (Neeland, Ian J.); Pronovost, P (Pronovost, Peter); Brook, RD (Brook, Robert D.); Wright, JT Jr (Wright Jr, Jackson T.); Al-Kindi, S (Al-Kindi, Sadeer); Levy, PD (Levy, Phillip D.) |
| Source: AMERICAN JOURNAL OF PREVENTIVE CARDIOLOGY Volume: 21 Article Number: 100944 DOI: 10.1016/j.ajpc.2025.100944 Early Access Date: FEB 2025 Published Date: 2025 MAR |
| Abstract: Access and adherence to prevention and therapeutic lifestyle change programs remain largely aspirational for many low resource and minority communities. Given the importance of prevention and the high cost of care in complex medical conditions such as cardiovascular kidney and metabolic syndrome (CKM), new models of care delivery that enhance value are needed. Community health workers (CHWs) may serve as an innovative link between healthcare systems and the community, improving last mile delivery of services for "at risk" community members through education, outreach, informal counseling, social service support, and advocacy. The impending new Center for Medicare Medicaid Services (CMS) reimbursements for Community Health Integration, Social Determinants of Health (SDOH) assessment, and Principal Illness Navigation services in medically necessary care, represents a major shift in reimbursement models. In this review, we explore four overarching barriers to widespread adoption of CHWs, current roles of CHWs in CKM care, including outcomes and data confirming economic viability and sustainability of engaging CHW's in CKM care. We explore problems with existing financial models for CHW involvement, and forthcoming reimbursement pathways and solutions. CHW's are frontline health workers who could be critical in enhancing value for CKM. However current reimbursement models and restructuring of payments needs to occur rapidly to embrace a new cadre of health workers in our fight against adverse CKM health. |
| PubMed ID: 40092650 |
| Title: Assessing the Clinical Utility of Published Prostate Cancer Polygenic Risk Scores in a Large Biobank Data Set |
| Author(s): Vince , RA Jr (Vince Jr, Randy A.); Sun, HL (Sun, Helen); Singhal, U (Singhal, Udit); Schumacher, FR (Schumacher, Fredrick R.); Trapl, E (Trapl, Erika); Rose, J (Rose, Johnie); Cullen, J (Cullen, Jennifer); Zaorsky, N (Zaorsky, Nicholas); Shoag, J (Shoag, Jonathan); Hartman, H (Hartman, Holly); Jia, AY (Jia, Angela Y.); Spratt, DE (Spratt, Daniel E.); Fritsche, LG (Fritsche, Lars G.); Morgan, TM (Morgan, Todd M.) |
| Source: EUROPEAN UROLOGY ONCOLOGY Volume: 8 Issue: 1 Pages: 47-55 DOI: 10.1016/j.euo.2024.04.017 Early Access Date: FEB 2025 Published Date: 2025 FEB |
| Abstract: Background and objective: Polygenic risk scores (PRSs) have been developed to identify men with the highest risk of prostate cancer. Our aim was to compare the performance of 16 PRSs in identifying men at risk of developing prostate cancer and then to evaluate the performance of the top-performing PRSs in differentiating individuals at risk of aggressive prostate cancer. Methods: For this case-control study we downloaded 16 published PRSs from the Polygenic Score Catalog on May 28, 2021 and applied them to Michigan Genomics Initiative (MGI) patients. Cases were matched to the Michigan Urological Surgery Improvement Collaborative (MUSIC) registry to obtain granular clinical and pathological data. MGI prospectively enrolls patients undergoing surgery at the University of Michigan, and MUSIC is a multi-institutional registry that prospectively tracks demographic, treatment, and clinical variables. The predictive performance of each PRS was evaluated using the area under the covariate-adjusted receiver operating characteristic curve (aAUC), and the association between PRS and disease aggressiveness according to prostate biopsy data was measured using logistic regression. Key findings and limitations: We included 18 050 patients in the analysis, of whom 15 310 were control subjects and 2740 were prostate cancer cases. The median age was 66.1 yr (interquartile range 59.9-71.6) for cases and 56.6 yr (interquartile range 42.6-66.7) for control subjects. The PRS performance in predicting the risk of developing prostate cancer according to aAUC ranged from 0.51 (95% confidence interval 0.51-0.53) to 0.67 (95% confidence interval 0.66-0.68). By contrast, there was no association between PRS and disease aggressiveness. Conclusions and clinical implications: Prostate cancer PRSs have modest real-world performance in identifying patients at higher risk of developing prostate cancer; however, they are limited in distinguishing patients with indolent versus aggressive disease. Patient summary: Risk scores using data for multiple genes (called polygenic risk scores) can identify men at higher risk of developing prostate cancer. However, these scores need to be refined to be able to identify men with the highest risk for clinically significant prostate cancer. (c) 2024 European Association of Urology. Published by Elsevier B.V. All rights are reserved, including those for text and data mining, AI training, and similar technologies. |
| PubMed ID: 38734542 |
| Title: A supply-based scoring approach to account for biological disadvantages in accessing lung transplant |
| Author(s): Rose, J (Rose, Johnie); Gunsalus, PR (Gunsalus, Paul R.); Lehr, CJ (Lehr, Carli J.); Swiler, MF (Swiler, Mark F.); Dalton, JE (Dalton, Jarrod E.); Valapour, M (Valapour, Maryam) |
| Source: JOURNAL OF HEART AND LUNG TRANSPLANTATION Volume: 44 Issue: 2 Pages: 193-201 DOI: 10.1016/j.healun.2024.09.022 Early Access Date: JAN 2025 Published Date: 2025 FEB |
| Abstract: BACKGROUND: The lung Composite Allocation Score (CAS) accounts separately for biological disadvantages stemming from candidate blood type and height using consensus-derived heuristics, which do not reflect the true supply of compatible organs available to candidates with specific combinations of blood type and height. Here, we develop an alternative CAS biological disadvantages subscore using a novel measure of donor supply. METHODS: Using Scientific Registry of Transplant Recipients data from February 19, 2015 to September 1, 2021, we modeled daily distance-adjusted supply of compatible donors, as a function of candidate blood type, height, and diagnosis group, using Poisson rate regression and applied the model to create a 10-point supply-based subscore. Substituting this subscore in place of the 10 total points allocated to blood type and height in CAS created a "Supply-Adjusted CAS". We simulated population outcomes under Supply-Adjusted CAS, original CAS (March 2023) and "ABO Modified" CAS (September 2023). RESULTS: The supply-based subscore was more responsive to variations in candidate blood type, height, and diagnosis group than corresponding CAS or ABO-Modified CAS subscores. In simulation, waitlist mortality improved from 13.95 per 100 waitlist years under CAS and 14.12 under ABO-Modified CAS to 13.09 under Supply-Adjusted CAS. Transplant rates improved from 121.6 and 126.2 under CAS and ABO-Modified CAS, respectively, to 128.8 under Supply-Adjusted CAS. Height disparities improved substantially, while blood type disparities grew slightly relative to ABO-Modified CAS. CONCLUSIONS: Supply-Adjusted CAS may improve lung transplant population outcomes overall while providing a more empirically based method to address equity. J Heart Lung Transplant 2025;44:193-201 (c) Published by Elsevier Inc. on behalf of International Society for Heart and Lung Transplantation. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/ by-nc-nd/4.0/). |
| PubMed ID: 39412460 |
| Title: Melanoma detection, treatment, survival, and mortality through year 2 of the pandemic |
| Author(s): Kim, U (Kim, Uriel); Hoehn, RS (Hoehn, Richard S.); Koroukian, SM (Koroukian, Siran M.); Rose, J (Rose, Johnie); Bordeaux, JS (Bordeaux, Jeremy S.); Carroll, BT (Carroll, Bryan T.) |
| Source: ARCHIVES OF DERMATOLOGICAL RESEARCH Volume: 317 Issue: 1 Article Number: 209 DOI: 10.1007/s00403-024-03751-1 Published Date: 2025 JAN 9 |
| Abstract: The COVID-19 pandemic affected the timely diagnosis and treatment of many cancers, including melanoma, the fifth most common cancer in the U.S. This study aimed to quantify the disruption and recovery of melanoma detection, treatment, survival, and mortality during the pandemic by analyzing data from the Surveillance, Epidemiology, and End Results (SEER) program from 2000 to 2021. Our epidemiological analysis found that melanoma incidence initially dropped by 14.8% (95% CI: - 17.2 to - 12.4) in 2020 compared to pre-pandemic projections. Although incidence rates substantially recovered by 2021, an estimated 10,274 patients (95% CI: - 12,824 to - 7,724) remained undiagnosed due to pandemic-related disruptions. Time-to-treatment and 1-year survival were mostly consistent with pre-pandemic trends, while melanoma-specific mortality modestly declined by 4.5% (95% CI: - 14.6 to 5.6) in 2021, though this was statistically non-significant. These findings suggest that healthcare systems adapted to the challenges posed by the pandemic, maintaining essential cancer services. However, the significant drop in melanoma diagnoses likely contributed to the observed reduction in mortality. Thus, re-establishing care for patients missed during the pandemic will be crucial to preventing a future increase in advanced-stage melanoma and related deaths. |
| PubMed ID: 39786504 |
| Title: A Rising Tide Raises All Ships: Was the Effect of Medicaid Expansion on Cancer Outcomes Similar Across Subgroups of Patients With Cancer on Medicaid? |
| Author(s): Koroukian, SM (Koroukian, Siran M.); Dong, WC (Dong, Weichuan); Albert, JM (Albert, Jeffrey M.); Kim, U (Kim, Uriel); Vu, L (Vu, Long); Eom, KY (Eom, Kirsten Y.); Rose, J (Rose, Johnie); Cooper, GS (Cooper, Gregory S.); Hoehn, RS (Hoehn, Richard S.); Tsui, JNF (Tsui, Jennifer) |
| Source: AJPM FOCUS Volume: 4 Issue: 1 Article Number: 100301 DOI: 10.1016/j.focus.2024.100301 Early Access Date: JAN 2025 Published Date: 2025 FEB |
| Abstract: Introduction: The authors determined whether certain subgroups of patients with cancer on Ohio Medicaid benefited from the program's expansion to a greater/lesser extent. Study outcomes included stage at diagnosis for screening-amenable cancers (breast [n=1,707 and 2,976], cervical [n=309 and 655], and colorectal [n=927 and 2,009] cancer, before and after expansion, respectively) and time to treatment initiation. Methods: Using linked data from the 2011-2017 Ohio cancer registry and Medicaid, the authors conducted a robust Poisson regression analysis for stage at diagnosis and Cox regression analysis for time to treatment initiation to obtain the adjusted risk for earlier stage at diagnosis before to after expansion or hazard of shorter time to treatment initiation for each demographic or clinical subgroup after compared with before pre-Medicaid expansion. The authors subsequently calculated the ratio of risk (or hazard) ratios. Results: The effect of Medicaid expansion on outcomes was mostly similar across subgroups of patients with cancer on Medicaid. However, those who were non-Hispanic Black or of other race had a lower probability of being diagnosed with early-stage breast cancer (ratio of risk ratio=0.85 [95% CI=0.74, 0.98] and ratio of risk ratio=0.72 [95% CI=0.55, 0.95], respectively) than non-Hispanic White women. Conclusions: These findings point to differences that should be investigated to ensure that the benefits of Medicaid expansion are realized equitably. AJPM Focus 2025;4(1):100301. (c) 2024 Published by Elsevier Inc. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). |
| PubMed ID: 39885959 |
| Title: Cost and Workflow Impact of a Primary Care Based Multi-Level Pediatric Oral Health Intervention |
| Author(s): Rose, J (Rose, Johnie); Selvaraj, D (Selvaraj, David); Ronis, SD (Ronis, Sarah D.); Curtan, S (Curtan, Shelley); Bales, GC (Bales, Gloria C.); Nelson, S (Nelson, Suchitra) |
| Source: JOURNAL OF PRIMARY CARE AND COMMUNITY HEALTH Volume: 16 Article Number: 21501319251369991 DOI: 10.1177/21501319251369991 Published Date: 2025 |
| Abstract: Objectives: A recent trial demonstrated the effectiveness of a primary care-based multilevel intervention to increase dental attendance in 3- to 6-year-old Medicaid-insured children. We estimate the cost and workflow impact for real-world practices wishing to implement this intervention.Methods: Intervention practices from the trial integrated oral health (OH) questions into their electronic medical records (EMR). Providers received theory-based training on delivering OH education and provided "prescriptions" for dental visits and a list of Medicaid-accepting dentists. EMR enhancement and training costs were estimated by applying nationally-representative, role-specific hourly labor costs to reported time spent by study participants performing each activity. Study staff timed the OH portion of 2 to 3 randomly selected encounters per provider.Results: Twenty-eight providers from 9 intervention pediatric practices participated. The percentage of Medicaid patients in these practices ranged from 22% to 86%. Practices corresponding in size to the smallest, median, and largest in the intervention group can expect first-year implementation costs of $579.79, $863.86, and $1482.15, respectively, with subsequent annual maintenance costs of $167.11, $451.18, and $1069.47. Encounter time for the intervention averaged 38 s longer than for standard care (control group).Conclusions: Implementation of this effective pediatric OH intervention appears to entail modest costs and lengthen encounters minimally. |
| PubMed ID: 41122957 |
| Title: Inability-to-walk-unaided-a single WHO danger sign predicts in-hospital mortality in people with HIV under routine care conditions in a low-resource setting |
| Author(s): Rambiki, E (Rambiki, Ethel); Thawani, A (Thawani, Agness); Kapenga, D (Kapenga, Davis); Malunda, C (Malunda, Chikaiko); Mseke, B (Mseke, Boniface); Mpesi, P (Mpesi, Patrick); Ganesh, P (Ganesh, Prakash); Steffen, HM (Steffen, Hans-Michael); Heller, T (Heller, Tom); Wallrauch, C (Wallrauch, Claudia) |
| Source: THERAPEUTIC ADVANCES IN INFECTIOUS DISEASE Volume: 12 Article Number: 20499361251341385 DOI: 10.1177/20499361251341385 Published Date: 2025 |
| Abstract: Background: People with advanced HIV admitted to hospitals are at high risk of mortality. Serious illness can be identified using WHO-defined danger signs ("WHO score") or bedside scores like the quick Sequential Organ Failure Assessment (qSOFA) score. Objectives: The study aimed at assessing clinical parameters as predictors of in-hospital mortality for people with HIV (PWH) admitted for routine medical care. Study design: A prospective observational study of all PWH admitted to medical wards at Kamuzu Central Hospital, Lilongwe, Malawi. Methods: WHO danger signs and qSOFA score were determined at the first encounter, CD4 count tests were performed, and discharge outcomes were recorded. The discriminatory power of different scores for predicting in-hospital mortality was assessed using the area under receiver-operating-characteristic curves (AUROCs). Results: From November 2022 to May 2023, 401 adults aged >= 18 years were admitted. Advanced HIV disease (CD4 < 200 cells/mm(3)) was present in 55.2% (95% CI 50.2-60.2). Overall, in-hospital mortality was 25.7% (95% CI 21.3-30.0). Neither sex, age, CD4 count, nor BMI < 18.5 was significantly associated with mortality. Both the WHO score and qSOFA score were significantly associated with increasing mortality. AUROC for WHO score and qSOFA were 0.68 (95% CI 0.61-0.75) and 0.71 (95% CI 0.64-0.78), respectively. Including BMI or CD4 did not significantly improve AUROC. Using only the individual danger sign "inability-to-walk-unaided" yielded a similar AUROC of 0.68 (95% CI 0.61-0.75). Conclusion: Increasing WHO danger sign scores were associated with in-hospital mortality; adding BMI or CD4 did not improve predictive accuracy. Notably, the predictive information derived from a single parameter-inability-to-walk-unaided-was as effective as the complete WHO score and was easier to obtain. Given the challenges in comprehensive vital sign recording, this simple measure may prove valuable in triaging PWH admitted to hospitals in resource-limited settings such as Malawi. |
| PubMed ID: 40487792 |
| Title: Amphetamine use and Parkinson's disease: integration of artificial intelligence prediction, clinical corroboration, and mechanism of action analyses |
| Author(s): Gorenflo, MP (Gorenflo, Maria P.); Gao, ZX (Gao, Zhenxiang); Davis, PB (Davis, Pamela B.); Kaelber, D (Kaelber, David); Xu, R (Xu, Rong) |
| Source: PLOS ONE Volume: 20 Issue: 5 Article Number: e0323761 DOI: 10.1371/journal.pone.0323761 Published Date: 2025 |
| Abstract: Parkinson's disease (PD) is an increasingly prevalent neurologic condition for which symptomatic, but not preventative, treatment is available. Drug repurposing is an innovate drug discovery method that uncovers existing therapeutics to treat or prevent conditions for which they are not currently indicated, a method that could be applied to incurable diseases such as PD. A knowledge graph artificial intelligence prediction system was used to select potential drugs that could be used to treat or prevent PD, and amphetamine was identified as the strongest candidate. Retrospective cohort analysis on a large, electronic health record database of deidentified patients with attention deficit hyperactive disorder (the main diagnosis for which amphetamine is prescribed) revealed a significantly reduced hazard of developing PD in patients prescribed amphetamine versus patients not prescribed amphetamine at 2, 4, and 6 years: Hazard Ratio (95% Confidence Interval) = 0.59 (0.36, 0.98), 0.63 (0.42, 0.93), and 0.55 (0.38, 0.79). Pathway enrichment analysis confirmed that amphetamine targets many of the biochemical processes implicated in PD, such as dopaminergic synapses and neurodegeneration. Together, these observational findings suggest that therapeutic and legal amphetamine use may reduce the risk of developing PD, in contrast to previous work that found the inverse relationship in patients using amphetamine recreationally. |
| PubMed ID: 40392924 |