Jacobs Institute of Women's Health
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Patient-Centric Approaches for Antipsychotic Medication Research: An Application of the Desirability of Outcome Ranking (DOOR) and Global Benefit-Risk (GBR) Score
Get PDFSelf-Sampling for Cervical Cancer Screening in LMICs: A Scoping Review of Current Practices, Gaps, and Adaptation Potential for Colorectal Cancer
Get PDFDeveloping and Refining Eco-friendly Messaging to Reduce Sugary Drink Consumption Among African American Children in Washington D.C.
No full textKnowledge and Attitudes toward the Human Papillomavirus Vaccine among GW Undergraduate Students
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Improving Access to Medical Aid in Dying in California by Including Nurse Practitioners as Providers
No full textBackground: Medical aid in dying (MAiD) in the United States is the process by which a terminally ill individual with a prognosis of six months or less can request a lethal prescription to end their life. In California, it became legal through a 2016 statute called the End-of-Life Option Act. The act mandates that two physicians agree on the prognosis of the terminally ill individual; one of the physicians is then responsible for prescribing the lethal medication. There is a significant physician shortage in primary and palliative care in the state, as well as a substantial percentage of physicians who choose not to participate in the program, leading to decreased access. Nurse practitioners (NPs) provide an ever-increasing percentage of primary care in California and are providers of MAiD in other states. Allowing NPs to function as MAiD providers will increase access to the program in the state without a decrease in quality.
Aims: This health policy project aimed to increase the knowledge among legislators of the difficulties with access to MAiD for persons who see nurse practitioners as providers, to educate legislators on other possible improvements to the current law, to increase knowledge among the legislators of the importance of the nurse practitioner profession in the state, and to increase understanding in the legislature that the current law with sunset in 2031.
Methods: This health policy project\u27s design involved a governmental analysis of MAiD in the state. Then an educational endeavor to increase legislators\u27 knowledge of the limitations of the current bill ensued. This focused on potential improvements to the act, particularly focusing on adding NPs as providers of MAiD and the sunsetting of the bill in 2031.
Results: Sixty-one legislative offices were provided an infographic on MAiD and the importance of allowing NPs to function as providers. Thirty legislative offices agreed to meetings, which took place over a six-month period. Meetings revolved around the lack of access to MAiD, nurse practitioner practice, the current bill’s sunset provision, and how to improve it in its next iteration. Meetings were initially made with legislators who had voted for both expanded nurse practitioner practice and the 2022 medical aid in dying bill, then expanded to those on the health committee and newly elected legislators.
Conclusions: Most legislative staff had some knowledge of the current iteration of MAiD in the state but had a limited understanding of nurse practitioner practice, particularly the critical role they provide to the traditionally underserved. The legislative staff was generally receptive to the expansion of the End-of-Life Option Act. Still, no legislator decided to sponsor a bill this legislative session, and many expressed a likelihood they would co-sponsor the bill if another legislator introduced such a bill. Barriers included a lack of urgency since the current bill does not sunset until 2031, worry about another scope of practice bill so soon after AB890, which succeeded in expanding NP scope of practice, and a recent decrease in the number of bills a legislator could introduce
Health System Expansion and Changes in Medicare Beneficiary Utilization of Safety Net Providers
No full textBACKGROUND: Evidence is limited on insured patients\u27 use of safety net providers as vertically integrated health systems spread throughout the United States. OBJECTIVES: To examine whether market-level health system penetration is associated with: (1) switches in Medicare beneficiaries\u27 usual source of primary care from federally qualified health centers (FQHCs) to health systems; and (2) FQHCs\u27 overall Medicare patient and visit volume. RESEARCH DESIGN: Beneficiary-level discrete-time survival analysis and market-level linear regression analysis using Medicare fee-for-service claims data from 2013 to 2018. SUBJECTS: A total of 659,652 Medicare fee-for-service beneficiaries aged 65 and older lived in one of 27,386 empirically derived primary care markets whose usual source of care in 2013 was an FQHC or a non-FQHC-independent physician organization that predominantly served low-income patients. MEASURES: Beneficiary-year measure of the probability of switching to health system-affiliated physician organizations and market-year measures of the number of FQHC visits by Medicare beneficiaries, number of beneficiaries attributed to FQHCs, and FQHC Medicare market shares. RESULTS: During 2013-2018, 16.5% of beneficiaries who sought care from FQHCs switched to health systems. When health system penetration increases from the 25th to 75th percentile, the probability of Medicare FQHC patient switching increases by 4.6 percentage points, with 22 fewer Medicare FQHC visits and 4 fewer beneficiaries attributed to FQHCs per market year. Complex patients and patients who sought care from non-FQHC, independent physician organizations exhibited higher rates of switching to health systems. CONCLUSIONS: Health system expansion was associated with the loss of Medicare patients by FQHCs, suggesting potential negative spillovers of vertical integration on independent safety net providers
Effect of semaglutide 2.4 mg on use of antihypertensive and lipid-lowering treatment in five randomized controlled STEP trials
No full textOBJECTIVE: The objective of this study was to assess antihypertensive and lipid-lowering treatment changes in participants receiving semaglutide 2.4 mg versus placebo across pooled populations from five Semaglutide Treatment Effect in People with Obesity (STEP) trials. METHODS: Efficacy and safety of semaglutide 2.4 mg were evaluated in the STEP clinical trials. In this post hoc analysis, STEP 1, 3, 6, and 8 (which included people with overweight or obesity) and, separately, STEP 2 and 6 (which included people with overweight or obesity and type 2 diabetes) were pooled for analysis. Changes in antihypertensive or lipid-lowering treatment intensity from randomization to end of treatment were evaluated. RESULTS: In both pooled samples, a higher proportion of participants in the semaglutide 2.4 mg group versus placebo underwent antihypertensive or lipid-lowering treatment intensity reduction by end of treatment. A smaller proportion underwent antihypertensive or lipid-lowering treatment intensification by end of treatment in the semaglutide 2.4 mg group of both samples versus placebo. In participants receiving antihypertensive or lipid-lowering medications in both samples, greater numeric reductions in body weight were observed in the semaglutide 2.4 mg group versus placebo. CONCLUSIONS: These results support a relationship between semaglutide 2.4 mg treatment of overweight and obesity and reduced need for antihypertensive and lipid-lowering treatment, facilitating treatment intensity reduction/discontinuation and abating treatment intensification
Gardnerella vaginalis-binding IgA in the urethra of sexually experienced males
No full textBACKGROUND: Genital inflammation increases HIV susceptibility and is associated with the density of pro-inflammatory anaerobes in the vagina and coronal sulcus. The penile urethra is a critical site of HIV acquisition, although correlates of urethral HIV acquisition are largely unknown. While Streptococcus mitis is a consistent component of the urethral flora, the presence of Gardnerella vaginalis has been linked with prior penile-vaginal sex and urethral inflammation. Here, we use a flow cytometry-based bacterial assay to quantify urethral IgA and IgG that bind G. vaginalis and S. mitis in a cross-sectional cohort of 45 uncircumcised Ugandan men and to evaluate their association with the urethral microbiome and local soluble immune factors. RESULTS: Urethral antibodies binding both bacterial species were readily detectable, with G. vaginalis predominantly bound by IgA, and S. mitis equivalently by IgA and IgG. Gardnerella vaginalis-binding IgA was elevated in participants with detectable urethral Gardnerella, with the latter only present in participants who reported prior penile-vaginal sex. In contrast, detectable urethral S. mitis was not associated with sexual history or levels of S. mitis-binding IgA/IgG. The time from the last penile-vaginal sex was inversely correlated with the urethral concentrations of total IgA, G. vaginalis-binding IgA, and chemokines IL-8 and MIP-1β; these inflammatory chemokines were independently associated with higher total IgA concentration, but not with G. vaginalis-binding IgA. CONCLUSIONS: This first description of microbe-binding antibodies in the penile urethra suggests that urethral colonization by Gardnerella after penile-vaginal sex specifically induces a G. vaginalis-binding IgA response. Prospective studies of the host-microbe relationship in the urethra may have implications for the development of vaccines against sexually-transmitted bacteria. Video Abstract
