AJPM focus最新文献

{"title":"Expanding Pharmacists’ Prescribing Authority and Medication Uptake: Evidence From Pre-Exposure Prophylaxis","authors":"Bita Fayaz-Farkhad PhD","doi":"10.1016/j.focus.2025.100415","DOIUrl":"10.1016/j.focus.2025.100415","url":null,"abstract":"<div><h3>Introduction</h3><div>Considering the crisis in access to care in the U.S., pharmacies are expected to significantly expand access to a variety of preventive care, including HIV care. As of August 2024, 10 states allow pharmacists to initiate pre-exposure prophylaxis, a medicine taken to prevent HIV, independently. This study analyzed how the expansion of pharmacists’ authority to independently initiate pre-exposure prophylaxis affected pre-exposure prophylaxis prescription rates per 100,000 county residents.</div></div><div><h3>Methods</h3><div>Hand-collected data on pharmacists’ prescribing authority from 2015 to 2023 were linked to county-level pre-exposure prophylaxis prescription rates. Using these data, the impact of the laws was estimated through a difference-in-differences approach. The analysis first calculated changes in pre-exposure prophylaxis prescription rates before and after the expansions and then compared these changes between counties in states that expanded pharmacists’ scope of practice (treatment group) and counties in states that did not (control group).</div></div><div><h3>Results</h3><div>Expanding pharmacists’ prescribing authority increased pre-exposure prophylaxis prescription rates by 11.6%. The largest effects were observed in states that allowed pharmacists to prescribe pre-exposure prophylaxis without any mandatory training, a requirement that may otherwise burden pharmacists. Effects were most prominent in nonrural counties and counties with high insurance coverage and lower proportions of Black and Latinx populations.</div></div><div><h3>Conclusions</h3><div>These results suggest that expanding pharmacists’ prescribing authority will not improve disparities in pre-exposure prophylaxis use if the laws fail to address structural barriers, such as staffing constraints or a lack of capacity.</div></div>","PeriodicalId":72142,"journal":{"name":"AJPM focus","volume":"4 6","pages":"Article 100415"},"PeriodicalIF":0.0,"publicationDate":"2025-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145268255","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Epidemiology of Colon Cancer Screening in a Safety-Net Setting","authors":"Ena Mahapatra MD, MS,&nbsp;Romina Kee MD, MPH,&nbsp;Kyungran Shim MD,&nbsp;Cathy Rowell RN,&nbsp;William E. Trick MD,&nbsp;David Goldberg MD","doi":"10.1016/j.focus.2025.100403","DOIUrl":"10.1016/j.focus.2025.100403","url":null,"abstract":"<div><h3>Introduction</h3><div>This study was aimed to describe the epidemiology of colon cancer screening in an underserved population. This is a cohort study, conducted in a primary care clinic in a safety-net public hospital.</div></div><div><h3>Methods</h3><div>Patients aged 49–78 years were categorized by initial screening status and followed over 28 months. Status was categorized into the following 3 groups with 8 subgroups: screening eligible (up to date or not up to date), non-screening eligible (Personal history of colon cancer, surveillance for colon cancer, work-up in progress, poor health status, and indeterminate), and refusal. Patient egress was defined as no primary care visit for 12 months or &lt;2 primary care visits separated by 60 days over 24 months.</div></div><div><h3>Results</h3><div>Of 1,074 patients reviewed, 856 (80%) were screening eligible, 177 (16%) were non-screening eligible, and 41 (4%) refused screening. Over 28 months, most patients retained in the practice did not change category (<em>n</em>=949; 88%). Of 125 patients who changed, most (<em>n</em>=101) went from screening eligible to non-screening eligible, most commonly to surveillance and work-up in progress subgroups. Egress was common; nearly half of patients (47%) were not evaluated owing to egress.</div></div><div><h3>Conclusions</h3><div>Maintaining a colon cancer registry was complex owing to the dynamic nature of screening status and unstable primary care attendance. Regional integration of electronic health records could substantially reduce manual effort.</div></div>","PeriodicalId":72142,"journal":{"name":"AJPM focus","volume":"4 5","pages":"Article 100403"},"PeriodicalIF":0.0,"publicationDate":"2025-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145010335","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Artificial Intelligence Moves Health Care From Reactive Risk Transfer to a Proactive Risk Avoidance System","authors":"Duane F. Wisk DO, MPH ,&nbsp;Stefan Gravenstein MD, MPH ,&nbsp;Denis P.H. Mihale MD, MBA ,&nbsp;Manijeh Berenji MD, MPH","doi":"10.1016/j.focus.2025.100411","DOIUrl":"10.1016/j.focus.2025.100411","url":null,"abstract":"","PeriodicalId":72142,"journal":{"name":"AJPM focus","volume":"4 6","pages":"Article 100411"},"PeriodicalIF":0.0,"publicationDate":"2025-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145159438","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Content Analysis of Cannabis Discourses on Twitter/X in the U.S.","authors":"Zidian Xie PhD ,&nbsp;Runtao Zhou BS ,&nbsp;Qihao Yun BS ,&nbsp;Jianghang Wu BS ,&nbsp;Zhengyuan Wang BS ,&nbsp;Mengmeng Yu BS ,&nbsp;Karen M. Wilson MD ,&nbsp;Dongmei Li PhD","doi":"10.1016/j.focus.2025.100408","DOIUrl":"10.1016/j.focus.2025.100408","url":null,"abstract":"<div><h3>Introduction</h3><div>With the legalization of both medical and recreational cannabis use in many U.S. states, this study aims to explore public perceptions and discussions about cannabis on social media in the U.S.</div></div><div><h3>Methods</h3><div>Twitter (now rebranded as X) data on cannabis were collected between February 2022 and February 2023 using the Twitter/X streaming Application Programming Interface. To assess the attitude of tweets toward cannabis and to determine whether Twitter/X users were cannabis users, human-guided deep-learning models called bidirectional encoder representations from transformers were used. The sex and age of users were inferred using a deep-learning facial recognition algorithm (DeepFace). The Latent Dirichlet Allocation topic model was used to comprehend the discussed topics.</div></div><div><h3>Results</h3><div>Among 2,865,562 unique noncommercial cannabis tweets from the U.S., 648,018 tweets (22.62%) had a positive attitude toward cannabis, 234,202 (8.17%) had a negative attitude, and 1,983,342 (69.21%) had a neutral attitude. Among 821,451 unique Twitter/X users, 348,795 (42.46%) were potential cannabis users. The U.S. states allowing recreational cannabis use had 12.19 Twitter/X and cannabis users per 10,000 population, compared to 7.22 users in states without it; however, the difference was not statistically significant (<em>p</em>=0.95). The 25–34 years age group (37.14%) was the most represented among Twitter/X and cannabis users. The predominant topic in the positive tweets was “Cannabis’s medical value,” whereas the main topic in the negative tweets was “Having difficulty quitting cannabis.”</div></div><div><h3>Conclusions</h3><div>This study provides a detailed overview of public perceptions of cannabis in the U.S., aiding policymakers and public health authorities in developing effective regulatory policies about cannabis.</div></div>","PeriodicalId":72142,"journal":{"name":"AJPM focus","volume":"4 6","pages":"Article 100408"},"PeriodicalIF":0.0,"publicationDate":"2025-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145050069","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Decline in Type 1 Diabetes in Young Children After Rotavirus Vaccination: Data From 8 Countries","authors":"Mary A.M. Rogers PhD, MS","doi":"10.1016/j.focus.2025.100409","DOIUrl":"10.1016/j.focus.2025.100409","url":null,"abstract":"<div><h3>Introduction</h3><div>Vaccination for rotavirus has been a component of national immunization programs in more than 100 countries, principally intended to decrease hospitalizations and deaths from gastroenteritis in young children. Rotavirus is a major cause of gastroenteritis in infants but can additionally result in apoptosis of pancreatic cells and hyperglycemia. Therefore, it is suspected to be a contributor to Type 1 diabetes mellitus. The purpose of this investigation was to examine whether the incidence of Type 1 diabetes in young children decreased after a rotavirus vaccination program was introduced.</div></div><div><h3>Methods</h3><div>Publications were assembled with country-specific incidence rates of Type 1 diabetes in children aged &lt;5 years. Data regarding the introduction of national rotavirus vaccination programs were available from the WHO. Using an interrupted time series design, prevaccination rates of Type 1 diabetes were compared with postvaccination rates.</div></div><div><h3>Results</h3><div>Data regarding incidence rates of Type 1 diabetes in children aged &lt;5 years before and after vaccine introduction were available from 8 countries. In 7 of these countries (Australia, Austria, Finland, Ireland, Israel, Mexico, and Wales), the incidence of Type 1 diabetes in young children decreased after the rotavirus vaccination program began. In 1 country (Dominican Republic), the number of annual cases of Type 1 diabetes was too small to evaluate an effect.</div></div><div><h3>Discussion</h3><div>The data suggest that a national rotavirus vaccination program may contribute to lower rates of Type 1 diabetes in young children.</div></div>","PeriodicalId":72142,"journal":{"name":"AJPM focus","volume":"4 6","pages":"Article 100409"},"PeriodicalIF":0.0,"publicationDate":"2025-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145159440","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Identifying Prenatal Care Barriers for Pregnant Individuals With Intellectual and Developmental Disabilities Living in Central Michigan","authors":"Nicholas J. Sirhan MD ,&nbsp;Paige B. Benard MD ,&nbsp;M. Ariel Cascio PhD ,&nbsp;Kelly R. Ellis WHNP, MPH, MSN, PMH-C ,&nbsp;Brenda M. Varriano MD, MSc ,&nbsp;Neli P. Ragina PhD","doi":"10.1016/j.focus.2025.100407","DOIUrl":"10.1016/j.focus.2025.100407","url":null,"abstract":"<div><h3>Introduction</h3><div>Pregnancy among individuals with intellectual or developmental disabilities poses unique challenges, with studies showing higher rates of adverse outcomes. There remains a gap in understanding patient-reported barriers to accessing health care during pregnancy, especially in rural areas such as central Michigan. This study investigates the barriers to prenatal care for pregnant individuals with intellectual or developmental disabilities in central Michigan.</div></div><div><h3>Methods</h3><div>Using a mixed-method approach, 9 participants from the Central Michigan University Healthcare obstetrics/gynecology clinic completed a survey designed to identify specific challenges in accessing care.</div></div><div><h3>Results</h3><div>The findings revealed several motivations for seeking prenatal care, such as learning about labor and ensuring a healthy baby, but also highlighted significant barriers, including transportation issues, discomfort with male examiners, unplanned pregnancies, and depression.</div></div><div><h3>Conclusions</h3><div>The study underscores the need for tailored educational resources and integrated mental health support to address these challenges. Despite recruitment difficulties due to the population's limited visibility and interaction with healthcare systems, the study provides valuable insights into the complex and intersecting factors affecting healthcare access for this vulnerable demographic. The results emphasize the necessity for further research with larger sample sizes to develop comprehensive strategies that ensure equitable prenatal care access for pregnant individuals with intellectual or developmental disabilities.</div></div>","PeriodicalId":72142,"journal":{"name":"AJPM focus","volume":"4 6","pages":"Article 100407"},"PeriodicalIF":0.0,"publicationDate":"2025-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145159439","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Projected Impact of Higher E-cigarette or Combustible Cigarette Taxes on Use of Both Products in the U.S.","authors":"Krishna P. Reddy MD, MS ,&nbsp;Nora Mulroy BA ,&nbsp;Breanna Richards ScM ,&nbsp;Linzy V. Rosen BA ,&nbsp;Amirah Fawziyyah ScM ,&nbsp;Nancy A. Rigotti MD ,&nbsp;Douglas E. Levy PhD ,&nbsp;Stavroula A. Chrysanthopoulou PhD","doi":"10.1016/j.focus.2025.100406","DOIUrl":"10.1016/j.focus.2025.100406","url":null,"abstract":"<div><h3>Introduction</h3><div>Higher taxes on e-cigarettes could reduce their use but might encourage combustible tobacco cigarette use. Simulation models enable evaluation of dynamic transitions between cigarette and e-cigarette use or nonuse and population-level projections in response to a policy change, such as higher taxes.</div></div><div><h3>Methods</h3><div>The authors used a microsimulation model to project the relative impact of higher taxes on cigarettes, e-cigarettes, or both on the prevalence of cigarette and e-cigarette use among U.S. youth (aged 12–17 years), young adults (aged 18–24 years), and adults (aged ≥25 years). They used multi-state models to derive the probabilities of transition across states of current/former/never cigarette smoking and e-cigarette use from Waves 2–5 (2015–2019) of the Population Assessment of Tobacco and Health Study. These transition probabilities were applied to a simulated cohort in the Simulation of Tobacco and Nicotine Outcomes and Policy model, reflective of Wave 5 of the Population Assessment of Tobacco and Health Study, to project cigarette and e-cigarette use over 5 years in a <em>Status Quo</em> scenario. For tax scenarios, the authors estimated the impact of a $1 increase in cigarette tax (<em>Cigarette Tax</em>), e-cigarette tax (<em>E-cig Tax</em>), or both (<em>Combined Tax</em>). They performed sensitivity analysis around transition parameters and tax effects to evaluate the influence of uncertainty in these estimates.</div></div><div><h3>Results</h3><div>Compared with Status Quo, the relative changes among youth/young adults/adults in the prevalence of use at 5 years would be as follows: Cigarette Tax, –4%/–19%/–3% (cigarette use) and 0%/+3%/+3% (e-cigarette use); E-cig Tax, 0%/–10%/–2% (cigarette use) and –27%/–63%/–25% (e-cigarette use); and Combined Tax, –5%/–28%/–3% (cigarette use) and –27%/–62%/–25% (e-cigarette use). Model results were the most variable in young adults, reflecting greater uncertainty around tax effects in this population. The results of cigarette smoking and e-cigarette use prevalence, regardless of tax impact, were sensitive to the probabilities of initiation among youth and young adults and the probabilities of cessation among adults.</div></div><div><h3>Conclusions</h3><div>A higher tax on e-cigarettes alone would likely reduce e-cigarette use prevalence at 5 years and might not increase cigarette smoking prevalence. A combined tax on both products would likely produce larger reductions in cigarette and e-cigarette use, maximizing public health benefits.</div></div>","PeriodicalId":72142,"journal":{"name":"AJPM focus","volume":"4 6","pages":"Article 100406"},"PeriodicalIF":0.0,"publicationDate":"2025-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145222023","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Centering Cultural Approaches in Community-Based Participatory Research to Address the Black Maternal Health Crisis","authors":"Natalie Hernandez PhD, MPH ,&nbsp;Dominique Guillaume MSN, AGPCNP-BC, ACRN, PhD ,&nbsp;Lasha Clarke PhD ,&nbsp;Andrea Parker PhD ,&nbsp;Sherilyn Francis MPH ,&nbsp;Kennedy Lewis MPH ,&nbsp;Morgan Davis MPH ,&nbsp;Kaprice S. Welsh CNM, MSN, MPH ,&nbsp;Joy Baker MD, FACOG ,&nbsp;Rasheeta D. Chandler PhD, RN, FNP-BC, FAANP, FAAN","doi":"10.1016/j.focus.2025.100402","DOIUrl":"10.1016/j.focus.2025.100402","url":null,"abstract":"<div><h3>Introduction</h3><div>Black women in Georgia are more likely to die from pregnancy-related complications during the postpartum period than other their non-Black counterparts. Developing effective solutions to address this public health crisis requires strengthened partnerships between researchers and community-based organizations, with the voices of Black women being at the center of the research and innovation. This study examined perspectives of community-advisory board members on a community-based participatory research approach that addresses adverse postpartum health outcomes for Black women living in rural Georgia.</div></div><div><h3>Methods</h3><div>This qualitative descriptive study employed semistructured qualitative interviews with members on the community-advisory board and research team (N=16) consisting of all Black women. Thematic analysis was used to analyze data deductively, with codes being categorized into overarching themes.</div></div><div><h3>Results</h3><div>Themes that were elicited from interviews included community; culture; acceptability of the Positive Outcomes, Research Recommendations, Community Collaborations, and Honorable delivery of healthcare research approach; and Black maternal health disparities. Participants voiced the importance of the inclusion of Black cultural aspects within maternal health interventions and the importance of providing Black women with a platform to share their perspectives and experiences. Participants provided insight on promoting Black maternal health equity and reducing power dynamics within research.</div></div><div><h3>Conclusions</h3><div>Centering culture and community and using Black women’s experiences to guide the development of research interventions will be critical in developing relevant solutions to address the Black maternal health crisis. Research should be designed with the input of target communities while supporting synergistic relationships between communities and researchers.</div></div>","PeriodicalId":72142,"journal":{"name":"AJPM focus","volume":"4 6","pages":"Article 100402"},"PeriodicalIF":0.0,"publicationDate":"2025-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145159443","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Caregiver Survey of Driving Readiness in Teens Born Extremely Preterm","authors":"Rebecca J. McAdams MA, MPH ,&nbsp;Jessica Quach BS ,&nbsp;Dominique M. Rose PhD, MPH ,&nbsp;Blake Hardin BA ,&nbsp;Carl Backes Jr. MD ,&nbsp;Jingzhen Yang PhD, MPH ,&nbsp;H. Gerry Taylor PhD","doi":"10.1016/j.focus.2025.100405","DOIUrl":"10.1016/j.focus.2025.100405","url":null,"abstract":"<div><h3>Introduction</h3><div>Teens born extremely preterm (defined as a gestational age of &lt;28 weeks) are at a higher risk of cognitive and physical disabilities, potentially affecting their ability to learn to drive safely. This exploratory study surveyed caregivers to obtain their perceptions of driving readiness in teens born extremely preterm.</div></div><div><h3>Methods</h3><div>A cross-sectional survey of caregivers of teens (aged 14–18 years) residing in Ohio who were born extremely preterm was conducted to assess teen interest and progress in obtaining a driver’s license, reasons for their lack of progress, and caregiver involvement in helping their teen to learn to drive.</div></div><div><h3>Results</h3><div>The sample included 60 caregivers of teens distributed across 4 age groups based on license eligibility. Most teens (87%) had a history of a neurodevelopmental or medical disorder. Only 9 (30%) of 30 teens aged &lt;18 years who were age-eligible for a temporary permit had obtained one, and only 1 (7%) of 14 teens who was age-eligible for a probationary license had obtained one. Rates of neurological disorders and concerns that the teen lacked maturity to drive or would get lost were significantly higher in 25 age-eligible teens who were not driving than in the 20 teens who were driving (<em>p</em>=0.013 and 0.038, respectively). Caregivers frequently talked to their teens about driving but less often practiced driving with their teens.</div></div><div><h3>Conclusions</h3><div>Delays in progressing toward obtaining a driving license are common in teens born extremely preterm. The findings from this study describe these delays and provide information on caregiver concerns and involvement in driving. Future research is needed to characterize and improve driving readiness in this population.</div></div>","PeriodicalId":72142,"journal":{"name":"AJPM focus","volume":"4 6","pages":"Article 100405"},"PeriodicalIF":0.0,"publicationDate":"2025-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145107315","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Editorial Board and Journal Information","authors":"","doi":"10.1016/S2773-0654(25)00081-1","DOIUrl":"10.1016/S2773-0654(25)00081-1","url":null,"abstract":"","PeriodicalId":72142,"journal":{"name":"AJPM focus","volume":"4 4","pages":"Article 100393"},"PeriodicalIF":0.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144809674","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}