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Open Access Publications from the University of California

Scholarly Works (104 results)

  • Thesis
  • Peer Reviewed
UC San Diego Electronic Theses and Dissertations (2024)

Background: Bystander cardiopulmonary resuscitation (BCPR) improves the low survival rate in out-of-hospital cardiac arrest (OHCA). We aim to estimate the potential impact of the San Diego County “Revive & Survive” initiative, a community BCPR training program with the goal to train 1 million San Diegans in hands-only CPR.

Methods: We adapted a decision tree model simulating health outcomes among a population with OHCA eligible for BCPR. The model was parameterized with the San Diego County Cardiac Arrest Registry to Enhance Survival (CARES) database from 2020-2023, which receives input from participating large healthcare agencies. Based on a systematic review, we assume community BCPR training increases the proportion of OHCA patients who receive BCPR by 41% and the chances of survival if BCPR is received by 59%. We estimate 5-year impacts on BCPR, deaths, and quality-adjusted life years (QALYs).

Results: Analysis suggests 8,445 (95% CI 7883.7-9006.1) OHCA cases eligible for BCPR will be tracked in CARES from 2024 to 2029. The model forecasts the implementation of Revive & Survive will result in an absolute increase of 1,701 (95% CI 1508.0-1906.0) BCPR events, leading to 467 (95% CI 312.5-648.5) lives and 1,730 (95% CI 1156.0-2403.7) QALYs saved compared to current interventions over five years.

Conclusions: Our model predicts that implementation of Revive & Survive will result in substantial increases in the number of OHCA patients in our population receiving BCPR, leading to increased survival rates in a large population. Additional benefits not examined include impacts on other populations, such as those not captured in CARES and organ transplant recipients.

    Cover page: Modeling the Potential Impact of a Community Bystander CPR Training Program in San Diego County
    • Thesis
    • Peer Reviewed
    UC San Diego Electronic Theses and Dissertations (2020)

    Background: Persons who inject drugs (PWID) are at increased risk for infectious diseases and overdose, and need access to primary care and substance use disorder (SUD) services. Yet, PWID historically have avoided and delayed seeking care, in part due to lacking insurance coverage for services they need and an availability of these services at local clinics. The Affordable Care Act (ACA) made insurance mandatory and included SUD services as an essential health benefit.Objectives: This dissertation research sought to examine the impact of the implementation of the ACA on the use of SUD treatment (Chapter 2) and primary care services (Chapter 3) among PWID in San Diego. It also sought to understand the changes in offering of SUD services at community and free primary care clinics after this health reform was implemented (Chapter 4). Methods: This dissertation is comprised of three papers assessing different aspects of health service use among PWID in San Diego County. Papers one and two (Chapters 2 and 3) used data from a longitudinal cohort study of 576 PWID in San Diego (STAHR 2 Study) to determine the impact of the ACA on the use of SUD treatment and the use of primary care services, respectively. Paper three (Chapter 3) used facility-level data on community and free primary care clinics in San Diego County from the California Office of Statewide Health Planning and Development to understand changes in offering of SUD services at these clinics after the ACA compared to before. Results: For paper one (Chapter 2), there was an increase (12%) in use of SUD treatment after the ACA compared to before, with a similar increase (10%) in insurance coverage. The ACA was associated with greater use of SUD treatment among PWID and the strength of this association was not impacted by insurance coverage. For paper two (Chapter 3), there was an increase (4%) in primary care use after the ACA compared to before, with a much larger increase (24%) in those who had insurance coverage. The ACA was associated with greater use of primary care services among PWID and the strength of the association was not entirely explained by an increase in insurance coverage. Paper three (Chapter 4) showed an decrease of 7% in the number of community and primary care clinics that offered SUD services after the ACA compared to before, but an increase in the proportion of patients covered by Medi-Cal and had contact with a substance abuse counselor. Conclusion: These findings suggest that the ACA may have been an effective health policy for increasing access and use of essential health services among PWID in San Diego, and for bolstering SUD services in community and free primary care clinics.

      Cover page: Essays on Healthcare Utilization in Persons Who Inject Drugs
      • Thesis
      • Peer Reviewed
      UC San Diego Electronic Theses and Dissertations (2023)

      Case investigation and contact tracing (CICT) is a strategy for preventing transmission of infectious diseases, deployed during the COVID-19 pandemic, to identify individuals before becoming symptomatic and/or infectious so they could test and quarantine in order to break chains of transmission. Since May 11, 2020, the UC San Diego Return to Learn program conducted CICT for UCSD students, faculty, and staff. Data collected through contact tracing efforts provides an estimate for adherence to social distancing efforts. Our study aimed to identify the number of close contacts per case as well as factors associated with changes in the number of close contacts. Using available data, cases investigated between July 2020 and April 2021, we examined case characteristics and determined the number of close contacts reported by cases over time. Trends in the number of contacts per case over time were examined using linear regression. Of the 968 cases investigated during this period, 33.9% were White/Middle Eastern, 51.1% were female, and 63.2% were 18-29 years old. Cases were stratified based on university affiliation, in which 56.4% were students (including student employees) and 43.6% were employees of UC San Diego. Findings indicated that the number of close contacts per case had a statistically significant association with age group and student status. Analyses showed an increase in the mean number of close contacts per case over time. Furthermore, we observed that the number of contacts per case increased after stay-at-home orders ended in San Diego county (p<0.001), but did not decrease after business closures and mask mandates were implemented (p=0.76). These findings suggest that changes in time and mitigation protocols (i.e., quarantine) can impact social distancing adherence by proxy of close contacts, which provide insights for future outbreak mitigation efforts and policy planning.

      • 1 supplemental PDF
      Cover page: Association between COVID-19 mitigation strategies and the number of close contacts reported per case at the University of California San Diego
      • Article
      • Peer Reviewed
      UC San Diego Previously Published Works (2019)
      Directly observed therapy (DOT) for monitoring tuberculosis (TB) treatment is intended to reduce disease transmission, mortality and acquired drug resistance by facilitating treatment adherence and support. Synchronous (S-VOT) and asynchronous (A-VOT) video observed therapy are mHealth solutions for remotely monitoring medication ingestion. This paper synthesizes literature through December 2018 to describe existing VOT approaches, summarize evidence, identify knowledge gaps, evaluate VOT strengths and weaknesses, and examine patient and provider factors influencing VOT feasibility and acceptability. High rates of adherence and patient acceptance were obtained using both VOT methods. VOT reduced travel time for TB program staff and/or patients, improving program efficiency compared to in-person DOT while maintaining high patient satisfaction. The impact of VOT on TB treatment outcomes, such as cure and relapse, require further study with longer follow-up. Individual patient, provider and program factors should be considered in selecting either or both VOT approaches for provision of patient-centered care.
        • Article
        • Peer Reviewed
        UC San Diego Previously Published Works (2020)
        Screening for latent tuberculosis infection is recommended for foreign-born persons in the United States. We used proxy data from electronic health records to determine that 17.5% of foreign-born outpatients attending the UC San Diego Health clinic (San Diego, CA, USA) underwent screening. Ending the global tuberculosis epidemic requires improved screening.
          • Article
          • Peer Reviewed
          UC San Diego Previously Published Works (2023)

          Background

          The COVID-19 pandemic has disproportionately impacted disabled people, especially those who are members of marginalized communities that were already denied access to the resources and opportunities necessary to ensure health equity before the pandemic.

          Objective

          Compare COVID-19 impact on basic needs access among households with and without disabled adults.

          Methods

          An online survey was distributed to households with children enrolled in one of 30 socially vulnerable elementary or middle schools in San Diego County, California. We measured disability using the single-item Global Activities Limitations Indicator. We measured pandemic impacts on basic needs access using the RADx-UP common data elements toolkit. We then assessed number of impact items reported by household disability using multivariable linear regression, adjusting for household income, household size, education, parent gender, and child's ethnicity.

          Results

          Of 304 participants, 41% had at least one disabled household member. Participants reporting a disabled household member were more likely to report challenges accessing basic needs, such as food, housing, healthcare, transportation, medication, and stable income during the pandemic (all p < 0.05). Difficulty accessing basic needs was significantly associated with household income and parent gender in the final regression model.

          Conclusions

          Households with a disabled member were significantly more likely to experience difficulty accessing basic needs during the COVID-19 pandemic. This has important implications for the disproportionate impact of COVID-19 on disabled people, especially those from low-income communities that already face barriers to accessing resources. To improve COVID-19 outcomes for disabled people, we must focus on meeting their basic needs.
            Cover page: COVID-19 disproportionately impacts access to basic needs among households with disabled members
            • Thesis
            • Peer Reviewed
            UC San Diego Electronic Theses and Dissertations (2022)

            Meeting sex partners online is associated with increased risk of acquiring sexually transmitted infections (STIs). We examined whether different venues where men who have sex with men (MSM) meet sex partners was associated with prevalent chlamydia and gonorrhea infection, and if prevalence increased during (vs. before) the COVID-19 pandemic.We conducted a cross-sectional analysis of data from the San Diego “Good To Go” (GTG) sexual health clinic from two enrollment periods: (1) 03/2019-09/2019 (pre-COVID-19), and (2) 03/2021-09/2021 (during COVID-19). Participants completed self-administered intake assessments. This analysis included males ≥18 years old self-reporting sex with other males within 3 months before enrollment. Participants were categorized as (1) meeting new sex partners in-person only (e.g. bars, clubs, etc.), (2) meeting new sex partners online (e.g. applications, websites, etc.), or (3) having sex only with existing partners. We used multivariable logistic regression, adjusting for year, age, race, ethnicity, number of sex partners, PrEP use, and drug use to examine whether venue or enrollment period were associated with chlamydia and gonorrhea infection (either vs. no STI). Among 2,546 participants, mean age was 35.5 (range: 18-79); 27.9% were non-white; 37.0% were Hispanic. Overall STI prevalence was 14.8% and was higher (17.8%) during COVID-19 versus pre-COVID-19 (13.3). Participants met sex partners online (56.9%), in-person (16.9%), or only had existing partners (26.2%) in the past 3 months. Compared to having only existing sex partners, meeting partners online was associated with higher STI prevalence (adjusted Odds Ratio [aOR]: 2.32; 95% confidence interval [CI]: 1.51-3.65), while meeting partners in-person was not associated with STI prevalence (aOR: 1.59; CI: 0.87-2.89). Enrollment during COVID-19 was associated with higher STI prevalence compared to pre-COVID-19 (aOR: 1.42; CI: 1.13-1.79). Meeting sex partners online was associated with increased chlamydia/gonorrhea prevalence among MSM. Prevalence appeared to increase during the COVID-19 pandemic.

              Cover page: Association between where men who have sex with men (MSM) meet sexual partners and chlamydia/gonorrhea infection before and during the COVID-19 pandemic in San Diego, CA
              • Article
              • Peer Reviewed
              UC San Diego Previously Published Works (2015)
              Health-related vulnerabilities associated with deportation are understudied. We conducted a cross-sectional study to identify factors associated with history of deportation from the US to Mexico among HIV-positive Latinos. From 2009 to 2010, we recruited a convenience sample from HIV clinics in San Diego, US and Tijuana, Mexico. Of 283 participants, 25% reported a prior deportation. Factors independently associated with increased odds of deportation history were being male [adjusted odds ratio (AOR) 2.77; 95% CI 1.18-6.48], having ≤high-school education (AOR 3.87; 95% CI 1.84-8.14), ever using cocaine (AOR 2.46; 95% CI 1.33-4.57), and reporting personalized HIV-stigma: "some have told me HIV is what I deserve for how I lived" (AOR 2.23; 95% CI 1.14-4.37). Lower self-reported antiretroviral medication adherence (AOR 0.35; 95% CI 0.12-0.96) and perceiving HIV-stigma: "most people believe a person who has HIV is dirty" (AOR 0.49; 95% CI 0.25-0.94) were associated with decreased odds of deportation history. Deportation is associated with specific socioeconomic indicators that are known to impact the health of individuals living with HIV.
                • Article
                • Peer Reviewed
                UC San Diego Previously Published Works (2016)

                Objective

                Sexual partner concurrency is common among MSM and may increase the probability of HIV transmission during recent (acute or early) infection. We examined the relationship between concurrency and HIV transmission network characteristics (proxies for HIV transmission) among MSM with recent HIV infection.

                Design

                Observational study integrating behavioral, clinical, and molecular epidemiology.

                Methods

                We inferred a partial HIV transmission network using 986 HIV-1 pol sequences obtained from HIV-infected individuals in San Diego, California (1996-2015). We further analyzed data from 285 recently HIV-infected MSM in the network who provided information on up to three sexual partners in the past 3 months, including the timing of intercourse with each partner. Concurrency was defined as sexual partners overlapping in time. Logistic and negative binomial regressions were used to investigate the link between concurrency and HIV transmission network characteristics (i.e. clustering and degree or number of connections to others in the network) among these MSM.

                Results

                Of recently HIV-infected MSM (n = 285), 54% reported concurrent partnerships and 54% were connected by at least one putative transmission link to others (i.e. clustered) in the network (median degree = 1.0; interquartile range: 0.0-3.0). Concurrency was positively associated with HIV transmission network clustering (adjusted odds ratio = 1.83, 95% confidence interval: 1.08, 3.10) and degree (adjusted incidence rate ratio = 1.48, 95% confidence interval: 1.02, 2.15).

                Conclusion

                Our findings provide empirical evidence consistent with the hypothesis that concurrency facilitates HIV transmission during recent infection. Interventions to mitigate the impact of concurrency on HIV transmission may help curb the HIV epidemic among MSM.
                  • Article
                  • Peer Reviewed
                  UC San Diego Previously Published Works (2019)
                  BACKGROUND:As mHealth apps proliferate, it is necessary for patients to feel capable and comfortable using devices that run them. However, limited research is available on changes in comfort level before and after the use of an mHealth app. OBJECTIVE:The objective of this study was to determine whether patients with tuberculosis who used an mHealth app called Video Directly Observed Therapy (VDOT) to monitor their antituberculosis treatment became more comfortable using mobile phones after the intervention and to identify factors associated with change in comfort. METHODS:We analyzed data from a longitudinal study assessing the feasibility and acceptability of the VDOT app among patients receiving antituberculosis treatment from public health departments in San Diego, San Francisco, and New York City. Comfort levels on six domains of mobile phone use (making phone calls, taking pictures, recording videos, text messaging, internet and email use on the phone) were measured on a 10-point scale (1=very uncomfortable; 10=very comfortable) at the start and end of treatment using VDOT via telephone interviews. The main outcomes were change in comfort level on each domain (recoded as binary measures) and an overall change score (sum of individual measures). Linear and logistic regression analyses were performed to assess whether sociodemographics, risk factors, and VDOT perceptions were associated with change of comfort measures. RESULTS:Among 120 participants with complete data, mean age was 39.8 years (SD 14.8, range 18-87 years), 46.7% (56/120) were female, and 76.7% (92/120) were foreign born. The combined comfort level at baseline was high overall (mean 48.8, SD 14.2, interquartile range 43.0-60.0) and the mean comfort score increased by 1.92 points at follow-up (P=.07). Statistically significant increases in comfort on individual domains included taking pictures (P=.02) and recording videos (P=.002). Females were more likely to have increased comfort in using the internet on the phone compared to males (odds ratio [OR] 3.03, 95% CI 1.08-8.52, P=.04). Participants who worked less hours per week were more likely to have increased comfort recording videos although this did not meet statistical significance (OR 1.03, 95% CI 1.00-1.05, P=.06). CONCLUSIONS:Findings suggest that, despite a high level of comfort using mobile phones at baseline, experience using the VDOT app was associated with increased comfort using mobile phone features. Additional research involving participants with lower baseline mobile phone experience is needed. An implication of these findings is that as patients begin to use mHealth apps for one health condition, they could acquire skills and confidence to more quickly adapt to using mHealth apps for other conditions.
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