Publications by authors named "D B Washburn"

185 Publications

Predictors of Pediatric Frequent Emergency Department Use Among 7.6 million Pediatric Patients in New York.

Acad Pediatr 2022 Apr 3. Epub 2022 Apr 3.

Population Informatics Lab, School of Public Health (SC Anyatonwu, TV Giannouchos, DJ Washburn, RL Ohsfeldt, and HC Kum), Texas A&M University, College Station, Tex; Department of Health Policy & Management, School of Public Health (SC Anyatonwu, DJ Washburn, RL Ohsfeldt, and HC Kum), Texas A&M University, College Station, Tex.

Objective: This study examines the characteristics and factors associated with frequent emergency department (ED) utilization among the pediatric population.

Methods: We conducted a pooled cross-sectional secondary analysis using the Healthcare Cost and Utilization Project State Emergency and Inpatient Databases on ED visits to all hospitals in New York from 2011 to 2016 by patients aged 0 to 21. We used multivariable logistic and negative binomial regressions to investigate the predictors of multiple ED visits in the pediatric population.

Results: Overall, our study included 7.6 million pediatric patients who accounted for more than 12 million ED visits. Of those, 6.2% of patients were frequent ED users (≥4 visits/year), accounting for 20.8% of all ED visits (5.4 ED visits/year on average). The strongest predictors of frequent ED use were having at least one ED visit related to asthma (aOR = 8.37 [95% CI: 6.34-11.04]), mental health disorders (aOR = 9.67 [95% CI: 8.60-10.89]), or multiple comorbidities compared to none. Larger shares of ED visits for not-emergent conditions were also associated with frequent ED use (aOR = 6.63 [95% CI = 5.08-8.65]). Being covered by Medicaid compared to private (aOR = 0.45 [95% CI: 0.42-0.47]) or no insurance (aOR = 0.41 [95% CI: 0.38-0.44]) were further associated with frequent ED use. The results from the negative binomial regression yielded consistent findings.

Conclusions: Pediatric patients who exhibit increased ED use are more medically complex and have increased healthcare needs that are inextricably tied to social determinants of health. Better integrated health systems should emphasize connecting vulnerable patients to appropriate social and primary care services outside of emergency settings.
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http://dx.doi.org/10.1016/j.acap.2022.03.016DOI Listing
April 2022

Imperfect messengers? An analysis of vaccine confidence among primary care physicians.

Vaccine 2022 04 18;40(18):2588-2603. Epub 2022 Mar 18.

Department of Political Science, Oklahoma State University, 210 Social Sciences and Humanities Hall, Stillwater, OK, United States.

Background: Growing narratives emphasize using primary care physicians as leaders in efforts to promote COVID-19 vaccination among the vaccine hesitant. Critically however, little is known about vaccine confidence among primary care physicians themselves. The objective of this study was to assess both physician confidence that in general, vaccines are safe, effective, and important, as well as physician confidence in each COVID-19 vaccine in the United States.

Methods: We rely on data from a national survey of primary care physicians conducted from May 14-May 25, 2021. We assess the influence of demographic, social, and political factors on physician beliefs that in general, vaccines are safe, effective, and important, as well as physician confidence in the safety of the Moderna, Pfizer, and Johnson & Johnson COVID-19 vaccines.

Results: 10.1% of primary care physicians do not agree that, in general, vaccines are safe, 9.3% do not agree they are effective, and 8.3% do not agree they are important. While 68.7% of physicians were 'very confident' in the safety of the Moderna vaccine and 72.7% were 'very confident' in the safety of the Pfizer vaccine, only 32.1% of physicians were 'very confident' in the safety of the Johnson & Johnson COVID-19 vaccine.

Conclusion: A troubling proportion of primary care physicians lack high levels of vaccine confidence. These physicians may not be well positioned to actively promote COVID-19 vaccination even as political and media narratives push physicians to lead this effort. Interventions aimed at improving vaccine confidence among some physicians may be needed so that all physicians can fulfill needed roles as trusted vaccine communicators.
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http://dx.doi.org/10.1016/j.vaccine.2022.03.025DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8931689PMC
April 2022

Overcoming cognitive set bias requires more than seeing an alternative strategy.

Sci Rep 2022 02 9;12(1):2179. Epub 2022 Feb 9.

Language Research Center, Department of Psychology, Georgia State University, Atlanta, GA, USA.

Determining when to switch from one strategy to another is at the heart of adaptive decision-making. Previous research shows that humans exhibit a 'cognitive set' bias, which occurs when a familiar strategy occludes-even much better-alternatives. Here we examined the mechanisms underlying cognitive set by investigating whether better solutions are visually overlooked, or fixated on but disregarded. We analyzed gaze data from 67 American undergraduates (91% female) while they completed the learned strategy-direct strategy (LS-DS) task, which measures their ability to switch from a learned strategy (LS) to a more efficient direct strategy (DS or shortcut). We found that, in the first trial block, participants fixated on the location of the shortcut more when it was available but most (89.6%) did not adopt it. Next, participants watched a video demonstrating either the DS (N = 34 Informed participants) or the familiar LS (N = 33 Controls). In post-video trials, Informed participants used the DS more than pre-video trials and compared to Controls. Notably, 29.4% of Informed participants continued to use the LS despite watching the DS video. We suggest that cognitive set in the LS-DS task does not stem from an inability to see the shortcut but rather a failure to try it.
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http://dx.doi.org/10.1038/s41598-022-06237-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8828898PMC
February 2022

Determinants of HIV Testing Uptake among Women (aged 15-49 years) in the Philippines, Myanmar, and Cambodia.

Int J MCH AIDS 2021 2;10(2):221-230. Epub 2021 Dec 2.

Department of Environmental & Occupational Health, Texas A&M University School of Public Health, College Station, TX, USA.

Background: Many countries have been trying to eliminate Mother-to-Child transmission of the Human Immunodeficiency Virus (HIV) and achieve the 90-90-90 target goals. The targets mean that 90% of People Living with HIV (PLWHIV) know their HIV status, 90% of those who are infected receive Antiretroviral treatment (ART), and 90% of those achieve viral suppression. Despite some progress, the goals have not been met in the Philippines, Myanmar, and Cambodia, countries with relatively high or growing HIV prevalence. This study identifies the sociodemographic determinants of testing among women in these countries so that better health education and stigma reduction strategies can be developed.

Methods: Descriptive and multivariable analyses were conducted using Demographic and Health Survey data conducted in the Philippines (2017), Myanmar (2015/2016), and Cambodia (2014). The outcome variable was having ever been tested for HIV. Independent variables included knowledge and attitudes about HIV and social determinants of health.

Results: A significant difference in testing rates among women was observed (the Philippines: 5%, Myanmar: 19%, Cambodia: 42%). In Myanmar and Cambodia, women who had more HIV knowledge and less stigma towards PLWHIV were more likely to get tested for HIV than those who did not. Marital status, education, wealth were strong predictors for HIV testing among women. Younger women aged 15-19 and those who live in the rural areas were less likely to get HIV tested than older and those living in urban areas. Employed women were less likely to seek an HIV test than the unemployed in Myanmar and Cambodia, whereas, in the Philippines, the opposite relationship was found.

Conclusion And Global Health Implications: Women with less education and those less familiar with HIV should be targeted for HIV testing interventions. Stigma reduction and different testing strategies could facilitate early screening leading to improved HIV testing among women.
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http://dx.doi.org/10.21106/ijma.525DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8647194PMC
December 2021

Racial, Ethnic, and Socioeconomic Disparities in Curative Treatment Receipt and Survival in Hepatocellular Carcinoma.

Hepatol Commun 2022 05 19;6(5):1186-1197. Epub 2021 Nov 19.

Population Informatics Lab, Texas A&M School of Public Health, College Station, TX, USA.

Hepatocellular carcinoma (HCC) disproportionately affects racial, ethnic, and low socioeconomic status (SES) populations. However, the interaction between race, ethnicity, and neighborhood SES in HCC prognosis is not well explored. This study evaluates the interaction between race and ethnicity and neighborhood SES on curative treatment utilization and overall survival among patients with HCC in the United States. We conducted a retrospective cohort study of 13,874 patients aged ≥65 years diagnosed with HCC from 2001 through 2015 using the Surveillance, Epidemiology, and End Results Medicare-linked database. We performed multivariable logistic regression to examine the association between race, ethnicity, and curative treatment receipt across SES. We also evaluated the association between curative treatment receipt and overall survival using a Cox proportional hazards model. Among 13,874 patients, only 2,617 (18.9%) patients received curative treatment. Overall, Black patients had lower odds of receiving curative treatment than White patients (odds ratio [OR], 0.76; 95% confidence interval [CI], 0.64-0.91). When stratified by neighborhood SES, Black patients living in high-poverty neighborhoods had lower odds of curative treatment receipt (OR, 0.64; 95% CI, 0.49-0.84) and worse survival (hazard ratio, 1.13; 95% CI, 1.02-1.25). Conversely, Hispanic and Asian patients had similar curative treatment receipt compared to White patients across all socioeconomic levels. Conclusion: Disparities in curative treatment receipt and overall survival are pronounced between Black and White patients. Black-White disparities appear to be moderated by neighborhood SES and are particularly evident among those living in high-poverty neighborhoods.
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http://dx.doi.org/10.1002/hep4.1863DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9035560PMC
May 2022
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