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Antonio-Aguirre B, Block SS, Asare AO, Baldanado K, Ciner EB, Coulter RA, DeCarlo DK, Drews-Botsch C, Fishman D, Hartmann EE, Killeen OJ, Yuen J, Collins ME. Association of Sociodemographic Characteristics with Pediatric Vision Screening and Eye Care: An Analysis of the 2021 National Survey of Children's Health. Ophthalmology 2024; 131:611-621. [PMID: 38086435 DOI: 10.1016/j.ophtha.2023.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 12/05/2023] [Accepted: 12/05/2023] [Indexed: 02/17/2024] Open
Abstract
PURPOSE Vision screening and regular eye care can help detect and treat potentially irreversible vision impairment. This study aims to investigate the associations between sociodemographic and health characteristics and the receipt of eye care among children aged 17 years and younger in the United States. DESIGN This cross-sectional study used data from the National Survey of Children's Health (NSCH), a nationally representative and population-based survey of randomly sampled households. PARTICIPANTS Participants were children aged 0 to 17 years, residing in all 50 states and the District of Columbia, whose caregivers or parents answered an address-based survey by mail or online. METHODS Weighted prevalence calculations were applied to analyze the data, and logistic regression was performed to explore associations between reported eye care and demographic, health, and parent-related variables. MAIN OUTCOME MEASURES Caregiver-reported vision screenings, referral to an eye doctor after vision screening, eye doctor visits, and prescription of corrective lenses. RESULTS Caregivers reported that 53.2% of children had a vision screening at least once (if child ≤ 5 years) or within the past 2 years (if child > 5 years). Of those screened, 26.9% were referred to an eye doctor. Overall, 38.6% of all children had a previous eye doctor visit, and among them, 55.4% were prescribed corrective lenses during the visit. Factors associated with decreased odds of vision screening included younger age, lack of health care visits, no insurance coverage, parent education high school or less, and lower household income. Non-White ethnicities, households with a non-English primary language, and lower incomes were more likely to be referred to an eye doctor after vision screening. Lower rates of eye doctor visits were associated with younger age, lack of insurance coverage, and primary household languages other than English. CONCLUSIONS Children from disadvantaged backgrounds are less likely to receive vision screening and eye care. Targeted strategies are needed to increase vision screening and access to eye care services in these vulnerable groups. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found after the references.
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Affiliation(s)
| | | | - Afua O Asare
- John A. Moran Eye Center, Department of Ophthalmology & Visual Sciences, Spencer Fox Eccles School of Medicine at the University of Utah Health, Salt Lake City, Utah
| | | | - Elise B Ciner
- Salus University Pennsylvania College of Optometry, Elkins Park, Pennsylvania
| | | | - Dawn K DeCarlo
- Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | | | | | | | | | - Jenay Yuen
- University of Southern California, Los Angeles, California
| | - Megan E Collins
- Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland.
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Flaharty K, Niziol LM, Woodward MA, Elam A, Bicket A, Killeen OJ, Zhang J, Johnson L, Kershaw M, John DA, Wood SK, Musch DC, Newman-Casey PA. Association of Contrast Sensitivity With Eye Disease and Vision-Related Quality of Life. Am J Ophthalmol 2024; 261:176-186. [PMID: 38281569 DOI: 10.1016/j.ajo.2024.01.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 01/15/2024] [Accepted: 01/19/2024] [Indexed: 01/30/2024]
Abstract
PURPOSE To investigate contrast sensitivity (CS) as a screening tool to detect eye disease and assess its association with both eye disease and vision-related quality of life. DESIGN Cross-sectional study. METHODS Setting and population: Adults receiving care from a free clinic and a Federally Qualified Health Center in Michigan. MAIN OUTCOME MEASURES Screening positive for eye disease and Visual Function Questionnaire (VFQ) score. OBSERVATION Participants received a vision exam reviewed via telemedicine for disease, completed a demographic survey, and the 9-item VFQ. The ability of CS to predict eye disease was explored and area under the curve (AUC) is reported. Logistic and linear regression were used to investigate the continuous effect of CS on the probability of screening positive for eye disease and VFQ score, respectively, adjusting for age and visual acuity. RESULTS 1159 included participants were, on average, 54.9 ± 14.5 years old, 62% identified as female, 34% as White, 54% as Black, 10% as Hispanic/Latino, and reported mean VFQ score of 79.7 ± 15.3. CS ranged from 0.00 to 1.95 log units (mean = 1.54 ± 0.24), 21% of eyes had glaucoma, 19% cataract, 6% DR, and 2% AMD. AUCs were 0.53 to 0.73. A 0.3 log unit decrease in better eye CS was associated with increased odds of glaucoma (odds ratio [OR] = 1.35, confidence interval [CI] = 1.09-1.67), cataract (OR = 1.35, CI = 1.05-1.72), DR (OR = 2.05, CI = 1.51-2.77), and AMD (OR = 2.08, CI = 1.10-3.91). A 0.3 log unit increase in better eye CS was associated with a 5.9 unit increase in VFQ. CONCLUSION While CS alone is not sufficient to identify people with eye disease, it is an important measure of visual function that can add value to comprehensive eye screening.
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Affiliation(s)
- Kathryn Flaharty
- From the University of Michigan Medical School (K.F.), Ann Arbor, Michigan, USA
| | - Leslie M Niziol
- Department of Ophthalmology and Visual Sciences, University of Michigan (L.M.N., M.A.W., A.E., A.B., O.J.K., J.Z., D.A.J., S.K.W., D.C.M., P.A.N.-C.), Ann Arbor, Michigan, USA
| | - Maria A Woodward
- Department of Ophthalmology and Visual Sciences, University of Michigan (L.M.N., M.A.W., A.E., A.B., O.J.K., J.Z., D.A.J., S.K.W., D.C.M., P.A.N.-C.), Ann Arbor, Michigan, USA
| | - Angela Elam
- Department of Ophthalmology and Visual Sciences, University of Michigan (L.M.N., M.A.W., A.E., A.B., O.J.K., J.Z., D.A.J., S.K.W., D.C.M., P.A.N.-C.), Ann Arbor, Michigan, USA
| | - Amanda Bicket
- Department of Ophthalmology and Visual Sciences, University of Michigan (L.M.N., M.A.W., A.E., A.B., O.J.K., J.Z., D.A.J., S.K.W., D.C.M., P.A.N.-C.), Ann Arbor, Michigan, USA
| | - Olivia J Killeen
- Department of Ophthalmology and Visual Sciences, University of Michigan (L.M.N., M.A.W., A.E., A.B., O.J.K., J.Z., D.A.J., S.K.W., D.C.M., P.A.N.-C.), Ann Arbor, Michigan, USA
| | - Jason Zhang
- Department of Ophthalmology and Visual Sciences, University of Michigan (L.M.N., M.A.W., A.E., A.B., O.J.K., J.Z., D.A.J., S.K.W., D.C.M., P.A.N.-C.), Ann Arbor, Michigan, USA
| | - Leroy Johnson
- Hamilton Community Health Network (L.J.), Flint, Michigan, USA
| | | | - Denise A John
- Department of Ophthalmology and Visual Sciences, University of Michigan (L.M.N., M.A.W., A.E., A.B., O.J.K., J.Z., D.A.J., S.K.W., D.C.M., P.A.N.-C.), Ann Arbor, Michigan, USA
| | - Sarah K Wood
- Department of Ophthalmology and Visual Sciences, University of Michigan (L.M.N., M.A.W., A.E., A.B., O.J.K., J.Z., D.A.J., S.K.W., D.C.M., P.A.N.-C.), Ann Arbor, Michigan, USA
| | - David C Musch
- Department of Ophthalmology and Visual Sciences, University of Michigan (L.M.N., M.A.W., A.E., A.B., O.J.K., J.Z., D.A.J., S.K.W., D.C.M., P.A.N.-C.), Ann Arbor, Michigan, USA; Department of Epidemiology, School of Public Health, University of Michigan (D.C.M.), Ann Arbor, Michigan, USA
| | - Paula Anne Newman-Casey
- Department of Ophthalmology and Visual Sciences, University of Michigan (L.M.N., M.A.W., A.E., A.B., O.J.K., J.Z., D.A.J., S.K.W., D.C.M., P.A.N.-C.), Ann Arbor, Michigan, USA.
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Killeen OJ, Gonzalez LA, Rothberg AE, Khanna S, Cornblath WT, Deveney T, Wong SH, De Lott LB. Facilitators and Barriers to Weight Loss Among Patients With Idiopathic Intracranial Hypertension. J Neuroophthalmol 2024:00041327-990000000-00622. [PMID: 38608181 DOI: 10.1097/wno.0000000000002133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/14/2024]
Abstract
BACKGROUND Little is known about motivation for weight loss and barriers to weight loss among patients with idiopathic intracranial hypertension (IIH). Such information is crucial for developing tailored weight management recommendations and novel interventions. METHODS We administered a survey to patients with IIH presenting to neuro-ophthalmology clinics at The University of Michigan Kellogg Eye Center (Michigan, USA) and St. Thomas' Hospital (London, England). Participants rated importance and motivation to lose weight (1-10 scale; 10 = extremely important/motivated). Facilitators and barriers to weight loss were assessed using open-ended survey questions informed by motivational interviewing methodology. Open-ended responses were coded by 2 team members independently using a modified grounded theory approach. Demographic data were extracted from medical records. Descriptive statistics were used to analyze quantitative responses. RESULTS Of the 221 (43 Michigan and 178 London) patients with IIH (Table 1), most were female (n = 40 [93.0%] Michigan and n = 167 [94.9%] London). The majority of patients in the United States were White (n = 35 [81.4%] Michigan), and the plurality were Black in the United Kingdom (n = 67 [37.6%] London]) with a mean (SD) BMI of 38.9 kg/m2 (10.6 kg/m2) Michigan and 37.5 kg/m2 (7.7 kg/m2) London. Participants' mean (SD) level of importance to lose weight was 8.5 (2.2) (8.1 [2.3] Michigan and 8.8 [2.1] London), but their mean (SD) level of motivation to lose weight was 7.2 (2.2) (6.8 [2.4] Michigan and 7.4 [2.1] London). Nine themes emerged from the 992 open-ended coded survey responses grouped into 3 actionable categories: self-efficacy, professional resources (weight loss tools, diet, physical activity level, mental health, and physical health), and external factors (physical/environmental conditions, social influences, and time constraints). Most responses (55.6%; n = 551) were about barriers to weight loss. Lack of self-efficacy was the most discussed single barrier (N = 126; 22.9% total, 28.9% Michigan, and 20.4% London) and facilitator (N = 77; 17.5% total, 15.9% Michigan, and 18.7% London) to weight loss. Other common barriers were related to physical activity level (N = 79; 14.3% total, 13.2% Michigan, and 14.8% London) and diet (N = 79; 14.3% total, 9.4% Michigan, and 16.3% London). Commonly reported facilitators included improvements in physical activity level (N = 73; 16.6% total, 18.5% Michigan, and 15.1% London) and dietary changes (N = 76; 17.2% total, 16.4% Michigan, and 17.9% London). CONCLUSIONS Patients with IIH believe weight loss is important. Self-efficacy was the single most mentioned important patient-identified barrier or facilitator of weight loss, but professional resource needs and external factors vary widely at the individual level. These factors should be assessed to guide selection of weight loss interventions that are tailored to individual patients with IIH.
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Affiliation(s)
- Olivia J Killeen
- Department of Ophthalmology (OJK), Duke University, Durham, North Carolina; Department of Ophthalmology & Visual Sciences (LAG, SK, WTC, TD, LBDL), University of Michigan, Ann Arbor, Michigan; The Ohio State University College of Medicine (LAG), Columbus, Ohio; Department of Internal Medicine (AER), The University of Michigan, Ann Arbor, Michigan; School of Public Health (AER), The University of Michigan, Ann Arbor, Michigan; Weight Management Program & Rewind (AER), The University of Michigan, Ann Arbor, Michigan; Department of Neurology (WTC, LBDL), University of Michigan, Ann Arbor, Michigan; Department of Neuro-Ophthalmology (SHW), Moorfields Eye Hospital, London, United Kingdom; Eye Department (SHW), St Thomas' Hospital, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; Institute of Neurology (SHW), University College London, London, United Kingdom; and Faculty of Life Sciences & Medicine (SHW), King's College London, London, United Kingdom
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Killeen OJ, Niziol LM, Elam AR, Bicket AK, John D, Wood SD, Musch DC, Zhang J, Johnson L, Kershaw M, Woodward MA, Newman-Casey PA. Visual Impairment from Uncorrected Refractive Error among Participants in a Novel Program to Improve Eye Care Access among Low-Income Adults in Michigan. Ophthalmology 2024; 131:349-359. [PMID: 37758028 PMCID: PMC10922592 DOI: 10.1016/j.ophtha.2023.09.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 08/07/2023] [Accepted: 09/15/2023] [Indexed: 10/03/2023] Open
Abstract
PURPOSE To assess the rate of visual impairment (VI) from uncorrected refractive error (URE) and associations with demographic and socioeconomic factors among low-income patients presenting to the Michigan Screening and Intervention for Glaucoma and Eye Health through Telemedicine (MI-SIGHT) program. DESIGN Cross-sectional study. PARTICIPANTS Adults ≥ 18 years without acute ocular symptoms. METHODS MI-SIGHT program participants received a telemedicine-based eye disease screening and ordered glasses through an online optical store. Participants were categorized based on refractive error (RE) status: VI from URE (presenting visual acuity [PVA], ≤ 20/50; best-corrected visual acuity [BCVA], ≥ 20/40), URE without VI (PVA, ≥ 20/40; ≥ 2-line improvement to BCVA), and no or adequately corrected RE (PVA, ≥ 20/40; < 2-line improvement to BCVA). Patient demographics, self-reported visual function, and satisfaction with glasses obtained through the program were compared among groups using analysis of variance, Kruskal-Wallis, chi-square, and Fisher exact testing. MAIN OUTCOME MEASURES PVA, BCVA, and presence of VI (defined as PVA ≤ 20/50). RESULTS Of 1171 participants enrolled in the MI-SIGHT program during the first year, average age was 55.1 years (SD = 14.5), 37.7% were male, 54.1% identified as Black, and 1166 (99.6%) had both PVA and BCVA measured. VI was observed in 120 participants (10.3%); 96 had VI from URE (8.2%), 168 participants (14.4%) had URE without VI, and 878 (75.3%) had no or adequately corrected RE. A smaller percentage of participants with VI resulting from URE reported having a college degree, and a larger percentage reported income < $10 000 compared with participants with no or adequately corrected RE (3.2% vs. 14.2% [P = 0.02]; 45.5% vs. 21.6% [P < 0.0001], respectively). Visual function was lowest among participants with VI from URE, followed by those with URE without VI, and then those with no or adequately corrected RE (9-item National Eye Institute Visual Function Questionnaire composite score, 67.3 ± 19.6 vs. 77.0 ± 14.4 vs. 82.2 ± 13.3, respectively; P < 0.0001). In total, 71.2% (n = 830) ordered glasses for an average cost of $36.80 ± $32.60; 97.7% were satisfied with their glasses. CONCLUSIONS URE was the main cause of VI at 2 clinics serving low-income communities and was associated with reduced vision-related quality of life. An online optical store with lower prices made eyeglasses accessible to low-income patients. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
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Affiliation(s)
- Olivia J Killeen
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan; Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan
| | - Leslie M Niziol
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan
| | - Angela R Elam
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan; Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan
| | - Amanda K Bicket
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan
| | - Denise John
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan
| | - Sarah Dougherty Wood
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan
| | - David C Musch
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan; Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan
| | - Jason Zhang
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan
| | | | | | - Maria A Woodward
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan; Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan
| | - Paula Anne Newman-Casey
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan; Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan.
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Johnson-Griggs MA, Hicks PM, Lu MC, Sherman E, Niziol LM, Elam AR, Woodward MA, Bicket AK, Killeen OJ, Wood S, John D, Johnson L, Kershaw M, Musch DC, Newman-Casey PA. Relationship between Unstable Housing, Food Insecurity, and Vision Status in the MI-SIGHT Community Eye Disease Screening Program. Ophthalmology 2024; 131:140-149. [PMID: 37709171 PMCID: PMC11044600 DOI: 10.1016/j.ophtha.2023.09.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 08/21/2023] [Accepted: 09/06/2023] [Indexed: 09/16/2023] Open
Abstract
PURPOSE Assess rate of visual impairment (VI) from uncorrected refractive error (URE) and associations with demographic and socioeconomic factors among low-income patients presenting to the Michigan Screening and Intervention for Glaucoma and Eye Health through Telemedicine (MI-SIGHT) program. DESIGN Cross-sectional study. PARTICIPANTS Adults ≥ 18 years without acute ocular symptoms. METHODS MI-SIGHT program participants received a telemedicine-based eye disease screening and ordered glasses through an online optical shop. Participants were categorized based on refractive error (RE) status: VI from URE (presenting visual acuity [PVA] ≤ 20/50, best corrected visual acuity [BCVA] ≥ 20/40), URE without VI (PVA ≥ 20/40, had ≥ 2 lines of improvement to BCVA), and no or adequately corrected RE (PVA ≥ 20/40, < 2 line improvement to BCVA). Patient demographics, self-reported visual function, and satisfaction with glasses obtained through the program were compared between groups using analysis of variance, Kruskal-Wallis, chi-square, and Fisher exact testing. MAIN OUTCOME MEASURES PVA, BCVA, and presence of VI (defined as PVA ≤ 20/50). RESULTS Of 1171 participants enrolled in the MI-SIGHT program during the first year, the average age was 55.1 years (standard deviation = 14.5), 37.7% were male, 54.1% identified as Black, and 1166 (99.6%) had both PVA and BCVA measured. VI was observed in 120 (10.3%); 96 had VI from URE (8.2%), 168 (14.4%) had URE without VI, and 878 (75.3%) had no or adequately corrected RE. A smaller percentage of participants with VI from URE reported having a college degree and a larger percentage reported income < $10 000 compared to participants with no or adequately corrected RE (3.2% versus 14.2%, P = 0.02; 45.5% versus 21.6%, respectively, P < 0.0001. Visual function was lowest among participants with VI from URE, followed by those with URE without VI, and then those with no or adequately corrected RE (VFQ9 composite score 67.3 ± 19.6 versus 77.0 ± 14.4 versus 82.2 ± 13.3, respectively; P < 0.0001). 71.2% (n = 830) ordered glasses for an average cost of $36.80 ± $32.60; 97.7% were satisfied with their glasses. CONCLUSIONS URE was the main cause of VI at 2 clinics serving low-income communities and was associated with reduced vision-related quality of life. An online optical shop with lower prices made eyeglasses accessible to low-income patients. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
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Affiliation(s)
- Mikaelah A Johnson-Griggs
- Department of Ophthalmology and Visual Sciences, University of Michigan Medical School, Ann Arbor, Michigan
| | - Patrice M Hicks
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan
| | - Ming-Chen Lu
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan
| | - Eric Sherman
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan
| | - Leslie M Niziol
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan
| | - Angela R Elam
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan
| | - Maria A Woodward
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan; Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan
| | - Amanda K Bicket
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan
| | - Olivia J Killeen
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan
| | - Sarah Wood
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan
| | - Denise John
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan
| | | | | | - David C Musch
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan; Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan; Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan
| | - Paula Anne Newman-Casey
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan; Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan.
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Killeen OJ, Choi H, Kannan NS, Asare AO, Stagg BC, Ehrlich JR. Association Between Health Insurance and Primary Care Vision Testing Among Children and Adolescents. JAMA Ophthalmol 2023; 141:909-911. [PMID: 37589987 PMCID: PMC10436181 DOI: 10.1001/jamaophthalmol.2023.3644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Accepted: 06/25/2023] [Indexed: 08/18/2023]
Abstract
This survey study assesses rates of vision testing by pediatrician or other primary care practitioners among insured and uninsured persons aged 3 to 17 years.
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Affiliation(s)
- Olivia J. Killeen
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor
| | - HwaJung Choi
- Department of Internal Medicine, University of Michigan, Ann Arbor
| | - Niharica S. Kannan
- College of Literature, Science and the Arts, University of Michigan, Ann Arbor
| | - Afua O. Asare
- Department of Ophthalmology and Visual Sciences, University of Utah, Salt Lake City
| | - Brian C. Stagg
- Department of Ophthalmology and Visual Sciences, University of Utah, Salt Lake City
| | - Joshua R. Ehrlich
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor
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Killeen OJ, Gebremariam A, Vorias T, Jacobson A, Clark SJ. Parental knowledge and behaviors related to prevention and early detection of eye problems in US children. J AAPOS 2023; 27:219-222. [PMID: 37356471 DOI: 10.1016/j.jaapos.2023.05.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 05/15/2023] [Accepted: 05/23/2023] [Indexed: 06/27/2023]
Abstract
We documented parental knowledge and actions around children's eye health using a cross-sectional, nationally representative survey of parents of children 3-18 years of age. Parents more frequently reported their child's vision was tested at a primary care visit than school, and many were unsure whether their child received school vision testing. One in 10 children with a possible eye problem had not seen an eye doctor in the previous 2 years. Many parents do not have their child wear eye protection during high-risk activities.
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Affiliation(s)
- Olivia J Killeen
- University of Michigan, Department of Ophthalmology and Visual Sciences, 1000 Wall Street, Ann Arbor, Michigan.
| | - Acham Gebremariam
- Susan B. Meister Child Health Evaluation and Research Center, University of Michigan, Ann Arbor, Michigan
| | - Theodora Vorias
- University of Michigan, Department of Ophthalmology and Visual Sciences, 1000 Wall Street, Ann Arbor, Michigan
| | - Adam Jacobson
- University of Michigan, Department of Ophthalmology and Visual Sciences, 1000 Wall Street, Ann Arbor, Michigan
| | - Sarah J Clark
- Susan B. Meister Child Health Evaluation and Research Center, University of Michigan, Ann Arbor, Michigan
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Killeen OJ, Zhou Y, Ehrlich JR. Objectively Measured Visual Impairment and Dementia Prevalence in Older Adults in the US. JAMA Ophthalmol 2023; 141:786-790. [PMID: 37440238 PMCID: PMC10346499 DOI: 10.1001/jamaophthalmol.2023.2854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 05/14/2023] [Indexed: 07/14/2023]
Abstract
Importance Estimates of the association between visual impairment (VI) and dementia in the US population are based on self-reported survey data or measures of visual function that are at least 15 years old. Older adults are at high risk of VI and dementia so there is a need for up-to-date national estimates based on objective assessments. Objective To estimate the association between VI and dementia in older US adults based on objective visual and cognitive function testing. Design, Setting, and Participants This secondary analysis of the 2021 National Health and Aging Trends Study (NHATS), a population-based, nationally representative panel study, included 3817 respondents 71 years and older. Data were analyzed from January to March 2023. Intervention In 2021, NHATS incorporated tablet-based tests of distance and near visual acuity and contrast sensitivity (CS) with habitual correction. Main Outcomes and Measures VI was defined as distance visual acuity more than 0.30 logMAR, near visual acuity more than 0.30 logMAR, and CS more than 1 SD below the sample mean. Dementia was defined as scoring 1.5 SDs or more below the mean in 1 or more cognitive domains, an AD8 Dementia Screening Interview Score indicating probable dementia, or diagnosed dementia. Poisson regression estimated dementia prevalence ratios adjusted for covariates. Results Of 2967 included participants, 1707 (weighted percentage, 55.3%) were female, and the median (IQR) age was 76.9 (77-86) years. The weighted prevalence of dementia was 12.3% (95% CI, 10.9-13.7) and increased with near VI (21.5%; 95% CI, 17.7-25.3), distance VI (mild: 19.1%; 95% CI, 13.0-25.2; moderate, severe, or blind: 32.9%; 95% CI, 24.1- 41.8), and CS impairment (25.9%; 95% CI, 20.5-31.3). Dementia prevalence was higher among participants with near VI and CS impairment than those without (near VI prevalence ratio: 1.40; 95% CI, 1.16-1.69; CS impairment prevalence ratio: 1.31; 95% CI, 1.04-1.66) and among participants with moderate to severe distance VI or blindness (prevalence ratio: 1.72; 95% CI, 1.26-2.35) after adjustment for covariates. Conclusions and Relevance In this survey study, all types of objectively measured VI were associated with a higher dementia prevalence. As most VI is preventable, prioritizing vision health may be important for optimizing cognitive function.
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Affiliation(s)
- Olivia J. Killeen
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor
| | - Yunshu Zhou
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor
| | - Joshua R. Ehrlich
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor
- Institute for Social Research, University of Michigan, Ann Arbor
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9
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Reed NS, Garcia-Morales EE, Myers C, Huang AR, Ehrlich JR, Killeen OJ, Hoover-Fong JE, Lin FR, Arnold ML, Oh ES, Schrack JA, Deal JA. Prevalence of Hearing Loss and Hearing Aid Use Among US Medicare Beneficiaries Aged 71 Years and Older. JAMA Netw Open 2023; 6:e2326320. [PMID: 37505496 PMCID: PMC10383002 DOI: 10.1001/jamanetworkopen.2023.26320] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/29/2023] Open
Abstract
Importance National prevalence estimates are needed to guide and benchmark initiatives to address hearing loss. However, current estimates are not based on samples that include representation of the oldest old US individuals (ie, aged ≥80 years), who are most at-risk of having hearing loss. Objective To estimate the prevalence of hearing loss and hearing aid use by age and demographic covariates in a large, nationally representative sample of adults aged 71 years and older. Design, Setting, and Participants In this cohort study, prevalence estimates of hearing loss by age, gender, race and ethnicity, education, and income were computed using data from the 2021 National Health Aging and Trends Study. Survey weights were applied to produce nationally representative estimates to the US older population. Data were collected from June to November 2021 and were analyzed from November to December 2022. Main Outcomes and Measures Criterion-standard audiometric measures of hearing loss and self-reported hearing aid use. Results In this nationally representative sample of 2803 participants (weighted estimate, 33.1 million individuals) aged 71 years or older, 38.3% (95% CI, 35.5%-41.1%) were aged 71 to 74 years, 36.0% (95% CI, 33.1%-38.8%) were aged 75 to 79 years, 13.8% (95% CI, 12.6%-14.9%) were aged 80 to 84 years, 7.9% (95% CI, 7.2%-8.6%) were aged 85 to 89 years, and 4.0% (95% CI, 3.5%-4.6%) were aged 90 years or older; 53.5% (95% CI, 50.9%-56.1%) were female and 46.5% (95% CI, 43.9%-49.1%) were male; and 7.5% (95% CI, 6.2%-8.7%) were Black, 6.5% (95% CI, 4.4%-8.7%) were Hispanic, and 82.7% (95% CI, 79.7%-85.6%) were White. An estimated 65.3% of adults 71 years and older (weighted estimate, 21.5 million individuals) had at least some degree of hearing loss (mild, 37.0% [95% CI, 34.7%-39.4%]; moderate, 24.1% [95% CI, 21.9%-26.4%]; and severe, 4.2% [95% CI, 3.3%-5.3%]). The prevalence was higher among White, male, lower-income, and lower education attainment subpopulations and increased with age, such that 96.2% (95% CI, 93.9%-98.6%) of adults aged 90 years and older had hearing loss. Among those with hearing loss, only 29.2% (weighted estimate, 6.4 million individuals) used hearing aids, with lower estimates among Black and Hispanic individuals and low-income individuals. Conclusions and Relevance These findings suggest that bilateral hearing loss is nearly ubiquitous among older US individuals, prevalence and severity increase with age, and hearing aid use is low. Deeper consideration of discrete severity measures of hearing loss in this population, rather than binary hearing loss terminology, is warranted.
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Affiliation(s)
- Nicholas S Reed
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland
- Cochlear Center for Hearing and Public Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Emmanuel E Garcia-Morales
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Cochlear Center for Hearing and Public Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Clarice Myers
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland
- Cochlear Center for Hearing and Public Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Alison R Huang
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Cochlear Center for Hearing and Public Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Joshua R Ehrlich
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor
- Institute for Social Research, University of Michigan, Ann Arbor
| | - Olivia J Killeen
- Cochlear Center for Hearing and Public Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Julie E Hoover-Fong
- Department of Genetic Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Frank R Lin
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland
- Cochlear Center for Hearing and Public Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Michelle L Arnold
- Department of Communication Sciences and Disorders, University of South Florida, Tampa
| | - Esther S Oh
- Cochlear Center for Hearing and Public Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Jennifer A Schrack
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Jennifer A Deal
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland
- Cochlear Center for Hearing and Public Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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10
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Chu HS, Killeen OJ, Hsieh YT, Su TH, Soong HK, Shih CL, Hu FR. Maximize Donor Cornea Use in a Hepatitis B Endemic Area via Serology Matching. Transplantation 2023; 107:1341-1347. [PMID: 36706071 DOI: 10.1097/tp.0000000000004460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND This study aims to investigate the rationality of the allocation guidelines in a hepatitis B endemic area that uses corneas from hepatitis B donors. METHODS Under Taiwan's current guidelines, corneas donated from hepatitis B surface antigen (HBsAg)(+) donors can be allocated to HBsAg(+) or hepatitis B surface antibody recipients. From January 1, 2015, to December 31, 2019, corneas donated to National Taiwan University Hospital were divided into HBsAg(+), HBsAg(-)/hepatitis B core antibody (anti-HBc)(+), and HBsAg(-)/anti-HBc(-) groups. Hepatitis B virus (HBV) DNA extracted from corneoscleral rims was quantified by polymerase chain reaction and correlated with donor serum HBsAg, anti-HBc, and HBV DNA. Recipients of HBV DNA(+) grafts were called back for serology and serum HBV DNA tests. RESULTS The corneoscleral HBV DNA of 170 corneas (113 donors) was quantified, of which 45 corneas were from 28 HBsAg(+) donors, 87 were from 57 HBsAg(-)/anti-HBc(+) donors, and 38 were from 28 HBsAg(-)/anti-HBc(-) donors, and HBV DNA was detected in 80.0%, 9.2%, and 0% of the corneoscleral rims in each group. Donor anti-HBc(+) provided the highest sensitivity (1.00) and negative predictive value (1.00) for corneoscleral HBV DNA. Twenty-eight of 40 recipients (70%) using HBV DNA(+) grafts were called back, and none developed hepatitis in follow-up periods ranging from 6 to 55.5 mo. CONCLUSIONS Donor anti-HBc should be tested routinely with HBsAg. Allocating corneas from HBsAg(+) or anti-HBc(+) donors to HBsAg(+) or hepatitis B surface antibody recipients maximizes cornea usage from hepatitis B donors without compromising transplant safety in a hepatitis B endemic setting.
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Affiliation(s)
- Hsiao-Sang Chu
- Department of Ophthalmology, National Taiwan University Hospital, Taipei City, Taiwan
- National Eye Bank of Taiwan, Ministry of Health and Welfare, Taipei City, Taiwan
- Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei City, Taiwan
| | - Olivia J Killeen
- Department of Ophthalmology and Visual Sciences, W.K. Kellogg Eye Center, University of Michigan, Ann Arbor, MI
| | - Yi-Ting Hsieh
- Department of Ophthalmology, National Taiwan University Hospital, Taipei City, Taiwan
| | - Tung-Hung Su
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, National Taiwan University Hospital, Taipei City, Taiwan
- Hepatitis Research Center, National Taiwan University Hospital, Taipei City, Taiwan
| | - H Kaz Soong
- Department of Ophthalmology and Visual Sciences, W.K. Kellogg Eye Center, University of Michigan, Ann Arbor, MI
| | | | - Fung-Rong Hu
- Department of Ophthalmology, National Taiwan University Hospital, Taipei City, Taiwan
- National Eye Bank of Taiwan, Ministry of Health and Welfare, Taipei City, Taiwan
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11
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Killeen OJ, De Lott LB, Zhou Y, Hu M, Rein D, Reed N, Swenor BK, Ehrlich JR. Population Prevalence of Vision Impairment in US Adults 71 Years and Older: The National Health and Aging Trends Study. JAMA Ophthalmol 2023; 141:197-204. [PMID: 36633858 PMCID: PMC9857701 DOI: 10.1001/jamaophthalmol.2022.5840] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 11/08/2022] [Indexed: 01/13/2023]
Abstract
Importance Existing estimates of the prevalence of vision impairment (VI) in the United States are based on self-reported survey data or measures of visual function that are at least 14 years old. Older adults are at high risk for VI and blindness. There is a need for up-to-date, objectively measured, national epidemiological estimates. Objective To present updated national epidemiological estimates of VI and blindness in older US adults based on objective visual function testing. Design, Setting, and Participants This survey study presents a secondary data analysis of the 2021 National Health and Aging Trends Study (NHATS), a population-based, nationally representative panel study of Medicare beneficiaries 65 years and older. NHATS includes community-dwelling older adults or their proxies who complete in-person interviews; annual follow-up interviews are conducted regardless of residential status. Round 11 NHATS data were collected from June to November 2021, and data were analyzed in August 2022. Interventions In 2021, NHATS incorporated tablet-based tests of distance and near visual acuity and contrast sensitivity with habitual correction. Main Outcomes and Measures National prevalence of impairment in presenting distance visual acuity (>0.30 logMAR, Snellen equivalent worse than 20/40), presenting near visual acuity (>0.30 logMAR, Snellen equivalent worse than 20/40), and contrast sensitivity (>1 SD below the sample mean). Prevalence estimates stratified by age and socioeconomic and demographic data were calculated. Results In the 2021 round 11 NHATS sample, there were 3817 respondents. After excluding respondents who did not complete the sample person interview (n = 429) and those with missing vision data (n = 362), there were 3026 participants. Of these, 29.5% (95% CI, 27.3%-31.8%) were 71 to 74 years old, and 55.2% (95% CI, 52.8%-57.6%) were female respondents. The prevalence of VI in US adults 71 years and older was 27.8% (95% CI, 25.5%-30.1%). Distance and near visual acuity and contrast sensitivity impairments were prevalent in 10.3% (95% CI, 8.9%-11.7%), 22.3% (95% CI, 20.3%-24.3%), and 10.0% (95% CI, 8.5%-11.4%), respectively. Older age, less education, and lower income were associated with all types of VI. A higher prevalence of near visual acuity and contrast sensitivity impairments was associated with non-White race and Hispanic ethnicity. Conclusions and Relevance More than 1 in 4 US adults 71 years and older had VI in 2021, higher than prior estimates. Differences in the prevalence of VI by socioeconomic and demographic factors were observed. These data could inform public health planning.
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Affiliation(s)
- Olivia J. Killeen
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
| | - Lindsey B. De Lott
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
| | - Yunshu Zhou
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor
| | - Mengyao Hu
- Institute for Social Research, University of Michigan, Ann Arbor
| | - David Rein
- National Opinion Research Center, University of Chicago, Chicago, Illinois
| | - Nicholas Reed
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Cochlear Center for Hearing and Public Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Bonnielin K. Swenor
- Johns Hopkins University School of Nursing, Baltimore, Maryland
- Johns Hopkins Disability Health Research Center, Johns Hopkins University, Baltimore, Maryland
| | - Joshua R. Ehrlich
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
- Institute for Social Research, University of Michigan, Ann Arbor
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12
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Killeen OJ, Saylor KM, Hogan C, Jacobson A, Collins M, Ehrlich JR. Barriers and facilitators to vision screening in the U.S. pediatric primary care setting: a mixed methods systematic review protocol. JBI Evid Synth 2023; 21:985-992. [PMID: 36598114 DOI: 10.11124/jbies-22-00026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
OBJECTIVE The objective of this review is to understand the barriers and facilitators to vision screening in the US primary care setting for children ages 3 to 17. INTRODUCTION Childhood vision screening is crucial because it detects children at risk for undiagnosed vision problems. Previous studies report low rates of appropriate vision screening in the primary care setting. We aim to identify barriers and facilitators to pediatric primary care vision screening to inform future interventions to improve childhood vision screening. INCLUSION CRITERIA Studies of all types that identify barriers and facilitators to vision screening in children aged 3 to 17 years old in the pediatric primary care setting in the US will be considered for inclusion. METHODS We will search PubMed, CINAHL Complete (EBSCO), Scopus, Web of Science (SCI-EXPANDED, ESCI, CPCI-S, SSCI), Cochrane Library, and Embase. We will also search gray literature, including conference proceedings, professional organization reports, and clinical trials. We will use supplemental search strategies, including citation tracking and contacting authors for unpublished data. Titles and abstracts will be screened independently by 2 reviewers and selected for full-text screening based on prespecified inclusion criteria. Only studies in English will be considered. Each included study will be appraised using the Mixed Methods Appraisal Tool. Data will be extracted using a modified JBI mixed methods data extraction form. Qualitative and quantitative data will be integrated using a convergent integrated approach. REVIEW REGISTRATION Open Science Framework https://osf.io/nhf5d/.
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Affiliation(s)
- Olivia J Killeen
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA.,Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, MI, USA
| | - Kate M Saylor
- Taubman Health Sciences Library, University of Michigan, Ann Arbor, MI, USA
| | - Caroline Hogan
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA.,Department of Pediatrics, University of Michigan, Ann Arbor, MI, USA
| | - Adam Jacobson
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, MI, USA
| | - Megan Collins
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Joshua R Ehrlich
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA.,Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, MI, USA.,Institute for Social Research, University of Michigan, Ann Arbor, MI, USA
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13
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Killeen OJ, Niziol LM, Cho J, Heisler M, Resnicow K, Darnley-Fisch D, Musch DC, Lee PP, Newman-Casey PA. Glaucoma Medication Adherence 1 Year after the Support, Educate, Empower Personalized Glaucoma Coaching Program. Ophthalmol Glaucoma 2023; 6:23-28. [PMID: 35953021 PMCID: PMC10246914 DOI: 10.1016/j.ogla.2022.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 07/29/2022] [Accepted: 08/03/2022] [Indexed: 06/09/2023]
Abstract
PURPOSE To assess the efficacy of the Support, Educate, Empower (SEE) glaucoma coaching program on medication adherence among poorly adherent patients with glaucoma for 12 months after cessation of the intervention. DESIGN Uncontrolled intervention study with a pre-post design. PARTICIPANTS The SEE cohort was recruited from the University of Michigan and included patients with glaucoma aged ≥ 40 years, taking ≥ 1 medication, who self-reported poor adherence. Electronic medication monitoring of those who completed the program continued for up to 1 year after the coaching intervention. METHODS Adherence was monitored electronically (AdhereTech) during the 7-month program and 12-month follow-up period. Adherence was the percentage of doses taken on time. Participants were censored for surgery, change in glaucoma medications, or adherence monitor disuse. The SEE program included automated medication reminders, 3 in-person motivational interviewing-based counseling sessions with a glaucoma coach, and 5 phone calls with the coach for between-session support. There was no contact between the study team and participants during the 12-month follow-up after program cessation. Baseline participant characteristics were summarized with descriptive statistics. Paired t tests and Wilcoxon signed rank tests were used to investigate significant changes in monthly adherence during follow-up. MAIN OUTCOME MEASURES Change in electronically monitored medication adherence over the 12 months following the conclusion of the SEE program. RESULTS Of 48 participants, 39 (81%) completed the SEE program and continued electronic medication monitoring for up to 1 year after program cessation. The mean age of the participants was 64 years (standard deviation [SD], 10); of the 39 participants, 56% were male, 49% were Black, and 44% were White. The mean length of follow-up was 284 days (SD, 110; range, 41-365 days). Censoring occurred in 18 (56%) participants. The mean adherence during the follow-up period was 67% (SD, 22%). This was significantly lower than the adherence during the SEE program (mean, 81%; SD, 18%; P < 0.0001) but significantly higher than the baseline preprogram adherence (mean, 60%; SD, 18%; P = 0.0393). The largest monthly losses occurred at months 1 (mean, 7%; P = 0.0001) and 4 (mean, 6%; P = 0.0077). CONCLUSIONS Glaucoma medication adherence decreased significantly in the year after cessation of the SEE coaching program but remained significantly higher than baseline adherence. To maintain excellent long-term medication adherence, intermittent reinforcement sessions may be necessary.
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Affiliation(s)
- Olivia J Killeen
- Department of Ophthalmology and Visual Sciences, School of Medicine, University of Michigan, Ann Arbor, Michigan
| | - Leslie M Niziol
- Department of Ophthalmology and Visual Sciences, School of Medicine, University of Michigan, Ann Arbor, Michigan
| | - Juno Cho
- Department of Ophthalmology and Visual Sciences, School of Medicine, University of Michigan, Ann Arbor, Michigan
| | - Michele Heisler
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, Michigan; Department of Internal Medicine, School of Medicine, University of Michigan, Ann Arbor, Michigan
| | - Ken Resnicow
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, Michigan
| | | | - David C Musch
- Department of Ophthalmology and Visual Sciences, School of Medicine, University of Michigan, Ann Arbor, Michigan; Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan
| | - Paul P Lee
- Department of Ophthalmology and Visual Sciences, School of Medicine, University of Michigan, Ann Arbor, Michigan
| | - Paula Anne Newman-Casey
- Department of Ophthalmology and Visual Sciences, School of Medicine, University of Michigan, Ann Arbor, Michigan.
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14
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Killeen OJ, Zhou Y, Musch DC, Woodward M, Newman-Casey PA, Moroi S, Speck N, Mukhtar A, Dewey C. Access to eye care and prevalence of refractive error and eye conditions at a high school-based eye clinic in southeastern Michigan. J AAPOS 2022; 26:185.e1-185.e6. [PMID: 35868623 DOI: 10.1016/j.jaapos.2022.04.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 04/04/2022] [Accepted: 04/10/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE To analyze clinical and demographic data from a twice monthly optometrist-run comprehensive eye program at a high school in a community with high rates of poverty. METHODS Students received comprehensive eye examinations. We collected demographic and ocular data on 429 initial visits from February 2015 to July 2019. Follow-up visits were excluded. RESULTS The average student age was 14.2 ± 2.7 years. Of the total, 55.7% were female, 59.7% were Black, and 61.7% had Medicaid. Of the total, 70.2% had a previous eye examination, 60.8% had worn glasses previously, and 24.1% still wore glasses. Hispanic students were less likely than non-Hispanic students to have had a prior eye examination (59.1% vs 75.3% [P = 0.022]) or worn glasses (47.8% vs 63.8% [P = 0.035]). Black students had significantly worse presenting visual acuity in the better seeing eye than White students (logMAR 0.22 vs 0.13 [P = 0.0004]). Of the 256 Black students, 62.7% had improvement of two or more lines, compared with 42.9% of White students (P = 0.01). Of the students who participated, 74.0% received glasses following their examination, and 21 required referrals to ophthalmologists, of whom 13 attended the appointment. CONCLUSIONS The high school-based clinic identified high rates of uncorrected refractive error, highlighting the benefit of a school-based eye clinic in a population with high rates of poverty. There were concerning racial and ethnic disparities in prior eye care.
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Affiliation(s)
- Olivia J Killeen
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor; Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor.
| | - Yunshu Zhou
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor
| | - David C Musch
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor; Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor; Department of Epidemiology, University of Michigan, Ann Arbor
| | - Maria Woodward
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor; Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
| | - Paula Anne Newman-Casey
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor; Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
| | - Sayoko Moroi
- Department of Ophthalmology and Visual Sciences, The Ohio State University, Columbus
| | - Nicole Speck
- Michigan Medicine Regional Alliance for Healthy Schools, Ann Arbor; School of Nursing, University of Michigan, Ann Arbor
| | - Ali Mukhtar
- Columbia University Vagelos College of Physicians and Surgeons, New York
| | - Courtney Dewey
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor; Michigan Medicine Regional Alliance for Healthy Schools, Ann Arbor
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15
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Killeen OJ, Lee PP. Broadening Access to Eyeglasses in the US. JAMA Health Forum 2022; 3:e215236. [DOI: 10.1001/jamahealthforum.2021.5236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Olivia J. Killeen
- Department of Ophthalmology and Visual Sciences, Kellogg Eye Center, University of Michigan, Ann Arbor
| | - Paul P. Lee
- Department of Ophthalmology and Visual Sciences, Kellogg Eye Center, University of Michigan, Ann Arbor
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16
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Killeen OJ, Xiang X, Powell D, Reed NS, Deal JA, Swenor BK, Ehrlich JR. Longitudinal Associations of Self-Reported Visual, Hearing, and Dual Sensory Difficulties With Symptoms of Depression Among Older Adults in the United States. Front Neurosci 2022; 16:786244. [PMID: 35153667 PMCID: PMC8829390 DOI: 10.3389/fnins.2022.786244] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 01/04/2022] [Indexed: 01/19/2023] Open
Abstract
Evidence conflicts on the association between sensory difficulty and depression. Few studies have examined this association using longitudinal or population-based data. We used data from Rounds 1-9 of the nationally representative National Health and Aging Trends Study to evaluate the longitudinal association between self-reported visual, hearing, and dual sensory difficulties and clinically significant depressive symptoms. Multivariable Cox regression models were used to evaluate the hazard of incident depressive symptoms. Group-based trajectory modeling identified depressive symptom trajectories (DSTs). Multinomial logistic regression was used to examine the association between sensory status and DSTs. A total of 7,593 participants were included: 56.5% were female, 53.0% were 65-74 years old, 19.0% (95% CI 17.9-20.2%) had hearing, 5.6% (4.9-6.4%) had visual, and 3.3% (2.9-3.8%) had dual sensory difficulties at baseline. Hazard ratios for depressive symptoms in those with visual, hearing, and dual sensory difficulties were 1.25 (95% CI 1.00-1.56, p = 0.047), 0.98 (95% CI 0.82-1.18, p = 0.82), and 1.67 (95% CI 1.29-2.16, p < 0.001), respectively, relative to those without sensory difficulty. A model with four trajectory groups best fit the data. Group 1 (35.8% of the sample, 95% CI: 34.1-37.4) had persistently low risk of depressive symptoms; Group 2 (44.8%, 43.4-46.3) had low but increasing risk; Group 3 (7.1%, 6.2-8.3) had moderate risk; and Group 4 (12.4%, 11.5-13.3) had moderate to high risk that increased. Compared to those without sensory difficulties, individuals with each difficulty were significantly more likely to belong to a group other than Group 1. This study reveals associations between sensory difficulties and mental health that can inform public health interventions.
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Affiliation(s)
- Olivia J. Killeen
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, MI, United States,Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, United States
| | - Xiaoling Xiang
- School of Social Work, University of Michigan, Ann Arbor, MI, United States
| | - Danielle Powell
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Nicholas S. Reed
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States,Cochlear Center for Hearing and Public Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States,Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, MD, United States
| | - Jennifer A. Deal
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States,Cochlear Center for Hearing and Public Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States,Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, MD, United States
| | - Bonnielin K. Swenor
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, United States,Center on Aging and Health, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Joshua R. Ehrlich
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, MI, United States,Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, United States,Institute for Social Research, University of Michigan, Ann Arbor, MI, United States,*Correspondence: Joshua R. Ehrlich,
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17
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Killeen OJ, Cho J, Newman-Casey PA, Kana L, Woodward MA. Barriers and Facilitators to Obtaining Eyeglasses for Vulnerable Patients in a Michigan Free Clinic. Optom Vis Sci 2021; 98:243-249. [PMID: 33771953 PMCID: PMC8007009 DOI: 10.1097/opx.0000000000001661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
SIGNIFICANCE Uncorrected refractive error is the main cause of visual impairment globally. Understanding barriers and facilitators underserved individuals face in obtaining eyeglasses will help address high rates of uncorrected refractive error. PURPOSE The purpose of this study was to understand the barriers and facilitators to obtaining eyeglasses among low-income patients in Michigan. METHODS Participants older than 18 years with hyperopia, myopia, or presbyopia and without active eye disease, severe mental illness, or cognitive impairment at Hope Clinic, Ypsilanti, Michigan, were included in this study. The participants answered a sociodemographic survey and underwent autorefraction and an interview. Interviews were audiorecorded, transcribed, and analyzed by two investigators. RESULTS Interviews were completed by 43 participants, and 30 participants' interviews were analyzed. The mean ± standard deviation age of 30 participants was 55 ± 12 years, 70% were female, 57% were African American, 40% had high school diploma or less, 57% earned less than U.S. $25,000 per year, 93% had worn glasses previously, and 87% had some medical insurance. Uncorrected visual acuity was logMAR 0.73 ± 0.61; best-corrected visual acuity was logMAR 0.16 ± 0.21. Thematic saturation was reached after 25 transcripts. Top barriers to using eyeglasses were cost (312 mentions, 29 participants), negative experiences with eyeglasses (263, 29), and limited access to eye care (175, 27). Top facilitators were positive experiences with glasses (230, 29), easy access to eyeglasses (143, 27), and availability of transportation (65, 27). Most participants (97%, 29) reported being negatively impacted by uncorrected refractive error. Most (97%, 29) were skeptical about obtaining eyeglasses online because of possible prescription problems. CONCLUSIONS Key barriers to correcting uncorrected refractive error in our community span across multiple health domains but are predominately rooted in external factors such as cost and access to vision care. Online eyeglasses may address access issues, but many participants were uncomfortable or unable to obtain glasses online.
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Affiliation(s)
- Olivia J Killeen
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan
| | - Juno Cho
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan
| | - Paula Anne Newman-Casey
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan
| | - Lulia Kana
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan
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Killeen OJ, Pillai MR, Udayakumar B, Shroff S, Vimalanathan M, Cho J, Newman-Casey PA. Understanding Barriers to Glaucoma Treatment Adherence among Participants in South India. Ophthalmic Epidemiol 2020; 27:200-208. [DOI: 10.1080/09286586.2019.1708121] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Affiliation(s)
- Olivia J. Killeen
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan, USA
| | | | | | | | | | - Juno Cho
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan, USA
| | - Paula Anne Newman-Casey
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan, USA
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Affiliation(s)
| | - Laura Bridges
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor
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Newman-Casey PA, Killeen OJ, Renner M, Robin AL, Lee P, Heisler M. Access to and Experiences with, e-Health Technology Among Glaucoma Patients and Their Relationship with Medication Adherence. Telemed J E Health 2018; 24:1026-1035. [PMID: 29683401 DOI: 10.1089/tmj.2017.0324] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: As online health information becomes common, it is important to assess patients' access to and experiences with online resources. Introduction: We examined whether glaucoma patients' technology usage differs by medication adherence and whether adherence is associated with online education experiences. Materials and Methods: We included 164 adults with glaucoma taking ≥1 glaucoma medication. Participants completed a survey including demographic and health information, the Morisky Adherence Scale, and questions about online glaucoma resource usage. Differences in technology access, adherence, and age were compared with chi-squared, Fisher exact, and two-sample t-tests. Results: Mean age was 66 years. Twenty-six percent reported poor adherence. Eighty percent had good technology access. Seventy-three percent of subjects with greater technology access wanted online glaucoma information and yet only 14% of patients had been directed to online resources by physicians. There was no relationship between technological connectivity and adherence (p = 0.51). Nonadherent patients were younger (mean age 58 years vs. 66 years for adherent patients, p = 0.002). Nonadherence was associated with negative feelings about online searches (68% vs. 42%, p = 0.06). Discussion: Younger, poorly adherent patients navigate online glaucoma resources without physician input. These online searches are often unsatisfying. Technology should be leveraged to create high quality, online glaucoma resources that physicians can recommend to provide guidance for disease self-management.
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Affiliation(s)
- Paula Anne Newman-Casey
- Department of Ophthalmology & Visual Sciences, Kellogg Eye Center, University of Michigan Medical School, Ann Arbor, Michigan
| | - Olivia J Killeen
- Department of Ophthalmology & Visual Sciences, Kellogg Eye Center, University of Michigan Medical School, Ann Arbor, Michigan
| | - Morgan Renner
- Department of Ophthalmology & Visual Sciences, Kellogg Eye Center, University of Michigan Medical School, Ann Arbor, Michigan
| | - Alan L Robin
- Department of Ophthalmology & Visual Sciences, Kellogg Eye Center, University of Michigan Medical School, Ann Arbor, Michigan.,Department of Ophthalmology & Visual Sciences, University of Maryland Medical School, Baltimore, Maryland
| | - Paul Lee
- Department of Ophthalmology & Visual Sciences, Kellogg Eye Center, University of Michigan Medical School, Ann Arbor, Michigan
| | - Michele Heisler
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan
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Killeen OJ, Davis A, Tucker JD, Mason Meier B. Chinese Global Health Diplomacy in Africa: Opportunities and Challenges. Glob Health Gov 2018; 12:4-29. [PMID: 30956750 PMCID: PMC6447313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
China has become a key actor in global health diplomacy, particularly in Africa, but little attention has been given to the evolution of Chinese health assistance to African states. This paper conceptualizes Chinese health diplomacy in Africa over the past fifty years through three analytic frameworks: realist vs. constructivist motivations in international relations, vertical vs. horizontal initiatives for health assistance, and bilateral vs. multilateral approaches to global health. Drawing lessons from the evolution of American health assistance, we argue that a better understanding of these frameworks-recognizing why countries pursue health diplomacy, what vertical and horizontal strategies they use, and how they engage in this work bilaterally or multilaterally-could improve global health diplomacy.
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Affiliation(s)
- Olivia J Killeen
- medical resident in ophthalmology at the University of Michigan's Kellogg Eye Center
| | - Alissa Davis
- Postdoctoral Research Fellow at the HIV Center for Clinical and Behavioral Studies at Columbia University and the New York State Psychiatric Institute
| | - Joseph D Tucker
- Assistant Professor of Medicine and Director of UNC Project-China. He is a Term Member at the Council on Foreign Relations
| | - Benjamin Mason Meier
- Associate Professor of Global Health Policy and the Zachary Taylor Smith Distinguished Professor of Public Policy at the University of North Carolina at Chapel Hill
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