Hildebrand Clubbs, B., Barnette, A., Gray, N., Weiner, L., Bond, A., Harden J., & Pineda R. (2019) A Community Hospital NICU Developmental Care Partner Program: Feasibility and Association with Decreased Nurse Burnout Without Increased Infection Rates, Advances in Neonatal Care, doi: 10.1097/ANC.0000000000000600
Abstract: Background: Volunteers can provide staff-directed sensory inputs to infants hospitalized in the NICU, but research on volunteer programs is limited. Purpose: To evaluate the feasibility of a developmental care partner (DCP) program in a level III NICU and determine its relationship with provider burnout and infant infection rates.Methods: DCPs were trained to provide sensory input to infants, based on the behavioral cues observed by the occupational therapists and nursing staff, in medically stable infants. Feasibility was assessed by documenting the process of training and utilizing volunteers, as well as tracking duration and frequency of DCP visits. Staff burnoutmeasures were assessed using the Maslach Burnout Inventory Human Services Survey (MBI-HSS) before and after implementation. Infant infection rates before and after the introduction of volunteers were compared. Results: Seventy-two volunteers were interested, and 25 (35%) completed the DCP competencies and provided sensory exposures to 54 neonates, who were visited an average of 8 times (range 1-15). Twelve (48%) DCPs did once-per-week visits, and 9 (36%) did at least 50 contact hours. MBI-HSS scores for staff emotional exhaustion (P < .001) and depersonalization (P < .006) were lower after DCP implementation. There were no differences in infant infection rates before and after DCP implementation (Fisher exact P = 1.000). Implications for Practice: Volunteer-based DCP programs may be feasible to implement in community hospitals and could help reduce staff emotional exhaustion and depersonalization without increasing the incidence of infant infections.Implications for Research: Future research on NICU volunteer programs with larger sample sizes and different infant populations is warranted.
Gray, N., & Picone, G. (2018). Evidence of Social Interactions in Mammography in the United States, Atlantic Economic Journal, 46 (4), pp 441-457
Abstract: This paper examines the extent of social interactions in an individual's decision to undergo mammography. Using Behavioral Risk Factors Surveillance System surveys from 1993-2016, the effect of other female screening behavior on an individual's decision to have a routine breast cancer screening was measured by calculating the size of a so called "social multiplier" in mammography. A vector of social multipliers was estimated in the use of mammograms in the past 1-2 years by taking the ratio of group-level effects of exogenous explanatory variables to individual-level effects of the same variables. Peer groups were defined as same-aged women living in the same state. Three age groups of women were considered: 40-49, 50-74, and 75 and older. Several econometric approaches were used to analyze the effect of social interactions on mammography use, including ordinary least squares, fixed effects, and split-sample instrumental variable. For all women, evidence was found of social interactions associated with individual's education, employment, and poor health. In addition, number of age-group-specific social multipliers was found. The strongest evidence of spillover in mammography was found for women ages 75 and older. Policy makers should be aware that, in the presence of a social multiplier, the value of any type of screening intervention is higher than the one that would be measured at the individual-level.
Gangaraju, V., Gray, N. (2017). Ease of Doing Business in the Developing World and Political and Civil Rights, Journal of International Business and Economics, 17(4), 79-88.
Abstract: This research investigates the relationship between political and civil rights and the ease of doing business through a cross-sectional analysis for 126 developing economies in 2015. Through this research it is shown that greater civil, but not political rights, lead to greater ease of doing business. Also, personal autonomy related aspects of the civil rights turned out to be a relatively more important factor for attracting or starting new businesses in the developing countries.
Gray, N., & Picone, G. (2016). The Effect of the 2009 US Preventive Services Task Force Breast Cancer Screening Recommendations on Mammography Rates, Health Services Research, 51(4), 1533-1545.
Abstract: Objective: To examine the effect of a change in United States Preventive Services Task Force (USPSTF) screening guidelines on mammography rates in the U.S. Principal Findings: In 2010, the year following the change in guidelines, twelve-month mammography prevalence among women ages 40-49 fell by 2.09 percentage points (95% confidence interval [CI]: - 2.87 to -1.31) from 54.63% in 2008. For women ages 50-74, and ages 75 and older, twelve-month screening rates were 2.21 (95% CI: - 2.65 to -1.77) and 3.60 (95% CI: - 4.48 to -2.70) percentage points lower than those in 2008. In 2012, for women ages 40-49, twelve-month prevalence fell to 52.51%, a decline of 2.12 percentage points (95% CI: - 2.79 to -1.32) relative to screening rates prior the USPSTF announcement. For women ages 50-74 and ages 75 and older screening rates were 2.45 (95% CI: - 2.96 to -2.07) and 5.71 (95% CI: - 6.61 to -4.81) percentage points lower respectively in 2012 than in 2008. Conclusion: This study demonstrates an immediate and lasting reduction in the rates of breast cancer screening among women of all age groups after the 2009 revision of screening guidelines by the USPSTF.
Gray, N., Picone, G., Sloan, F., & Yashkin, A. (2015). The Relationship between BMI and Onset of Diabetes Mellitus and its Complications, Southern Medical Journal, 108(1), 29-36.
Abstract: This study examined relationships between elevated body mass index (BMI) and time to diagnosis with type 2 diabetes mellitus (DM) and its complications among U.S. elderly. Data came from the Medicare Current Beneficiary Survey (MCBS), 1991-2010. A Cox proportional hazard model was used to assess relationship between excess BMI at the first MCBS interview and time to DM diagnosis, complications, and insulin dependence among Medicare beneficiaries, age 65+ with no prior DM diagnosis and not enrolled in Medicare Advantage (N=14,657). Among individuals diagnosed with DM, elevated BMIs were associated with progressively higher risk of DM complications. For women with BMI ≥ 40, the risk of insulin dependence (hazard ratio (HR) =3.57; 95% confidence interval [CI]: 2.36 to 5.39) was twice the risk for women with 25 ≤ BMI < 27.5 (HR=1.77; 95% CI: 1.33 to 2.33). A similar pattern was observed in risk of cardiovascular (25 ≤ BMI < 27.5: HR=1.34; 95% CI: 1.15 to 1.54; BMI ≥ 40: HR=2.45; 95% CI: 1.92 to 3.11), cerebrovascular (25 ≤ BMI < 27.5: HR=1.30; 95% CI: 1.06 to 1.57; BMI ≥ 40: HR=2.00; 95% CI: 1.42 to 2.81), renal (25 ≤ BMI < 27.5: HR=1.31; 95% CI: 1.04 to 1.63; BMI ≥ 40: HR=2.23; 95% CI: 1.54 to 3.22), and lower extremity complications (25 ≤ BMI < 27.5: HR=1.41; 95% CI: 1.22 to 1.61; BMI ≥ 40: HR=2.95; 95% CI: 2.35 to 3.69). Any increase in BMI above normal weight levels is associated with increased risk of being diagnosed with DM complications. For men, increased risk of DM complications occurred at higher BMI levels than in women. Ocular complications occurred at higher BMI levels than other complication types in both genders.