Preeti Zanwar - Academia.edu (original) (raw)

Papers by Preeti Zanwar

Alzheimer's & Dementia

IntroductionThe projected growth of Alzheimer's disease (AD) and AD‐related dementia (ADRD) c... more IntroductionThe projected growth of Alzheimer's disease (AD) and AD‐related dementia (ADRD) cases by midcentury has expanded the research field and impelled new lines of inquiry into structural and social determinants of health (S/SDOH) as fundamental drivers of disparities in AD/ADRD.MethodsIn this review, we employ Bronfenbrenner's ecological systems theory as a framework to posit how S/SDOH impact AD/ADRD risk and outcomes.ResultsBronfenbrenner defined the “macrosystem” as the realm of power (structural) systems that drive S/SDOH and that are the root cause of health disparities. These root causes have been discussed little to date in relation to AD/ADRD, and thus, macrosystem influences, such as racism, classism, sexism, and homophobia, are the emphasis in this paper.DiscussionUnder Bronfenbrenner's macrosystem framework, we highlight key quantitative and qualitative studies linking S/SDOH with AD/ADRD, identify scientific gaps in the literature, and propose guidance...

Archives of Physical Medicine and Rehabilitation

Innovation in Aging

The COVID-19 pandemic has been a natural global epidemiological experiment unique to our century ... more The COVID-19 pandemic has been a natural global epidemiological experiment unique to our century and a massive shock to older adults and to systems that care for them. There was a lack of a global unified plan to mitigate and control the spread of COVID-19. Several middle-or-high income nations struggled to control the viral spread resulting in increased mortality due to a combination of lack of public health measures and existing disparities which were magnified during the pandemic. The purpose of this review by a team of international experts is to (1) to examine reasons for the varied COVID-19 responses within U.S. and among other middle-or-high-income countries and the emergence of variants and vaccine inequities, and (2) to examine the country specific burden of cultural/structural/political determinants on access to care and mortality among older adults in various settings.

Frontiers in Public Health

Flowchart for construction of primary care provider sample with high versus low prostate specific... more Flowchart for construction of primary care provider sample with high versus low prostate specific antigen test ordering rate, 100% Texas U.S. Medicare public insurance claims data. (DOC 31Â kb)

Background All authorities recommend against prostate specific antigen (PSA) screening in men 75 ... more Background All authorities recommend against prostate specific antigen (PSA) screening in men 75 years and older. However, some primary care physicians (PCPs) continue to have high rates of PSA, with large variation in testing. We assessed the tests, treatments, and payments for prostate cancer care in men aged 75 or older who have PCPs with high or low PSA testing rates. Methods We performed a retrospective cohort study using the 2010 Medicare beneficiaries aged 75 or older in Texas, United States who had no prostate cancer in 2007–2009 and had an identifiable PCP. We first identified high vs. low PSA testing PCPs, and then grouped older men in the two PCP groups. We determined health care visits to any provider and to urologists in office and outpatient settings. We estimated the direct medical payments for prostate cancer care for diagnostics, treatments and visits to providers in 2010–2011 using the generalized gamma model with log link function. Results In multilevel, multivari...

Frontiers in Public Health, 2021

Background: The benefits of engaging in outdoor physical activity are numerous for older adults. ... more Background: The benefits of engaging in outdoor physical activity are numerous for older adults. However, previous work on outdoor monitoring of physical activities did not sufficiently identify how older adults characterize and respond to diverse elements of urban built environments, including structural characteristics, safety attributes, and aesthetics.Objective: To synthesize emerging multidisciplinary trends on the use of connected technologies to assess environmental barriers and stressors among older adults and for persons with disability.Methods: A multidisciplinary overview and literature synthesis.Results: First, we review measurement and monitoring of outdoor physical activity in community environments and during transport using wearable sensing technologies, their contextualization and using smartphone-based applications. We describe physiological responses (e.g., gait patterns, electrodermal activity, brain activity, and heart rate), stressors and physical barriers duri...

Cancer Epidemiology, Biomarkers & Prevention, 2020

Background: The morbidity and mortality rates of prostate cancer (PCa) in African American (AA) a... more Background: The morbidity and mortality rates of prostate cancer (PCa) in African American (AA) are 2-3 times higher than European American (EuA) men. The molecular mechanisms underlying the aggressiveness of PCa have not fully identified. Thus, our aim was to evaluate the diagnostic/prognostic utility of exosomal microRNAs (miRs) to classify PCa patients according their race and aggressive phenotype in AA patients. Their functional role in tumor aggressiveness was also determined. Methods: Exosomes were isolated from the conditioned media of AA and EuA PCa cell lines. The expression of miRs was validated in exosomes, free-circulating plasma, and FFPE tissue specimens of forty AA and EuA patients using quantitative real-time PCR analysis. The sensitivity and specificity of exosomal miRs to classify prostate cancer patients according their race and aggressiveness were assessed using receiver operating characteristic (ROC) curve analysis. To study the functional significance of exosom...

Value in Health, 2020

Objectives: Type 2 diabetes is one of the leading chronic, non-communicable diseases of the world... more Objectives: Type 2 diabetes is one of the leading chronic, non-communicable diseases of the world. Our aim was to determine the annual health insurance treatment cost of non-insulin-dependent diabetes with multiple complications in Hungary. Methods: Data were derived from the financial database of the NHIFA, for the year 2018. Data analysed included annual patient numbers, case numbers and prevalence of care utilisation per 100.000 population according to age groups and sex. The following health insurance treatment categories were included into our study: general practice care, home care, in-and outpatient care, medical imaging, laboratory diagnostics, drugs and medical aids. Patients with non-insulin-dependent diabetes with multiple complications were identified with the following code of the International Classification of Diseases 10 th revision: E1170. Results: The highest national patient numbers were in general practice care: 30,028 men, 32,355 women, in total 62,383 patients, followed by outpatient care (25,063 men, 26,021women, in total 51,084 patients), and use of pharmaceuticals (23,189 men, 24,126 women, in total 47,315 patients). Based on patient numbers in general practice care, prevalence in 100,000 among men was 642.8 patients, among women 633.6, in total 638.0 patients. Patients above age 55 accounted for 90.28%, those above age 65 accounted for 66.07% and patients aged above 75 accounted for 32.11% of patient numbers including all forms of care. Regarding sex, in general practice care 48.1% were men, 51.9% were women, the use of pharmaceuticals showed a similar ratio (49.0% were men and 51.0% were women). Conclusions: Regarding patients' sex, there was no difference between men and women at the onset of the disease. Age was found to have a significant impact upon prevalence of diabetes with multiple complications.

Innovation in Aging, 2018

BMC health services research, Jan 15, 2016

All authorities recommend against prostate specific antigen (PSA) screening in men 75 years and o... more All authorities recommend against prostate specific antigen (PSA) screening in men 75 years and older. However, some primary care physicians (PCPs) continue to have high rates of PSA, with large variation in testing. We assessed the tests, treatments, and payments for prostate cancer care in men aged 75 or older who have PCPs with high or low PSA testing rates. We performed a retrospective cohort study using the 2010 Medicare beneficiaries aged 75 or older in Texas, United States who had no prostate cancer in 2007-2009 and had an identifiable PCP. We first identified high vs. low PSA testing PCPs, and then grouped older men in the two PCP groups. We determined health care visits to any provider and to urologists in office and outpatient settings. We estimated the direct medical payments for prostate cancer care for diagnostics, treatments and visits to providers in 2010-2011 using the generalized gamma model with log link function. In multilevel, multivariable analyses, 25.4 % (n = ...

Disability and Health Journal, 2016

BACKGROUND Recent state dual-eligible (Medicare and Medicaid) payment reform demonstrations have ... more BACKGROUND Recent state dual-eligible (Medicare and Medicaid) payment reform demonstrations have included groups of both working-age and older adults, but relatively little is known about how access to care varies between these two populations. OBJECTIVES/HYPOTHESIS To examine access to a usual source of care for younger and older dual-eligible adults, to analyze whether timely access to several types of care differed in these two populations, and to understand some of the underlying reasons for delayed care among younger and older dual-eligibles. METHODS Using observations pooled across calendar years 2003-2012 of the Medical Expenditure Panel Survey, this study conducted descriptive and multivariate analyses to examine access to care measures. RESULTS Younger dual-eligible adults were more likely to encounter problems with accessing medical care, dental care, and prescription medications than older dual-eligible adults. Both groups of dual-eligible adults reported that a lack of affordability, gaps in existing insurance coverage, and difficulty in getting to a provider's office were the most common reasons for delayed access to care. CONCLUSIONS A lack of affordability for medical care, dental care, and prescription medications suggests that high co-payments and cost sharing for some services may be deterring access to needed care. Younger dual-eligibles were more likely to encounter service coverage gaps than older dual-eligibles. States should monitor Medicare-Medicaid plans to confirm they have adequate provider networks.