All Publications

  • Impact of recent climate extremes on mosquito-borne disease transmission in Kenya. PLoS neglected tropical diseases Nosrat, C., Altamirano, J., Anyamba, A., Caldwell, J. M., Damoah, R., Mutuku, F., Ndenga, B., LaBeaud, A. D. 2021; 15 (3): e0009182


    Climate change and variability influence temperature and rainfall, which impact vector abundance and the dynamics of vector-borne disease transmission. Climate change is projected to increase the frequency and intensity of extreme climate events. Mosquito-borne diseases, such as dengue fever, are primarily transmitted by Aedes aegypti mosquitoes. Freshwater availability and temperature affect dengue vector populations via a variety of biological processes and thus influence the ability of mosquitoes to effectively transmit disease. However, the effect of droughts, floods, heat waves, and cold waves is not well understood. Using vector, climate, and dengue disease data collected between 2013 and 2019 in Kenya, this retrospective cohort study aims to elucidate the impact of extreme rainfall and temperature on mosquito abundance and the risk of arboviral infections. To define extreme periods of rainfall and land surface temperature (LST), we calculated monthly anomalies as deviations from long-term means (1983-2019 for rainfall, 2000-2019 for LST) across four study locations in Kenya. We classified extreme climate events as the upper and lower 10% of these calculated LST or rainfall deviations. Monthly Ae. aegypti abundance was recorded in Kenya using four trapping methods. Blood samples were also collected from children with febrile illness presenting to four field sites and tested for dengue virus using an IgG enzyme-linked immunosorbent assay (ELISA) and polymerase chain reaction (PCR). We found that mosquito eggs and adults were significantly more abundant one month following an abnormally wet month. The relationship between mosquito abundance and dengue risk follows a non-linear association. Our findings suggest that early warnings and targeted interventions during periods of abnormal rainfall and temperature, especially flooding, can potentially contribute to reductions in risk of viral transmission.

    View details for DOI 10.1371/journal.pntd.0009182

    View details for PubMedID 33735293

  • Effects of surgeon sociodemographics on patient-reported satisfaction. Surgery Nuyen, B., Altamirano, J., Fassiotto, M., Alyono, J. 2021


    BACKGROUND: Patient-reported satisfaction scores, including the Press Ganey surveys, are increasingly used as measures for quality healthcare among surgical subspecialties. However, the influence of surgeon sociodemographics is not clear.METHODS: This cross-sectional study analyzed Press Ganey surveys linked to outpatient surgical visits at a single academic institution from January 2015 to December 2018 as they related to surgeon age, gender, and race. The primary outcome variable was achievement of a top-box score (5/5) on likelihood to recommend surgeon queries. Secondary analysis examined the relationship of likelihood to recommend surgeon to other survey questions, such as those regarding surgeon courtesy, concern, understandability, patient inclusion in medical decision making, and patient confidence in surgeon. chi2 tests and generalized estimating equation regression models were run to assess correlation.RESULTS: In bivariate analysis of 36,840 surveys, non-Hispanic white surgeons were more likely to receive likelihood to recommend surgeon top-box ratings than Asian (P < .001) or underrepresented minority surgeons (P < .001). Additionally, male gender (P < .01) and older surgeon age (P < .001) were associated with higher top-box scores. However, in multivariate generalized estimating equation analysis, the effect of age was no longer significant, but female gender continued to be associated with lower odds of top-box likelihood to recommend surgeon ratings (odds ratio 0.83; 95% confidence interval, 0.70%-0.99%), as did Asian compared with white race (odds ratio 0.78; 95% confidence interval, 0.65%-0.95%). Likelihood to recommend surgeon scores correlated most closely with patients' "confidence" in the surgeon rather than measures of courtesy, concern, understandability, or inclusion in medical decision making.CONCLUSION: Top-box scores varied by surgeon race and gender in correlation with patients' perceived confidence in the provider. Interpretation of Press Ganey scores should account for potential bias in patient satisfaction surveys based on surgeon demographics.

    View details for DOI 10.1016/j.surg.2020.12.006

    View details for PubMedID 33531133

  • Effect of Surgeon Sociodemographics on Patient-Reported Satisfaction Nuyen, B. A., Altamirano, J., Fassiotto, M., Alyono, J. ELSEVIER SCIENCE INC. 2020: S138
  • Rank Equity Index: Measuring Parity in the Advancement of Underrepresented Populations in Academic Medicine. Academic medicine : journal of the Association of American Medical Colleges Fassiotto, M., Flores, B., Victor, R., Altamirano, J., Garcia, L. C., Kotadia, S., Maldonado, Y. 2020


    As educators, researchers, clinicians, and administrators, faculty serve pivotal roles in academic medical centers (AMCs). Thus, the quality of faculty members' experiences is inseparable from an AMC's success. In seeking new methods to assess equity in advancement in academic medicine, the authors developed the Rank Equity Index (REI)-adapted from the Executive Parity Index, a scale previously implemented within the business sector-to examine national data on gender and racial/ethnic equity across faculty ranks. The REI was employed on self-reported demographic data, collected by the Association of American Medical Colleges, from U.S. medical school faculty in 2017, to make pairwise rank comparisons of the professoriate by demographic characteristics and department. Overall results indicated that women did not attain parity at any pairwise rank comparison, while men were above parity at all ranks. Similar results were observed across all departments surveyed: women in the basic sciences had REIs closest to parity, women in pediatrics had the highest representation but had REIs that were further from parity than the REIs in the basic sciences, and women in surgery demonstrated the lowest REIs. Nationally, REIs were below 1.00 for all racial/ethnic group rank comparisons except for White and, in one case, multiple race non-Hispanic/Latinx. Across all analyzed departments, Black/African American, Asian, Hispanic/Latinx, and multiple race Hispanic/Latinx faculty had REIs below parity at all ranks except in two cases. In a comparison of 2017 and 2007 data, REIs across both race/ethnicity and gender were lower in 2007 for nearly all groups. REI analyses can highlight inequities in faculty rank that may be masked when using aggregate faculty proportions, which do not account for rank. The REI provides AMCs with a new tool to better analyze institutional data to inform efforts to increase parity across all faculty ranks.

    View details for DOI 10.1097/ACM.0000000000003720

    View details for PubMedID 32889948

  • The association between Asian patient race/ethnicity and lower satisfaction scores. BMC health services research Liao, L., Chung, S., Altamirano, J., Garcia, L., Fassiotto, M., Maldonado, B., Heidenreich, P., Palaniappan, L. 2020; 20 (1): 678


    BACKGROUND: Patient satisfaction is increasingly being used to assess, and financially reward, provider performance. Previous studies suggest that race/ethnicity (R/E) may impact satisfaction, yet few practices adjust for patient R/E. The objective of this study is to examine R/E differences in patient satisfaction ratings and how these differences impact provider rankings.METHODS: Patient satisfaction survey data linked to electronic health records from two large outpatient centers in northern California - a non-profit organization of community-based clinics (Site A) and an academic medical center (Site B) - was collected and analyzed. Participants consisted of adult patients who received outpatient care at Site A from December 2010 to November 2014 and Site B from March 2013 to August 2014, and completed Press-Ganey Medical Practice Survey questionnaires (N=216,392 (Site A) and 30,690 (Site B)). Self-reported non-Hispanic white (NHW), Black, Latino, and Asian patients were studied. For six questions each representing a survey subdomain, favorable ratings were defined as top-box ("very good") compared to all other categories ("very poor," "poor," "fair," and "good"). Using multivariable logistic regression with provider random effects, we assessed whether the likelihood of giving favorable ratings differed by patient R/E, adjusting for patient age and sex.RESULTS: Asian, younger and female patients provided less favorable ratings than other R/E, older and male patients. After adjustment, Asian patients were less likely than NHW patients to provide top-box ratings to the overall assessment question "likelihood of recommending this practice to others" (Site A: Asian predicted probability (PP) 0.680, 95% confidence interval (CI): 0.675-0.685 compared to NHW PP 0.820, 95% CI: 0.818-0.822; Site B: Asian PP 0.734, 95% CI: 0.733-0.736 compared to NHW PP 0.859, 95% CI: 0.859-0.859). The effect sizes for Asian R/E were greater than the effect sizes for older age and female sex. An absolute 3% decrease in mean composite score between providers serving different percentages of Asian patients translated to an absolute 40% drop in national ranking.CONCLUSIONS: Patient satisfaction scores may need to be adjusted for patient R/E, particularly for providers caring for high panel percentages of Asian patients.

    View details for DOI 10.1186/s12913-020-05534-6

    View details for PubMedID 32698825

  • Patient Age, Race and Emergency Department Treatment Area Associated with "Topbox" Press Ganey Scores. The western journal of emergency medicine Lee, M. O., Altamirano, J. n., Garcia, L. C., Gisondi, M. A., Wang, N. E., Lippert, S. n., Maldonado, Y. n., Gharahbaghian, L. n., Ribeira, R. n., Fassiotto, M. n. 2020; 21 (6): 117–24


    Hospitals commonly use Press Ganey (PG) patient satisfaction surveys for benchmarking physician performance. PG scores range from 1 to 5, with 5 being the highest, which is known as the "topbox" score. Our objective was to identify patient and physician factors associated with topbox PG scores in the emergency department (ED).We looked at PG surveys from January 2015-December 2017 at an academic, urban hospital with 78,000 ED visits each year. Outcomes were topbox scores for the questions: "Likelihood of your recommending our ED to others"; and "Courtesy of the doctor." We analyzed topbox scores using generalized estimating equation models clustered by physician and adjusted for patient and physician factors. Patient factors included age, gender, race, ethnicity, and ED area where patient was seen. The ED has four areas based on patient acuity: emergent; urgent; vertical (urgent but able to sit in a recliner rather than a gurney); and fast track (non-urgent). Physician factors included age, gender, race, ethnicity, and number of years at current institution.We analyzed a total of 3,038 surveys. For "Likelihood of your recommending our ED to others," topbox scores were more likely with increasing patient age (odds ratio [OR] 1.07; 95% confidence interval [CI], 1.03-1.12); less likely among female compared to male patients (OR 0.81; 95% CI, 0.70-0.93); less likely among Asian compared to White patients (OR 0.71; 95% CI, 0.60-0.83); and less likely in the urgent (OR 0.71; 95% CI, 0.54-0.93) and vertical areas (OR 0.71; 95% CI 0.53-0.95) compared to fast track. For "Courtesy of the doctor," topbox scores were more likely with increasing patient age (OR 1.1; CI, 1.06-1.14); less likely among Asian (OR 0.70; 95% CI, 0.58-0.84), Black (OR 0.66; 95% CI, 0.45-0.96), and Hispanic patients (OR 0.68; 95% CI, 0.55-0.83) compared to White patients; and less likely in urgent area (OR 0.69; 95% CI, 0.50-0.95) compared to fast track.Increasing patient age was associated with increased likelihood of topbox scores, while Asian patients, and urgent and vertical areas had decreased likelihood of topbox scores. We encourage hospitals that use PG topbox scores as financial incentives to understand the contribution of non-service factors to these scores.

    View details for DOI 10.5811/westjem.2020.8.47277

    View details for PubMedID 33207156

  • Gender Differences in Patient Perceptions of Physicians' Communal Traits and the Impact on Physician Evaluations. Journal of women's health (2002) Chen, H. n., Pierson, E. n., Schmer-Galunder, S. n., Altamirano, J. n., Jurafsky, D. n., Leskovec, J. n., Fassiotto, M. n., Kothary, N. n. 2020


    Background: Communal traits, such as empathy, warmth, and consensus-building, are not highly valued in the medical hierarchy. Devaluing communal traits is potentially harmful for two reasons. First, data suggest that patients may prefer when physicians show communal traits. Second, if female physicians are more likely to be perceived as communal, devaluing communal traits may increase the gender inequity already prevalent in medicine. We test for both these effects. Materials and Methods: This study analyzed 22,431 Press Ganey outpatient surveys assessing 480 physicians collected from 2016 to 2017 at a large tertiary hospital. The surveys asked patients to provide qualitative comments and quantitative Likert-scale ratings assessing physician effectiveness. We coded whether patients described physicians with "communal" language using a validated word scale derived from previous work. We used multivariate logistic regressions to assess whether (1) patients were more likely to describe female physicians using communal language and (2) patients gave higher quantitative ratings to physicians they described with communal language, when controlling for physician, patient, and comment characteristics. Results: Female physicians had higher odds of being described with communal language than male physicians (odds ratio 1.29, 95% confidence interval 1.18-1.40, p < 0.001). In addition, patients gave higher quantitative ratings to physicians they described with communal language. These results were robust to inclusion of controls. Conclusions: Female physicians are more likely to be perceived as communal. Being perceived as communal is associated with higher quantitative ratings, including likelihood to recommend. Our study indicates a need to reevaluate what types of behaviors academic hospitals reward in their physicians.

    View details for DOI 10.1089/jwh.2019.8233

    View details for PubMedID 32857642

  • Assessment of Sensitivity and Specificity of Patient-Collected Lower Nasal Specimens for Sudden Acute Respiratory Syndrome Coronavirus 2 Testing. JAMA network open Altamirano, J. n., Govindarajan, P. n., Blomkalns, A. L., Kushner, L. E., Stevens, B. A., Pinsky, B. A., Maldonado, Y. n. 2020; 3 (6): e2012005

    View details for DOI 10.1001/jamanetworkopen.2020.12005

    View details for PubMedID 32530469

  • Achieving Speaker Gender Equity at the SIR Annual Scientific Meeting: The Effect of Female Session Coordinators. Journal of vascular and interventional radiology : JVIR Ghatan, C. E., Altamirano, J., Fassiotto, M., Perez, M. G., Maldonado, Y., Josephs, S., Sze, D. Y., Kothary, N. 2019


    PURPOSE: To examine the impact of targeted efforts to increase the number of female speakers at the Society of Interventional Radiology (SIR) Annual Scientific Meeting (ASM) by reporting gender trends for invited faculty in 2017/2018 vs2016.MATERIALS AND METHODS: Faculty rosters for the 2016, 2017, and 2018 SIR ASMs were stratified by gender to quantify female representation at plenary sessions, categorical courses, symposia, self-assessment modules, and "meet-the-expert" sessions. Keynote events, scientific abstract presentations, and award ceremonies were excluded. In 2017, the SIR Annual Meeting Committee issued requirements for coordinators to invite selected women as speakers. Session coordinators are responsible for issuing speaker invitations, and invited speakers have the option to decline.RESULTS: Years 2017 and 2018 showed increases in female speaker representation, with women delivering 13% (89 of 687) and 14% (85 of 605) of all assigned presentations, compared with 9% in 2016 (46 of 514; P= .03 and P= .01, respectively). Gender diversity correlated with the gender of the session coordinator(s). When averaged over a 3-year period, female speakers constituted 7% of the speaker roster (112 of 1,504 presentations) for sessions led by an all-male coordinator team, compared with 36% (108 of 302) for sessions led by at least 1 female coordinator (P < .0001). Results of the linear regression model confirmed the effect of coordinator team gender composition (P < .0001).CONCLUSIONS: Having a woman as a session coordinator increased female speaker participation, which suggests that the inclusion of more women as coordinators is one mechanism for achieving gender balance at scientific meetings.

    View details for DOI 10.1016/j.jvir.2019.07.006

    View details for PubMedID 31587951

  • Drs. Kothary et al respond. Journal of vascular and interventional radiology : JVIR Kothary, N., Fassiotto, M., Altamirano, J. 2019

    View details for DOI 10.1016/j.jvir.2019.04.008

    View details for PubMedID 31126787

  • Untapped Resources: Attaining Equitable Representation for Women in IR JOURNAL OF VASCULAR AND INTERVENTIONAL RADIOLOGY Perez, M. G., Fassiotto, M., Altamirano, J., Hwang, G. L., Maldonado, Y., Josephs, S., Sze, D. Y., Kothary, N. 2019; 30 (4): 579–83
  • Comparison of Outpatient Satisfaction Survey Scores for Asian Physicians and Non-Hispanic White Physicians JAMA NETWORK OPEN Garcia, L. C., Chung, S., Liao, L., Altamirano, J., Fassiotto, M., Maldonado, B., Heidenreich, P., Palaniappan, L. 2019; 2 (2)
  • CHIKUNGUNYA AND DENGUE VIRUS SEROPREVALENCE AMONG CHILDREN IN COASTAL AND WESTERN KENYA AND RISK FACTORS FOR EXPOSURE Cash-Goldwasser, S., Altamirano, J., Ndenga, B., Ng'ang'a, C., Malumbo, S., Amugongo, J., Lwamba, L., Denga, F., Musaki, S., Mutuku, F., LaBeaud, A. AMER SOC TROP MED & HYGIENE. 2019: 243–44
  • Protocol Paper: Oral Poliovirus Vaccine Transmissibility in Communities After Cessation of Routine Oral Poliovirus Vaccine Immunization CLINICAL INFECTIOUS DISEASES Sarnquist, C., Holubar, M., Garcia-Garcia, L., Ferreyra-Reyes, L., Delgado-Sanchez, G., Pablo Cruz-Hervert, L., Montero-Campos, R., Altamirano, J., Purington, N., Boyle, S., Modlin, J., Ferreira-Guerrero, E., Canizales-Quintero, S., Diaz Ortega, J., Desai, M., Maldonado, Y. A. 2018; 67: S115–S120

    View details for DOI 10.1093/cid/ciy606

    View details for Web of Science ID 000450051800016

  • Pediatric HIV Infection and Decreased Prevalence of OPV Point Mutations Linked to Vaccine-associated Paralytic Poliomyelitis CLINICAL INFECTIOUS DISEASES Halpern, M. S., Altamirano, J., Maldonado, Y. 2018; 67: S78–S84

    View details for DOI 10.1093/cid/ciy635

    View details for Web of Science ID 000450051800010

  • Spatial Analyses of Oral Polio Vaccine Transmission in an Community Vaccinated With Inactivated Polio Vaccine CLINICAL INFECTIOUS DISEASES Jarvis, C., Altamirano, J., Sarnquist, C., Edmunds, W., Maldonado, Y. 2018; 67: S18–S25

    View details for DOI 10.1093/cid/ciy622

    View details for Web of Science ID 000450051800003

  • Assessing the Risk of Vaccine-derived Outbreaks After Reintroduction of Oral Poliovirus Vaccine in Postcessation Settings CLINICAL INFECTIOUS DISEASES Fu, R., Altamirano, J., Sarnquist, C. C., Maldonado, Y. A., Andrews, J. R. 2018; 67: S26–S34

    View details for DOI 10.1093/cid/ciy605

    View details for Web of Science ID 000450051800004

  • Validation of a High-throughput, Multiplex, Real-time Qualitative Polymerase Chain Reaction Assay for the Detection of Sabin Oral Polio Vaccine in Environmental Samples CLINICAL INFECTIOUS DISEASES Altamirano, J., Leary, S., van Hoorebeke, C., Sarnquist, C., Behl, R., Garcia-Garcia, L., Ferreyra-Reyes, L., Huang, C., Sommer, M., Maldonado, Y. 2018; 67: S98–S102

    View details for DOI 10.1093/cid/ciy639

    View details for Web of Science ID 000450051800013

  • OPV Vaccination and Shedding Patterns in Mexican and US Children CLINICAL INFECTIOUS DISEASES Altamirano, J., Sarnquist, C., Behl, R., Garcia-Garcia, L., Ferreyra-Reyes, L., Leary, S., Maldonado, Y. 2018; 67: S85–S89

    View details for DOI 10.1093/cid/ciy636

    View details for Web of Science ID 000450051800011

  • Lab Protocol Paper: Use of a High-throughput, Multiplex Reverse-transcription Quantitative Polymerase Chain Reaction Assay for Detection of Sabin Oral Polio Vaccine in Fecal Samples CLINICAL INFECTIOUS DISEASES van Hoorebeke, C., Huang, C., Leary, S., Holubar, M., Altamirano, J., Halpern, M. S., Sommer, M., Maldonado, Y. 2018; 67: S121–S126

    View details for DOI 10.1093/cid/ciy648

    View details for Web of Science ID 000450051800017

  • Characterization of Household and Community Shedding and Transmission of Oral Polio Vaccine in Mexican Communities With Varying Vaccination Coverage CLINICAL INFECTIOUS DISEASES Altamirano, J., Purington, N., Behl, R., Sarnquist, C., Holubar, M., Garcia-Garcia, L., Ferreyra-Reyes, L., Montero-Campos, R., Pablo Cruz-Hervert, L., Boyle, S., Modlin, J., van Hoorebeke, C., Leary, S., Huang, C., Sommer, M., Ferreira-Guerrero, E., Delgado-Sanchez, G., Canizales-Quintero, S., Diaz Ortega, J., Desai, M., Maldonado, Y. A. 2018; 67: S4–S17

    View details for DOI 10.1093/cid/ciy650

    View details for Web of Science ID 000450051800002

  • Associations between women's perceptions of gender relations and self-esteem and self-efficacy in a former conflict zone: baseline findings in South Kivu, DR Congo Sarnquist, C., Behl, R., Talib, A., Altamirano, J., Jerome, B., Inungu, J., Maldonado, Y. ELSEVIER SCI LTD. 2018: S5
  • Physician Gender Is Associated with Press Ganey Patient Satisfaction Scores in Outpatient Gynecology. Women's health issues : official publication of the Jacobs Institute of Women's Health Rogo-Gupta, L. J., Haunschild, C. n., Altamirano, J. n., Maldonado, Y. A., Fassiotto, M. n. 2018; 28 (3): 281–85


    Patient satisfaction is gaining increasing attention as a quality measure in health care, but the methods used to assess it may negatively impact women physicians.Our objective was to examine the relationship between physician gender and patient satisfaction with outpatient gynecology care as measured by the Press Ganey patient satisfaction survey.This cross-sectional study analyzed 909 Press Ganey patient satisfaction surveys linked to outpatient gynecology visits at a single academic institution (March 2013-August 2014), including self-reported demographics and satisfaction. Surveys are delivered in a standardized fashion electronically and by mail. Surveys were completed by 821 unique patients and 13,780 gynecology visits occurred during the study period. The primary outcome variable was likelihood to recommend (LTR) a physician. We used χ2 tests of independence to assess the effect of demographic concordance on LTR and two generalized estimating equations models were run clustered by physician, with topbox physician LTR as the outcome variable. Analysis was performed in SAS Enterprise Guide 7.1 (SAS, Inc., Cary, NC).Nine hundred nine surveys with complete demographic data were completed by women during the study period (mean age, 49.3 years). Age- and race-concordant patient-physician pairs received significantly higher proportions of top LTR score than discordant pairs (p = .014 and p < .0001, respectively). In contrast, gender-concordant pairs received a significantly lower proportion of top scores than discordant pairs (p = .027). In the generalized estimating equations model adjusting for health care environment, only gender remained statistically significant. Women physicians had significantly lower odds (47%) of receiving a top score (odds ratio, 0.53; 95% CI, 0.37-0.78; p = .001).Women gynecologists are 47% less likely to receive top patient satisfaction scores compared with their male counterparts owing to their gender alone, suggesting that gender bias may impact the results of patient satisfaction questionnaires. Therefore, the results of this and similar questionnaires should be interpreted with great caution until the impact on women physicians is better understood.

    View details for PubMedID 29429946