Digital Commons Network^™

Characterizing Multimorbidity Prevalence And Adverse Outcomes In Ethnically And Culturally Diverse Sub-Populations In India: Gaps, Opportunities, And Future Directions, Preeti Zanwar, Robyn Taylor, Tanisha Hill-Jarrett, Elena Tsoy, Jason Flatt, Zunera Mirza, Carl Hill, Arokiasamy Perianayagam

College of Population Health Faculty Papers

India is a large middle-income country and has surpassed China in overall population, comprising 20% of the global population (over 1.43 billion people). India is experiencing a major demographic shift in its aging population. Chronic diseases are common among older adults and can be persistent over the life course, lead to the onset of disability, and be costly. Among older adults in India, the existence of multiple comorbid chronic conditions (i.e., multimorbidity) is rapidly growing and represents a burgeoning public health burden. Prior research identified greater rates of multimorbidity (e.g., overweight/obesity diabetes, hypertension, cardiovascular disease, stroke, and malignancies) in minority …

Depression By Gender And Associated Factors Among Older Adults In India: Implications For Age-Friendly Policies, Ronak Paul, T. Muhammad, Rashmi Rashmi, Palak Sharma, Shobhit Srivastava, Preeti Zanwar

College of Population Health Faculty Papers

Inspite of implementing policies to control mental health problems, depression remains a severe health concern among older adults in India. We examined self-reported differences in the depression among older men and women in India and examined associated factors for gender differences in depression at the population level. We utilized nationally representative data from the Longitudinal Aging Study in India (LASI) wave I, for years 2017-2019. Our analytical sample comprised of 30,637 older adults ages 60 years and above (14,682 men and 15,655 women). We conducted descriptive statistics and Chi-Square tests followed by binary logistic regression and multivariate decomposition analyses to …

Strategies For Strengthening The Resilience Of Public Health Systems For Pandemics, Disasters, And Other Emergencies, Benjamin Ryan, Mayumi Kako, Rok Fink, Perihan Şimşek, Paul Barach, Jose Acosta, Sanjaya Bhatia, Mark Brickhouse, Matthew Fendt, Alicia Fontenot, Nahuel Arenas Garcia, Shelby Garner, Abdülkadir Gunduz, D Mike Hardin, Tim Hatch, Lashonda Malrey-Horne, Makiko Macdermot, Ryoma Kayano, Joshua Mckone, Chaverle Noel, Shuhei Nomura, Jeremy Novak, Andrew Stricklin, Raymond Swienton, Ismail Tayfur, Bryan Brooks

College of Population Health Faculty Papers

OBJECTIVE: The aim of this study was to identify and prioritize strategies for strengthening public health system resilience for pandemics, disasters, and other emergencies using a scorecard approach.

METHODS: The United Nations Public Health System Resilience Scorecard (Scorecard) was applied across 5 workshops in Slovenia, Turkey, and the United States of America. The workshops focused on participants reviewing and discussing 23 questions/indicators. A Likert type scale was used for scoring with zero being the lowest and 5 the highest. The workshop scores were analyzed and discussed by participants to prioritize areas of need and develop resilience strategies. Data from all …

Gross Hematuria And Lower Urinary Tract Symptoms Associated With Military Burn Pits Exposures In Us Veterans Deployed To Iraq And Afghanistan, Mosammat M. Perveen, Henry E. Mayo-Malasky, Mary F. Lee-Wong, Julie M. Tomaska, Edward Forsyth, Amy Gravely, Mark A. Klein, Janeen H. Trembley, Tammy A. Butterick, Robert A. Promisloff, Pamela K. Ginex, Paul Barach, Anthony M. Szema

College of Population Health Faculty Papers

OBJECTIVE: The aim of the study is to describe rates of hematuria and other lower urinary tract symptoms, including self-reported cancer rates, among veterans postburn pits emissions exposure during deployment to Iraq and Afghanistan.

METHODS: US post-9/11 veterans with burn pits emissions exposure confirmed via DD214 forms in the Burn Pits360.org Registry were sent a modified survey. Data were deidentified and anonymously coded.

RESULTS: Twenty-nine percent of the 155 respondents exposed to burn pits self-reported seeing blood in their urine. The average index score of our modified American Urological Association Symptom Index Survey was 12.25 (SD, 7.48). High rates of …

Simulation As A Key Training Method For Inculcating Public Health Leadership Skills: A Mixed Methods Study, Keren Dopelt, Itamar Shevach, Ofek Eliad Vardimon, Katarzyna Czabanowska, Jascha De Nooijer, Robert Otok, Lore Leighton, Osnat Bashkin, Mariusz Duplaga, Hagai Levine, Fiona Macleod, Maureen Malowany, Leah Okenwa-Emegwa, Shira Zelber-Sagi, Nadav Davidovitch, Paul Barach

College of Population Health Faculty Papers

BACKGROUND: Successful management of public health challenges requires developing and nurturing leadership competencies. We aimed to evaluate the effectiveness of training simulations to assess public health leadership and decision-making competencies during emergencies as an effective learning and training method.

METHODS: We examined the effects of two simulation scenarios on public health school students in terms of their experience (compared to face-to-face learning) and new skills acquired for dealing with similar emergent situations in the future. A mixed-methods design included developing a validated and pre-tested questionnaire with open-and closed-ended questions that examined the simulation impact and the degree of student satisfaction …

African American Males Have More Distress During Cancer Treatment Than White Males, Stephanie Kjelstrom, Charis Wynn, Sharon Larson

College of Population Health Faculty Papers

African American (AA) males have a higher incidence and mortality rate for some cancers than other races and sexes, which could be associated with distress during treatment, medical mistrust, and health disparities. We hypothesize distress in AA males during treatment is higher than in other races and sexes. We assessed effect modification of moderate to severe (≥ 4) distress scores during cancer treatment by race and sex, age, and socioeconomic status (SES). National Comprehensive Cancer Network's distress thermometer (scale 0-10) and characteristics for 770 cancer patients were collected from a Philadelphia hospital. Variables included age, sex, race, smoking status, marital …

Physical And Stressful Psychological Impacts Of Prolonged Personal Protective Equipment Use During The Covid-19 Pandemic: A Cross-Sectional Survey Study, Giuseppe Candido, Costanza Tortù, Chiara Seghieri, Riccardo Tartaglia, Chiara Baglioni, Paolo Citti, Ida Marina Raciti, Micaela La Regina, Silvia Simonini, Moira Urbani, Chiara Parretti, Paul Barach

College of Population Health Faculty Papers

BACKGROUND: Healthcare workers (HCWs) caring for COVID-19 infected patients are exposed to stressful and traumatic events with potential for severe and sustained adverse mental and physical health consequences. Our aim was to assess the magnitude of physical and mental health outcomes of HCWs due to the prolonged use of personal protective equipment (PPE) treating COVID-19 patients.

METHODS: This cross-sectional study assessed the symptoms of stress, anxiety, insomnia, and psychological resilience using the Stress and Anxiety to Viral Epidemics (SAVE) scale, Insomnia Severity Index (ISI), and Resilience Scale (RS), respectively, in Italy between 1st February and 31st March 2022. The physical …

I Don't Believe A Person Has To Die When Trying To Get High: Overdose Prevention And Response Strategies In Rural Illinois, Suzan M. Walters, Marisa Felsher, David Frank, Jessica Jaiswal, Tarlise Townsend, Brandon Muncan, Alex S. Bennett, Samuel R. Friedman, Wiley Jenkins, Mai T. Pho, Scott Fletcher, Danielle C. Ompad

College of Population Health Faculty Papers

BACKGROUND: Overdose is a leading cause of morbidity and mortality among people who inject drugs. Illicitly manufactured fentanyl is now a major driver of opioid overdose deaths.

METHODS: Semi-structured interviews were conducted with 23 participants (19 persons who inject drugs and 4 service providers) from rural southern Illinois. Data were analyzed using constant comparison and theoretical sampling methods.

RESULTS: Participants were concerned about the growing presence of fentanyl in both opioids and stimulants, and many disclosed overdose experiences. Strategies participants reported using to lower overdose risk included purchasing drugs from trusted sellers and modifying drug use practices by partially injecting …

Blood Pressure Responses Are Dependent On Call Type And Related To Hypertension Status In Firefighters, Paige J Rynne, Cassandra C Derella, Carly Mcmorrow, Rachel L Dickinson, Stephanie Donahue, Andrew A Almeida, Megan Carty, Deborah L Feairheller

College of Population Health Faculty Papers

Background: Impaired cardiovascular health is a concern for firefighters, with over 50% of line-of-duty deaths having cardiac causes. Many firefighters have hypertension and <25% have their blood pressure (BP) controlled. The alarm response could be an unidentified cardiac risk, but interestingly, the BP response to different calls and on-the-job activity is unknown.

Purpose: We aimed to measure the physiological stress resulting from different call types (fire, medical) and job activity (riding apparatus, pre-alert alarms) through ambulatory BP (ABP) monitoring in a population of firefighters.

Materials and methods: During 111 12-h work shifts firefighters wore an ABP monitor. BP was measured at 30-min intervals and manual measurements were prompted when the pager went off or whenever they felt stress.

Results: Firefighters were hypertensive (124.3 ± 9.9/78.1 ± 6.7 mmHg), overweight …

Commentary: Examining Contextual Factors Contributing To Differentials In Covid-19 Mortality In U.S. Vs. India., Preeti Zanwar, Katrine L Wallace, Christopher Soria, Arokiasamy Perianayagam

College of Population Health Faculty Papers

No abstract provided.

Improving Cancer Care Through Digital Health Coaching, Jennifer Nguyen, Pharmd, Vittorio Maio, Pharmd, Ms, Msph, Nathan Handley, Md, Mba

College of Population Health Faculty Papers

No abstract provided.

Accrediting Graduate Programs In Healthcare Quality And Safety, Willie H. Oglesby, Allyson G Hall, Annette L Valenta, Kenneth J Harwood, Deidre Mccaughey, Sue Feldman, Anthony C Stanowski, Sandra Chrapah, Teri Chenot, Eric Brichto, David B. Nash

College of Population Health Faculty Papers

The number of master's degree programs in healthcare quality and safety (HQS) has increased significantly over the past decade. Academic accreditation provides assurance that educational programs are of a high quality and meet the needs of students, employers, and the general public. Under the guidance of the Commission on Accreditation of Healthcare Management Education, faculty from 9 universities collaborated in the development of criteria and related content domains to be used in the accreditation of graduate programs in HQS. Thirteen content domains were identified. Four of the content domains, safety and error science, improvement science and quality principles, evidence-based practice, …

Clinical Outcomes In Patients Co-Infected With Covid-19 And Staphylococcus Aureus: A Scoping Review, Jenna Adalbert, Karan Varshney, Rachel Tobin, Rafael Pajaro

College of Population Health Faculty Papers

BACKGROUND: Endemic to the hospital environment, Staphylococcus aureus (S. aureus) is a leading bacterial pathogen that causes deadly infections such as bacteremia and endocarditis. In past viral pandemics, it has been the principal cause of secondary bacterial infections, significantly increasing patient mortality rates. Our world now combats the rapid spread of COVID-19, leading to a pandemic with a death toll greatly surpassing those of many past pandemics. However, the impact of co-infection with S. aureus remains unclear. Therefore, we aimed to perform a high-quality scoping review of the literature to synthesize the existing evidence on the clinical outcomes of COVID-19 …

Disparities In Sars-Cov-2 Positivity Rates: Associations With Race And Ethnicity, Harvey W Kaufman, Justin K Niles, David B. Nash

College of Population Health Faculty Papers

Numerous reports indicate that African Americans and Latinos are being affected disproportionately by coronavirus disease 2019 (COVID-19). Positivity rates have not been analyzed on scale because only 4 states report race/ethnicity as part of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) testing. Previous studies also have had little ability to control for many known risk factors to better identify the effects of COVID-19 on racial and ethnic communities. Using test results from a large national reference laboratory database that included patients from all 50 states and the District of Columbia, this study compared positivity rates for SARS-CoV-2 nucleic acid amplification …

The Jefferson Scale Of Empathy: A Nationwide Study Of Measurement Properties, Underlying Components, Latent Variable Structure, And National Norms In Medical Students., Mohammadreza Hojat, Jennifer Desantis, Stephen C. Shannon, Luke H. Mortensen, Mark R. Speicher, Lynn Bragan, Marianna Lanoue, Leonard H. Calabrese

College of Population Health Faculty Papers

The Jefferson Scale of Empathy (JSE) is a broadly used instrument developed to measure empathy in the context of health professions education and patient care. Evidence in support of psychometrics of the JSE has been reported in health professions students and practitioners with the exception of osteopathic medical students. This study was designed to examine measurement properties, underlying components, and latent variable structure of the JSE in a nationwide sample of first-year matriculants at U.S. colleges of osteopathic medicine, and to develop a national norm table for the assessment of JSE scores. A web-based survey was administered at the beginning …

Internet And Social Media Access Among Youth Experiencing Homelessness: Mixed-Methods Study., Lauren A. Houdek Vonholtz, Rosemary Frasso, Jesse M. Golinkoff, Alicia J. Lozano, Alexandra Hanlon, Nadia Dowshen

College of Population Health Faculty Papers

BACKGROUND: Youth experiencing homelessness are at a risk for a variety of adverse outcomes. Given the widespread use of the internet and social media, these new technologies may be used to address their needs and for outreach purposes. However, little is known about how this group uses these resources.

OBJECTIVE: This study investigated how homeless adolescents use these technologies for general and health-related purposes, whether the scope of their use changes with housing status, and their interest in a website dedicated to youth experiencing homelessness.

METHODS: A convenience sample of youth aged 18 to 21 years was recruited from a …

Mortality Differences Between Traditional Medicare And Medicare Advantage: A Risk-Adjusted Assessment Using Claims Data., Roy A. Beveridge, Sean M. Mendes, Arial Caplan, Teresa L. Rogstad, Vanessa Olson, Meredith C. Williams, Jacquelyn M. Mcrae, Stefan Varga

College of Population Health Faculty Papers

Medicare Advantage (MA) has grown rapidly since the Affordable Care Act; nearly one-third of Medicare beneficiaries now choose MA. An assessment of the comparative value of the 2 options is confounded by an apparent selection bias favoring MA, as reflected in mortality differences. Previous assessments have been hampered by lack of access to claims diagnosis data for the MA population. An indirect comparison of mortality as an outcome variable was conducted by modeling mortality on a traditional fee-for-service (FFS) Medicare data set, applying the model to an MA data set, and then evaluating the ratio of actual-to-predicted mortality in the …

Clinical And Economic Impact Of Infusion Reactions In Patients With Colorectal Cancer Treated With Cetuximab., K A Foley, P F Wang, B L Barber, S R Long, J E Bagalman, V Wagner, X Song, Z Zhao

College of Population Health Faculty Papers

BACKGROUND: Systemic agents in cancer treatment were often associated with possible infusion reactions (IRs). This study estimated the incidence of IRs requiring medical intervention and assessed the clinical and economic impacts of IRs in patients with colorectal cancer (CRC) treated with cetuximab.

PATIENTS AND METHODS: Details on patients with CRC receiving cetuximab in 2004-2006 were extracted from a large USA administrative claims database. IRs were identified based on the occurrence of outpatient treatment, emergency room (ER) visit, and/or hospitalization for hypersensitivity and allergic reactions. Multivariate regressions were used to examine potential risk factors and quantify the economic impact of IRs. …

Indirect Costs Associated With Surgery For Low Back Pain-A Secondary Analysis Of Clinical Trial Data., Reginald Fayssoux, Neil I Goldfarb, Alexander R Vaccaro, James Harrop

College of Population Health Faculty Papers

This study examines the indirect costs associated with surgery for axial low back pain using data obtained from a prospective multicenter clinical trial that compared Charité artificial disc replacement with anterior lumbar interbody fusion using iliac crest bone graft. While 75% of study subjects reported full- or part-time employment prior to surgery, this percentage dropped to 45% at 6 weeks postoperatively. Return to preoperative employment levels occurred at approximately 6 months postoperatively. Two years after surgery, employment levels were 16% higher than preoperative levels. Lost productivity related to absenteeism resulted in lost wages averaging $2884 per patient during the first …

Hand Hygiene Compliance Rates In The United States--A One-Year Multicenter Collaboration Using Product/Volume Usage Measurement And Feedback., Maryanne Mcguckin, Richard Waterman, John Govednik

College of Population Health Faculty Papers

Hand hygiene (HH) is the single most important factor in the prevention of health care-acquired infections. The 3 most frequently reported methods of measuring HH compliance are: (1) direct observation, (2) self-reporting by health care workers (HCWs), and (3) indirect calculation based on HH product usage. This article presents the results of a 12-month multicenter collaboration assessing HH compliance rates at US health care facilities by measuring product usage and providing feedback about HH compliance. Our results show that HH compliance at baseline was 26% for intensive care units (ICUs) and 36% for non-ICUs. After 12 months of measuring product …