Digital Commons Network^™

Brief Report: The Impact Of Disease Stage On Early Gaps In Art In The "Treatment For All" Era - A Multisite Cohort Study., Ingrid T. Katz, Nicholas Musinguzi, Kathleen Bell, Anna Cross, Mwebesa Bosco Bwana, Gideon Amanyire, Stephen Asiimwe, Catherine Orrell, David R. Bangsberg, Jessica E. Haberer

OHSU-PSU School of Public Health Faculty Publications and Presentations

Adoption of "Treat All" policies has increased ART initiation in sub-Saharan Africa; however, unexplained early losses continue to occur. More information is needed to understand why treatment discontinuation continues at this vulnerable stage in care.

Aligning Food Environments With Institutional Values: A Mixed Methods Study Of Oregon Health Care Organizations, Elizaveta Walker

Dissertations and Theses

A major driver of the obesity epidemic is obesogenic food environments, characterized by nutrient-poor and energy-dense foods that saturate the collective physical, economic and sociocultural conditions that influence nutritional status. Food environments in organizations such as hospitals and public health agencies warrant special consideration given their health-focused mission. Improving food environments within health care settings has been highlighted by the Centers for Disease Control and Prevention (CDC) as one of seven key strategies to prevent obesity. However, most of the refereed literature examining healthy food environment policies (HFEPs) within hospitals focuses on the inpatient dietary environment, leaving a paucity of …

Provider Perspectives On Persistent Urinary Incontinence Following Obstetric Fistula Repair In Ethiopia, Laura E. Jacobson, Melaku Abriha Marye, Elena Phoutrides, Rahel Nardos

OHSU-PSU School of Public Health Faculty Publications and Presentations

Each year an estimated 50,000 to 100,000 women worldwide are affected by obstetric fistula. This devastating but preventable maternal morbidity leaves women incontinent, stigmatized, isolated, and often with a still birth. While fistula rates in Ethiopia have declined in recent years, estimates range from 7 to 40 percent of women suffer from persistent urinary incontinence after successful closure of their fistula. Few studies have focused on the unique experiences and challenges that providers face treating fistula patients, particularly those who experience persistent urinary incontinence. The goal of this research is to characterize the fistula provider's accounts of how to manage, …

Assisting Students And Families During The Covid-19 Crisis: Diversity & Equity In Action Through A Educator-Family-Community Health Worker Intersection, Eric J. López, Oscar J. Muñoz, Eva Menchaca-López

Northwest Journal of Teacher Education

The current COVID-19 crisis has exposed new and existing issues related to access and equity for our students and families. The following article discusses a model for interconnecting educators, families, and community health workers (CHW) that can integrate diversity and equity for practitioners and educator preparation programs. Integrating CHWs provides a unique opportunity to utilize their cultural responsive skills and knowledge. Implications for practitioners and educator preparation programs are discussed.

What You Should Know About Racism-20: A Fact Sheet In The Time Of Covid-19, Ryan J. Petteway

OHSU-PSU School of Public Health Faculty Publications and Presentations

Satire has a history within public health and medical scholarship. However, research and academic works related to COVID-19, health inequities, and structural racism to date have not engaged/explored satire as a critical mode of reflection, analysis, and commentary. Drawing from social epidemiology literature related to structural racism, and rooted in critical race theory and critical theory related to narrative power, this paper—in the form of a "RACISM-20" fact sheet/health promotion flyer—uses satire and humor as critical commentary on mainstream public health discourse of/responses to COVID-19, transposing structural racism and COVID-19 to accentuate how individualist, apolitical, and “colorblind” downstream frames of …

Exploratory Study Of Obesogenic Commercial School Food Environments In The Portland Metropolitan Area, Sruthi Eapen

University Honors Theses

Objective

The purpose of this exploratory research was to study commercial food environments around high schools in the Portland metropolitan area to explore the question: How do the economic, geographic, and racial demographics of public high schools in the Portland metropolitan area affect the prevalence and make-up of obesogenic commercial food environments surrounding these schools?

Methods

Commercial food environments within a 1 km radius of 35 public high schools in the Portland metropolitan area were surveyed. The “healthiness” of the environment was calculated by establishing a “Food Environment Score.” This score was correlated with economic, geographic, and racial demographics obtained …

Adherence To Hiv Antiretroviral Therapy Among Pregnant And Postpartum Women During The Option B+ Era: 12-Month Cohort Study In Urban South Africa And Rural Uganda, Lynn T. Matthews, Catherine Orrell, Mwebesa B. Bwana, Alexander C. Tsai, Christina A. Psaros, Stephen Asiimwe, Gideon Amanyire, Nicholas Musinguzi, Kathleen Bell, David Bangsberg, Jessica E. Haberer

OHSU-PSU School of Public Health Faculty Publications and Presentations

Introduction: We conducted a cohort study to understand patterns of anti-retroviral therapy (ART) adherence during pregnancy, postpartum and non-pregnancy follow-up among women initiating ART in public clinics offering Option B+ in rural Uganda and urban South Africa. Methods: We collected survey data, continuously monitored ART adherence (Wisepill), HIV-RNA and pregnancy tests at zero, six and twelve months from women initiating ART in Uganda and South Africa, 2015 to 2017. The primary predictor of interest was follow-up time categorized as pregnant (pregnancy diagnosis to pregnancy end), postpartum (pregnancy end to study exit) or non-pregnancy-related (neither pregnant nor postpartum). Fractional regression …

Impact And Mortality Of Covid-19 On People Living With Dementia: Cross-Country Report, Aida Suárez-González, Gill Livingston, Lee Fay Low, Suzanne Cahill, Niamh Hennelly, Walter D. Dawson, Wendy Weidner, Martina Bocchetta, Cleusa P. Ferri, Jordi A. Matias-Guiu, Multiple Additional Authors

Institute on Aging Publications

This report brings together international evidence on the impact of the COVID-19 pandemic on people living with dementia and an overview of international policy and practice measures to mitigate the impact of COVID-19 among people living with dementia.

Key Findings

• We have collected data on impact and mortality of COVID-19 in people living with dementia in 9 countries: The United Kingdom (UK), Spain, Ireland, Italy, Australia, the United States (US), India, Kenya and Brazil.
• The share of people whose deaths were linked to COVID-19 in care homes who had dementia ranges from 29% to 75% across those countries. Within countries, …

How Does The Effect Of Hurricane Katrina Influence Healthcare Infrastructure And Resilience?, Sean Y. Wei

University Honors Theses

In August 2005, Hurricane Katrina brought upon the city of New Orleans, LA one of the costliest natural disasters in U.S. history. This paper looks at how hospitals were prepared before Katrina, responded to, and grappled with the aftermath of this natural disaster. In the aftermath of Katrina, careful investigation of the healthcare system along with its hospitals, physicians, patients, and residents allow us to take innovative measures and provide guidance to create recommendations to better monitor and care for individuals in the future. Frameworks of resilience theories, studies, and recommendations display how and why disaster planning is essential. The …

Differential Vpu-Mediated Cd4 And Tetherin Downregulation Functions Among Major Hiv-1 Group M Subtypes, Gisele Umviligihozo, Kyle D. Cobarrubias, Sandali Chandrarathna, Steven W. Jin, Nicole Reddy, Helen Byakwaga, Conrad Muzoora, Mwebesa B. Bwana, Guinevere Q. Lee, Peter W. Hunt, David Bangsberg, Multiple Additional Authors

OHSU-PSU School of Public Health Faculty Publications and Presentations

Downregulation of BST-2/tetherin and CD4 by HIV-1 viral protein U (Vpu) promotes viral egress and allows infected cells to evade host immunity. Little is known however about the natural variability in these Vpu functions among the genetically diverse viral subtypes that contribute to the HIV-1 pandemic. We collected Vpu isolates from 332 treatment-naive individuals living with chronic HIV-1 infection in Uganda, Rwanda, South Africa, and Canada. Together, these Vpu isolates represent four major HIV-1 group M subtypes (A [n = 63], B [n = 84], C [n = 94], and D [n = 59]) plus intersubtype …

Differential Effects Of Buprenorphine/Naloxone Vs. Methadone On Quality Of Life Over Time: A Subset Of The Bravo Study (Buprenorphine To Improve Hiv Care Engagement And Outcomes: A Randomized Trial), Ali Mirzazadeh Javaheri

University Honors Theses

Health-related Quality of Life (QoL) is generally poorer in individuals with opioid use disorder (OUD) in comparison with those suffering from other chronic diseases. Little is known about the difference each buprenorphine/naloxone (BUP/NX) or methadone maintenance therapy (MMT) may make in the QoL for the HIV-infected people with OUD who are new to HIV care. The objective of this study is to evaluate the difference in the impact that BUP/NX and MMT treatment delivery models make on the QoL of the HIV-infected participants with OUD in Vietnam.

This study was a subset of the BRAVO study, buprenorphine to improve HIV …

The Role Of Strategic Governance In Reducing Infant Mortality Under Crisis Conditions, Lynn Christine Finley

Dissertations and Theses

The infant mortality rate (IMR) in some developing countries has decreased faster than the global average even though these countries lack strong economic growth, good governance, and democracy (often acknowledged precursors to improved health outcomes). What accounts for the improvement of the IMR in the absence of these traditional pathways to health gains? Some scholars suggest that the concept of "strategic governance" might help direct attention to intermediary factors that reduce neonatal deaths in countries that experience crisis conditions. The main objective of this dissertation is to investigate the set of governance practices that have reduced IMR in two such …

Do Household Asset Wealth Measurements Depend On Who Is Surveyed? Asset Reporting Concordance Within Multi-Adult Households In Rural Uganda., Meghan L. Smith, Bernard Kakuhikire, Charles Baguma, Justin D. Rasmussen, David Bangsberg, Alexander C. Tsai

OHSU-PSU School of Public Health Faculty Publications and Presentations

Background: In resource-limited settings, the Filmer & Pritchett asset index is frequently used to measure household economic status. Little is known about how its validity is affected by differential reporting or recall within households.

Methods: As part of a whole-population survey in a rural region of southwestern Uganda, we elicited household asset information from married dyads (404 men and 404 matched women) residing within the same households. We assessed the extent to which the asset index yielded differing measures of relative household wealth, depending on whether the husband’s or wife’s survey data were used in its calculation. To …

Health And Dental Care Expenditures In The United States From 1996 To 2016, Man Hung, Martin S. Lipsky, Ryan Moffat, Evelyn Lauren, Eric S. Hon, Jungweon Park, Gagandeep Gill, Julie Xu, Lourdes Peralta, Multiple Additional Authors

OHSU-PSU School of Public Health Faculty Publications and Presentations

Introduction: As total health and dental care expenditures in the United States continue to rise, healthcare disparities for low to middle-income Americans creates an imperative to analyze existing expenditures. This study examined health and dental care expenditures in the United States from 1996 to 2016 and explored trends in spending across various population subgroups.

Methods: Using data collected by the Medical Expenditure Panel Survey, this study examined health and dental care expenditures in the United States from 1996 to 2016. Trends in spending were displayed graphically and spending across subgroups examined. All expenditures were adjusted for inflation or …

A Public Health Recommendation Countering The Online Anti-Vaccination Movement, Grace M. Neumann

University Honors Theses

The anti-vaccination movement had posed a threat to the health of communities, since the inception of the smallpox inoculation practice. As the anti-vaxx movement continues to grow in strength and reach, public health officials must be prepared to combat the flow of misinformation, with sound scientific data in a way that connects with individuals from all communities. Online platforms such as blogs and social media, allow newfound access to vaccine opinions and information, posing an even greater risk of vaccine misinformation being spread to the public. Different communities hold different reasons for vaccine hesitancy and avoidance. An effective public health …

Sudden Cardiac Death In Young Adults With Long-Chain 3-Hydroxyacyl Coa Dehydrogenase Deficiency (Lchadd), Ajesh Saini

University Honors Theses

Long-chain 3-Hydroxyacyl CoA Dehydrogenase Deficiency (LCHADD) is an autosomal recessive defect in fatty acid oxidation that presents with hypoketotic hypoglycemia and/or hypertrophic cardiomyopathy in infancy, and recurrent rhabdomyolysis in adolescence, however, sudden cardiac death has not been a previously reported complication of LCHADD. We have conducted a case review study comparing young adult LCHADD patients who have experienced sudden cardiac arrest events (n=5) to similar patients who have not (n=5) for the purpose of evaluating associated cardiac risk factors. We reviewed medical records from ECG tests, hospitalization reports, acylcarnitine, and complete metabolic panels, clinic notes, and autopsy reports. Retrospective chart …

Emergence In The Strengths And Love Of My People To Counter Invisibility For Liberation In The White Academy, Emily D. Carrillo-Casares

University Honors Theses

Through a literature review and personal reflection, my thesis will focus on the strengths and love of my people to counter invisibility for liberation in the white academy. More importantly, my aim in this paper is to illustrate the strengths, courage, and will-power I came across to dismantle the concealed barriers in a system that misperceived my values. I will speak from the first person to express my feelings and experiences. When I use the words, my people, I mean people who identify themselves as Hispanic/Latino or non-white. The goal of this paper is to explicate how I remained strong …

Meta-Analysis Of Tobacco Control Policies For Reducing Tobacco Consumption, Arya Kevin Naghdi

University Honors Theses

The harmful effects of tobacco consumption and smoking have been well documented, and the literature is conclusive on their negative effects. However, there is still a great deal of discussion to be had on which policies and strategies can be employed to decrease smoking rates. Tobacco control policies used in the past included tobacco taxes, smoke free zones, anti-smoking media, sale to minors bans, and advertising restrictions on tobacco companies. Yet, it is still unclear which policies are most effective and least effective when it comes to reducing smoking rates. A meta-analysis of 11 articles analyzing the effects of each …

Ethnic Enclaves And Pregnancy And Behavior Outcomes Among Asian/Pacific Islanders In The Usa, Andrew D. Williams, Lynne C. Messer, Jenna Kanner, Sandie Ha, Katherine L. Grantz, Pauline Mendola

OHSU-PSU School of Public Health Faculty Publications and Presentations

Objectives—Ethnic enclaves are ethnically, spatially, and socially distinct communities that may promote health through access to culturally appropriate resources and reduced exposure to discrimination. This study examined ethnic enclave residence and pregnancy outcomes among Asian/Pacific Islander (API) women in the USA.

Design—We examined 9206 API births in the Consortium on Safe Labor (2002–2008). Ethnic enclaves were defined as hospital regions with high percentage of API residents (> 4%), high dissimilarity index (> 0.41; distribution of API and white residents within a geographic area), and high isolation index (> 0.03; interaction between API and white residents in an area). …

Life Satisfaction In Division Iaa And Division Iii Football Players, Krista Haunani Francisco

Dissertations and Theses

Level of life satisfaction is not something of which many sit down and take appraisal. However, levels of life satisfaction, especially low levels of life satisfaction, can have a direct effect on health. Low levels of life satisfaction cause an increase in self-reported stress. Inversely, high levels of stress cause a decrease in life satisfaction. This decrease in life satisfaction is associated with poor mental and physical health outcomes. A majority of student-athlete healthcare is centered around the physical aspects of health, with mental health just recently becoming a concern. It was apparent through the research for this study that …

Migrant Health Policies In The European Union: A Comparative Policy Analysis, Jessica Joanne Currier

Dissertations and Theses

There is an undeniable relationship between migration and health. Despite the fact that the concept of health as a fundamental human right has been enshrined in numerous international and supranational policy instruments, health disparities between migrants and host nation populations persist. Inequities in health are perpetuated by several factors that include, but are not limited to, immigration status, lack of knowledge of health system access points, appropriateness of health care services, language barriers, and unique health profiles of migrants. The literature firmly positions migrants as a vulnerable population due to their collective risk of poor health outcomes in multiple areas. …

Menthol In Electronic Cigarettes: A Contributor To Respiratory Disease?, Vijayalekshmi Nair, Malcolm Tran, Rachel Z. Behar, Song Zhai, Xinping Cui, Rattapol Phandthong, Yuhuan Wang, Songqin Pan, Wentai Luo, James F. Pankow, David C. Volz, Prue Talbot

Civil and Environmental Engineering Faculty Publications and Presentations

Menthol is widely used in tobacco products. This study compared the effects of menthol on human bronchial epithelium using submerged cultures, a VITROCELL® cloud chamber that provides air liquid interface (ALI) exposure without solvents or heating, and a Cultex ALI system that delivers aerosol equivalent to that inhaled during vaping. In submerged culture, menthol significantly increased calcium influx and mitochondrial reactive oxygen species (ROS) via the TRPM8 receptor, responses that were inhibited by a TRPM8 antagonist. VITROCELL® cloud chamber exposure of BEAS-2B monolayers increased mitochondrial protein oxidation, expression of the antioxidant enzyme SOD2, activation of NF-κB, and secretion of inflammatory …

Trajectories Of Hiv-Related Internalized Stigma And Disclosure Concerns Among Art Initiators And Non-Initiators In South Africa, Brian T. Chan, Brendan G. Maughan-Brown, Laura M. Bogart, Valerie A. Earnshaw, Gugulethu Tshabalala, Ingrid Courtney, Janan J. Dietrich, Catherine Orrell, Glenda Gray, David R. Bangsberg, Alexander C. Tsai, Ingrid T. Katz

OHSU-PSU School of Public Health Faculty Publications and Presentations

HIV-related stigma among people living with HIV (PLHIV) is associated with worse health outcomes. We used longitudinal data from a multisite cohort in South Africa to assess changes over time in stigma after HIV diagnosis and determine whether antiretroviral therapy (ART) initiation is associated with stigma reduction. We administered the Internalized AIDS-Related Stigma Scale (IARSS, a six-item dichotomous scale questionnaire) at baseline, 3 months, and 6 months to newly diagnosed ART-eligible participants between 2014 and 2015. A confirmatory factor analysis indicated that the IARSS contained a four-item internalized stigma factor (α = .80) and a two-item disclosure concerns factor (α …

Tracking Multimorbidity Changes In Diverse Racial/Ethnic Populations Over Time: Issues And Considerations, Ana R. Quiñones, Heather G. Allore, Anda Botoseneanu, Jason T. Newsom, Corey L. Nagel, David A. Dorr

OHSU-PSU School of Public Health Faculty Publications and Presentations

Multimorbidity is widely recognized as having adverse effects on health and wellbeing and may threaten the ability of older adults to live independently. Much of what is known about multimorbidity rests on research that has largely focused on one point in time, or from a static perspective. Given that there remains a lack of agreement in the field on how to standardize multimorbidity definitions and measurement, it is not surprising that analyzing and predicting multimorbidity development, progression over time, and its impact are still largely unaddressed. As a result, there are important gaps and challenges to measuring and studying multimorbidity …

Challenging Aggressive Behaviors Experienced By Personal Support Workers In Comparison To Home Care Workers: Relationships Between Caregiver Experiences And Psychological Health, Kelsey N. Womack, Teala W. Alvord, Caitlyn F. Trullinger-Dwyer, Sean P.M. Rice, Ryan Olson

OHSU-PSU School of Public Health Faculty Publications and Presentations

Personal support workers (PSW) are caregivers for children and adults with intellectual and developmental disabilities (IDDs) or adults experiencing mental illness or other behavioral health conditions. The work can be very meaningful, but many PSWs must prepare for, monitor, and manage challenging behaviors, including aggression. This study was designed to estimate the prevalence of aggression experienced by PSWs in Oregon, and compare it to a previous sample of Oregon home care workers (HCWs). This comparison included an analysis of relationships between exposures to aggression and psychological health factors. PSWs in Oregon (N = 240) were surveyed electronically at a single …

Improving Smoking Cessation Outcomes Through Tailored-Risk Patient Messages At A University Hospital Tobacco Cessation Service, David Gonzales, Wendy G. Bjornson, Catherine J. Markin, Trisha M. Coleman, Frances Favela, Noal Clemons, Caroline Koudelka, Jodi Lapidus

OHSU-PSU School of Public Health Faculty Publications and Presentations

Background: Postdischarge follow-up is a critical step for increasing effectiveness of hospital smoking cessation treatment. A quality improvement project was undertaken at an academic medical center tobacco cessation consult service to evaluate whether a tailored message (TM) linking immediate risks of continued smoking—particularly carbon monoxide exposure— to hospital recovery would stimulate more patient interest in the hospital’s cessation treatment, including agreement to postdischarge follow-up, compared to patients receiving the usual treatment protocol with a standard message (SM) regarding more general health benefits of abstinence. Methods: Data from 697 smokers ordered/referred for smoking cessation treatment in 2013 who received either the …