Medicine and Health Sciences Commons^™

The Effect Of Rare Variants In Trem2 And Pld3 On Longitudinal Cognitive Function In The Wisconsin Registry For Alzheimer's Prevention, Corinne D. Engelman, Burcu F. Darst, Murat Bilgel, Eva Vasiljevic, Rebecca L. Koscik, Bruno M. Jedynak, Sterling C. Johnson

Mathematics and Statistics Faculty Publications and Presentations

Recent studies have found an association between functional variants in TREM2 and PLD3 and Alzheimer's disease (AD), but their effect on cognitive function is unknown. We examined the effect of these variants on cognitive function in 1449 participants from the Wisconsin Registry for Alzheimer's Prevention, a longitudinal study of initially asymptomatic adults, aged 36–73 years at baseline, enriched for a parental history of AD. A comprehensive cognitive test battery was performed at up to 5 visits. A factor analysis resulted in 6 cognitive factors that were standardized into z scores (∼N [0, 1]); the mean of these z scores was …

Hospital Variation In Costs – A Challenge To The Value Proposition, Aaron B. Caughey, Jonathan M. Snowden

OHSU-PSU School of Public Health Faculty Publications and Presentations

Mini Commentary on 2017-OG-19978R1: Hospital Variation in Cost of Childbirth and Contributing Factors: A Cross-Sectional Study. To view this article visit https://doi.org/10.1111/1471-0528.15007.

Treatment And Prevention Of Opioid Use Disorder: Challenges And Opportunities, Dennis Mccarty, Kelsey C. Priest, P. Todd Korthuis

OHSU-PSU School of Public Health Faculty Publications and Presentations

Treatment for opioid use disorder in the United States evolved in response to changing federal policy and advances in science. Inpatient care began in 1935 with the US Public Health Service Hospitals in Lexington, Kentucky, and Fort Worth, Texas. Outpatient clinics emerged in the 1960s to provide aftercare. Research advances led to opioid agonist and opioid antagonist therapies. When patients complete opioid withdrawal, return to use is often rapid and frequently deadly. US and international authorities recommend opioid agonist therapy (i.e., methadone or buprenorphine). Opioid antagonist therapy (i.e., extended-release naltrexone) may also inhibit return to use. Prevention efforts emphasize public …

Patient-Provider Relationship And Perceived Provider Weight Bias Among American Indians And Alaska Natives, Kelly L. Gonzales, Ginny Garcia, Michelle M. Jacob, C. Muller, Lonnie A. Nelson, Spero M. Manson

OHSU-PSU School of Public Health Faculty Publications and Presentations

Objective The objective of this study was to examine patient–provider relationships among American Indians and Alaska Native (AI/AN) patients by examining associations between patient activation, perceived provider weight bias and working alliance. Patient activation is generally defined as having the knowledge, skills and confidence to manage one's health.

Methods Among a sample of 87 AI/AN adults presenting for general medical care at an urban clinic in the north-west region of the USA, ordinary least squares regression analysis was completed to examine associations.

Results Better working alliance scores were associated with increased patient activation, while perceived provider weight bias was associated …

Treatment Guidelines And Early Loss From Care For People Living With Hiv In Cape Town, South Africa: A Retrospective Cohort Study, Ingrid T. Katz, Richard Kaplan, Garrett Fitzmaurice, Dominick Leone, David R. Bangsberg, Linda-Gail Bekker, Catherine Orrell

OHSU-PSU School of Public Health Faculty Publications and Presentations

South Africa has undergone multiple expansions in antiretroviral therapy (ART) eligibility from an initial CD4+ threshold of ≤200 cells/μl to providing ART for all people living with HIV (PLWH) as of September 2016. We evaluated the association of programmatic changes in ART eligibility with loss from care, both prior to ART initiation and within the first 16 weeks of starting treatment, during a period of programmatic expansion to ART treatment at CD4+ ≤ 350 cells/μl.

Frequency Of Cannabis Use Among Primary Care Patients In Washington State, Gwen T. Lapham, Amy K. Lee, Ryan M. Caldeiro, Dennis Mccarty, Kendall C. Browne, Denise D. Walker, Daniel R. Kivlahan, Katharine A. Bradley

OHSU-PSU School of Public Health Faculty Publications and Presentations

Background and Objectives—Over 12% of U.S. adults report past-year cannabis use, and among those who use daily, 25% or more have a cannabis use disorder. Use is increasing as legal access expands. Yet, cannabis use is not routinely assessed in primary care, and little is known about use among primary care patients and relevant demographic and behavioral health subgroups. This study describes the prevalence and frequency of past-year cannabis use among primary care patients assessed for use during a primary care visit.

Methods—This observational cohort study included adults who made a visit to primary care clinics with annual behavioral health …

Comparison Of Respondent-Reported And Sensor-Recorded Latrine Utilization Measures In Rural Bangladesh: A Cross-Sectional Study, Maryann G. Delea, Corey L. Nagel, Evan A. Thomas, Amal K. Halder, Nuhu Amin, Abul K. Shoab, Matthew C. Freeman, Leanne Unicomb, Thomas F. Clasen

OHSU-PSU School of Public Health Faculty Publications and Presentations

Background: Health improvements realized through sanitation are likely achieved through high levels of facilities utilization by all household members. However, measurements of sanitation often rely on either the presence of latrines, which does not guarantee use, or respondent-reported utilization of sanitation facilities, which is prone to response bias. Overstatement of sanitation metrics limits the accuracy of program outcome measures, and has implications for the interpretation of related health impact data.

Methods: We conducted a cross-sectional study of 213 households in 14 village water, sanitation and hygiene committee clusters throughout rural Bangladesh and used a combined data- and relationship-scale approach …

Teaching Undergraduate Students To Visualize And Communicate Public Health Data With Infographics, Justin D. Shanks, Betty Izumi, Christina J. Sun, Allea Martin, Carmen Byker Shanks

OHSU-PSU School of Public Health Faculty Publications and Presentations

The purpose of this study was to explore the degree to which an infographic assignment facilitated student learning around health science issues, as well as the ways in which the assignment was an effective teaching tool. The objectives of the assignment were to (1) understand the purposes of and potential uses for infographics, (2) cultivate creative visual communication skills, and (3) disseminate a complex health topic to diverse audiences. The infographic assignment was developed at Montana State University and piloted at Portland State University. Students were assigned to small groups of three or four to create an infographic focused on …

Preliminary Findings Of A Technology-Delivered Sexual Health Promotion Program For Black Men Who Have Sex With Men: Quasi-Experimental Outcome Study, Charles H. Klein, Tamara Kuhn, Danielle Huxley, Jamie Kennel, Elizabeth Withers, Carmela Lomonaco

Anthropology Faculty Publications and Presentations

Background: Human immunodeficiency virus (HIV) disproportionately affects black men who have sex with men (MSM), yet there are few evidence-based interventions specifically designed for black MSM communities. In response, the authors created Real Talk, a technology-delivered, sexual health program for black MSM.

Objective: The objective of our study was to determine whether Real Talk positively affected risk reduction intentions, disclosure practices, condom use, and overall risk reduction sexual practices.

Methods: The study used a quasi-experimental, 2-arm methodology. During the first session, participants completed a baseline assessment, used Real Talk (intervention condition) or reviewed 4 sexual health brochures (the standard of …

Ahrq Series On Complex Intervention Systematic Reviews-Paper 6: Prisma-Ci Extension Statement And Checklist, Jeanne-Marie Guise, Mary E. Butler, Christine Chang, Meera Viswanathan, Terri Pigott, Peter Tugwell

OHSU-PSU School of Public Health Faculty Publications and Presentations

Background: Complex interventions are widely used in health systems, public health, education, and communities and are increasingly the subject of systematic reviews. Oversimplification and inconsistencies in reporting about complex interventions can limit the usability of review findings. Rationale: Although guidance exists to ensure that reports of individual studies and systematic reviews adhere to accepted scientific standards, their design-specific focus leaves important reporting gaps relative to complex interventions in health care. This paper provides a stand-alone extension to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting tool for complex interventionsdPRISMA-CIdto help authors, publishers, and readers understand and apply …

Ahrq Series On Complex Intervention Systematic Reviews-Paper 1: An Introduction To A Series Of Articles That Provide Guidance And Tools For Reviews Of Complex Interventions, Jeanne-Marie Guise, Christine Chang, Mary E. Butler, Meera Viswanathan, Peter Tugwell

OHSU-PSU School of Public Health Faculty Publications and Presentations

An introduction to a series of articles that provide guidance and tools for reviews of complex interventions

Ahrq Series On Complex Intervention Systematic Reviews-Paper 4: Selecting Analytic Approaches, Meera Viswanathan, Melissa L. Mcpheeters, M. Hassan Murad, Jeanne-Marie Guise, Emily E. Devine, Michele P. Dyson, Leila C. Kahwati, Jeremy M.V. Miles, Sally C. Morton

OHSU-PSU School of Public Health Faculty Publications and Presentations

Background: Systematic reviews of complex interventions can vary widely in purpose, data availability and heterogeneity, and stakeholder expectations. Rationale: This article addresses the uncertainty that systematic reviewers face in selecting methods for reviews of complex interventions. Specifically, it lays out parameters for systematic reviewers to consider when selecting analytic approaches that best answer the questions at hand and suggests analytic techniques that may be appropriate in different circumstances. Discussion: Systematic reviews of complex interventions comprising multiple questions may use multiple analytic approaches. Parameters to consider when choosing analytic methods for complex interventions include nature and timing of the decision (clinical …

Ahrq Series On Complex Intervention Systematic Reviews-Paper 2: Defining Complexity, Formulating Scope, And Questions, Michael P. Kelly, Jane Noyes, Robert Kane, Christine Chang, Stacey Uhl, Karen A. Robinson, Stacey Springs, Mary E. Butler, Jeanne-Marie Guise

OHSU-PSU School of Public Health Faculty Publications and Presentations

Background: The early stages of a systematic review set the scope and expectations. This can be particularly challenging for complex interventions given their multidimensional and dynamic nature. Rationale: This paper builds on concepts introduced in paper 1 of this series. It describes the methodological, practical, and philosophical challenges and potential approaches for formulating the questions and scope of systematic reviews of complex interventions. Furthermore, it discusses the use of theory to help organize reviews of complex interventions. Discussion: Many interventions in medicine, public health, education, social services, behavioral health, and community programs are complex, and they may not fit neatly …

Ahrq Series On Complex Intervention Systematic Reviews-Paper 7: Prisma-Ci Elaboration And Explanation, Jeanne-Marie Guise, Mary E. Butler, Christine Chang, Meera Viswanathan, Terri Pigott, Peter Tugwell

OHSU-PSU School of Public Health Faculty Publications and Presentations

Background Complex interventions are widely used in health care, public health, education, criminology, social work, business, and welfare. They have increasingly become the subject of systematic reviews and are challenging to effectively report. The Complex Interventions Methods Workgroup developed an extension to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Complex Interventions (PRISMA-CI). Rationale Following the EQUATOR Network guidance for Preferred Reporting Items for Systematic Reviews and Meta-Analysis extensions, this Explanation and Elaboration (EE) document accompanies the PRISMA-CI checklist to promote consistency in reporting of systematic reviews of complex interventions. Discussions The EE document explains the meaning and …

Controlling Water Exchange Kinetics And Improving Paracest Imaging, Jacqueline R. Slack

Dissertations and Theses

Generating MR image contrast from exogenous contrast media through chemical exchange saturation transfer (CEST) offers several exciting new possibilities, such as multicolored imaging, the interleaving of pre- and post-contrast images, and the potential to perform ratiometric metabolic imaging. The major limitation of the deployment of CEST imaging is the comparatively high detection limits of exogenous agents and particularly at the low B_¹ power levels required to meet SAR requirements. The large chemical shifts afforded by paramagnetic (paraCEST) agents permit more rapid exchange kinetics and therefore potentially more effective contrast agents. Despite comparatively large chemical shifts, many Ln³⁺ DOTA-tetraamide …

Concussion As A Multi-Scale Complex System: An Interdisciplinary Synthesis Of Current Knowledge, Erin S. Kenzie, Elle L. Parks, Erin D. Bigler, Miranda M. Lim, James C. Chesnutt, Wayne Wakeland

Systems Science Faculty Publications and Presentations

Traumatic brain injury (TBI) has been called “the most complicated disease of the most complex organ of the body” and is an increasingly high-profile public health issue. Many patients report long-term impairments following even “mild” injuries, but reliable criteria for diagnosis and prognosis are lacking. Every clinical trial for TBI treatment to date has failed to demonstrate reliable and safe improvement in outcomes, and the existing body of literature is insufficient to support the creation of a new classification system. Concussion, or mild TBI, is a highly heterogeneous phenomenon, and numerous factors interact dynamically to influence an individual’s recovery trajectory. …

Long-Term Effectiveness Of The Diabetes Conversation Map Program: A Prepost Education Intervention Study Among Type 2 Diabetic Patients In Taiwan, Jui-Yu Hung, Pin-Fan Chen, Hanoch Livneh, Yi-Yu Chen, How-Ran Guo, Tzung-Yi Tsai

Counselor Education Faculty Publications and Presentations

Health education is compulsory for patients with chronic and life-threatening disease, especially for those with diabetes mellitus (DM). This study aimed to examine the long-term effectiveness of the Diabetes Conversation Map Program (DCMP) among DM patients in Taiwan.

A quasi-experimental research design using convenience sampling and nonrandom group assignment was applied to recruit 95 type 2 diabetic subjects from a hospital in Taiwan. In addition to routine care, the experiment group (n = 49) received 7 sessions of DCMP that delivered over 2 months, while the control group (n = 46) received only routine care during the same period. We …

Health Disparities In Veterans: A Map Of The Evidence, Karli Kondo, Allison Low, Teresa Everson, Christine D. Gordon, Stephanie Veazie, Crystal Lozier, Michele Freeman, Makalapua Motu’Apuaka, Aaron Mendelson, Marl Friesen, Robin Paynter, Caroline Friesen, Johanna Anderson, Erin Boundy, Somnath Saha, Ana Quiñones, Devan Kansagara

Chemistry Faculty Publications and Presentations

Background: Goals for improving the quality of care for all Veterans and eliminating health disparities are outlined in the Veterans Health Administration Blueprint for Excellence, but the degree to which disparities in utilization, health outcomes, and quality of care affect Veterans is not well understood.

Objectives: To characterize the research on health care disparities in the Veterans Health Administration by means of a map of the evidence.

Research Design: We conducted a systematic search for research studies published from 2006 to February 2016 in MEDLINE and other data sources. We included studies of Veteran populations that examined disparities in 3 …

Why Faculty Choose To Work In Academic Medicine, Sarah Bunton, Valerie Dandar

University Studies Faculty Publications and Presentations

Medical school faculty are crucial to advancing academic medicine’s missions of providing high-quality, patient-centered health care; training the next generation of physicians; and conducting research to inform advancement and innovation in health care delivery. This Analysis in Brief (AIB) takes an in-depth look at why faculty choose careers in academic medicine, by examining faculty responses to that very question. As institutional leadership strives to recruit and retain faculty, understanding these sentiments can inform work to help guide students, provide insight for those considering academic careers, and educate the public about the work of academic medicine and the vital role that …

Molecularly Targeted Drug Combinations Demonstrate Selective Effectiveness For Myeloid- And Lymphoidderived Hematologic Malignancies, Stephen E. Kurtz, Christopher A. Eide, Andy Kaempf, Vishesh Khanna

OHSU-PSU School of Public Health Faculty Publications and Presentations

Translating the genetic and epigenetic heterogeneity underlying human cancers into therapeutic strategies is an ongoing challenge. Large-scale sequencing efforts have uncovered a spectrum of mutations in many hematologic malignancies, including acute myeloid leukemia (AML), suggesting that combinations of agents will be required to treat these diseases effectively. Combinatorial approaches will also be critical for combating the emergence of genetically heterogeneous subclones, rescue signals in the microenvironment, and tumor-intrinsic feedback pathways that all contribute to disease relapse. To identify novel and effective drug combinations, we performed ex vivo sensitivity profiling of 122 primary patient samples from a variety of hematologic malignancies …

Development Of Physics Curriculum For Pre-Health Students, Elliot Eckman Mylott

Dissertations and Theses

Many pre-health students are required to take introductory physics as undergraduates, though they often struggle to see the relationship between medicine and what they learn in these courses. In order to help students make that connection, reformed curriculum was adopted that teaches physics through the context of biomedicine. This dissertation will discuss the development, implementation, and assessment of the reformed curriculum for the introductory and intermediate level physics courses that targets the needs of pre-health students.

The curriculum created during this project include laboratory activities, multimedia content, and other instructional materials all of which present physics in biomedical contexts. The …

Enhancing Value-Based Healthcare With Reconstructability Analysis: Predicting Risk For Hip And Knee Replacements, Cecily Corrine Froemke

Dissertations and Theses

Legislative reforms aimed at slowing growth of US healthcare costs are focused on achieving greater value, defined specifically as health outcomes achieved per dollar spent. To increase value while payments are diminishing and tied to individual outcomes, healthcare must improve at predicting risks and outcomes.

One way to improve predictions is through better modeling methods. Current models are predominantly based on logistic regression (LR). This project applied Reconstructability Analysis (RA) to data on hip and knee replacement surgery, and considered whether RA could create useful models of outcomes, and whether these models could produce predictions complimentary to or even stronger …

County-Level Cumulative Environmental Quality Associated With Cancer Incidence, Jyotsna S. Jagai, Lynne C. Messer, Kristen M. Rappazzo, Christine L. Gray, Shannon C. Grabich, Danelle T. Lobdell

Institute for Sustainable Solutions Publications and Presentations

BACKGROUND: Individual environmental exposures are associated with cancer development; however, environmental exposures occur simultaneously. The Environmental Quality Index (EQI) is a county-level measure of cumulative environmental exposures that occur in 5 domains.

METHODS: The EQI was linked to county-level annual age-adjusted cancer incidence rates from the Surveillance, Epidemiology, and End Results (SEER) Program state cancer profiles. All-site cancer and the top 3 site-specific cancers for male and female subjects were considered. Incident rate differences (IRDs; annual rate difference per 100,000 persons) and 95% confidence intervals (CIs) were estimated using fixed-slope, random intercept multilevel linear regression models. Associations were assessed with …

Planning And Designing The Improving Addiction Care Team (Impact) For Hospitalized Adults With Substance Use Disorder, Honora Englander, Melissa B. Weimer, Rachel Solotaroff, Christina Nicolaidis, Benjamin Chan, Christine M. Velez, Alison Noice, Tim Hartnett, Ed Blackburn, Pen Barnes, P. Todd Korthuis

School of Social Work Faculty Publications and Presentations

People with substance use disorders (SUD) have high rates of hospitalization and readmission, long lengths of stay, and skyrocketing healthcare costs. Yet, models for improving care are extremely limited. We performed a needs assessment and then convened academic and community partners, including a hospital, community SUD organizations, and Medicaid accountable care organizations, to design a care model for medically complex hospitalized patients with SUD. Needs assessment showed that 58% to 67% of participants who reported active substance use said they were interested in cutting back or quitting. Many reported interest in medication for addiction treatment (MAT). Participants had high rates …

Supported Employment For Veterans With Traumatic Brain Injury: Provider Perspectives, Terri K. Pogoda, Kathleen F. Carlson, Katelyn E. Gormley, Sandra Resnick

OHSU-PSU School of Public Health Faculty Publications and Presentations

Objective: In 2006, 13 sites were provided with one-time pilot funding to provide supported employment (SE) to Veterans with traumatic brain injury (TBI) history. In 2014, we surveyed SE providers at pilot and non-pilot sites that did not receive this funding. Our objectives were to identify any pilot and non-pilot site differences regarding current: (1) provision of SE to Veterans with TBI; (2) staffing and communication between the SE and polytrauma/TBI teams; and (3) provider perceptions on facilitators and barriers to providing, and suggestions for improving, SE.

Design: Mixed methods cross-sectional survey study.

Participants: Providers included a …

Prevalence, Age Profile, And Associated Risk Factors For Hymenolepis Nana Infection In A Large Population-Based Study In Northern Peru, Percy M. Vilchez Barreto, Ricardo Gamboa, Saul Santivañez, Seth E. O'Neal, Claudio Muro, Andrés G. Lescano, Luz M. Moyano, Guillermo Gonzálvez, Hector H. García

OHSU-PSU School of Public Health Faculty Publications and Presentations

Hymenolepis nana, the dwarf tapeworm, is a common intestinal infection of children worldwide. We evaluated infection and risk factor data that were previously collected from 14,761 children aged 2-15 years during a large-scale program in northern Peru. We found that 1,124 of 14,761 children (7.61%) had H. nana infection, a likely underestimate given that only a single stool sample was examined by microscopy for diagnosis. The strongest association with infection was lack of adequate water (adjusted prevalence ratio [aPR] 2.22, 95% confidence interval [CI] 1.82-2.48) and sanitation infrastructure in the house (aPR 1.94, 95% CI 1.64-2.29). One quarter of …

Household Water Insecurity, Missed Schooling, And The Mediating Role Of Caregiver Depression In Rural Uganda, Christine E. Cooper-Vince, Bernard Kakuhikire, Dagmar Vořechovská, Amy Q. Mcdonough, Jessica M. Perkins, Atheendar S. Venkataramani, Rumbidzai Mushavi, Charles Baguma, Scholastic Ashaba, David Bangsberg, Alexander C. Tsai

OHSU-PSU School of Public Health Faculty Publications and Presentations

Background: School attendance rates in sub-Saharan Africa are among the lowest worldwide, placing children at heightened risk for poor educational and economic outcomes. One understudied risk factor for missed schooling is household water insecurity, which is linked to depression among women and may increase children’s water-fetching burden at the expense of educational activities, particularly among children of depressed caregivers. In this study conducted in rural Uganda, we assessed the association between household water insecurity and child school participation and the mediating pathways behind these associations.

Method: We conducted a population-based, cross-sectional study of female household heads (N = 257) and …

The Role Of Relationship Dynamics And Gender Inequalities As Barriers To Hiv-Serostatus Disclosure: Qualitative Study Among Women And Men Living With Hiv In Durban, South Africa, Divya S. Bhatia, Abigail D. Harrison, Muriel Kubeka, Cecilia Milford, Angela Kaida, Francis Bajunirwe, Ira B. Wilson, Christina Psaros, Steven A, Safren, David R. Bangsberg, Jennifer A. Smit, Lynn T. Matthews

OHSU-PSU School of Public Health Faculty Publications and Presentations

Background: This qualitative study investigated gender power inequalities as they contribute to relationship dynamics and HIV-serostatus disclosure among men and women living with HIV in Durban, South Africa. HIV serodiscordance among men and women within stable partnerships contributes to high HIV incidence in southern Africa, yet disclosure rates remain low. Given the emphasis on prevention for HIV-serodiscordant couples, this research supports the urgent need to explore how best to support couples to recognize that they are part of this priority population and to access appropriate prevention and treatment.

Methods: Thirty-five in-depth individual interviews were conducted with 15 HIV-positive men …

The Influence Of Sense Of Community On The Relationship Between Community Participation And Recovery For Individuals With Serious Mental Illnesses, Rachel Elizabeth Terry

Dissertations and Theses

The Community Mental Health Act of 1963 launched the deinstitutionalization movement, whereby individuals with serious mental illnesses were released from psychiatric hospitals and began living and receiving mental health care in the community (Carling, 1995). However, these actions have not necessarily integrated those individuals into all aspects of community life (Dewees, Pulice, & McCormick, 1996). This is unfortunate because people with serious mental illnesses frequently report that community integration is not only important to them, but that it also aids in reducing symptoms and promoting recovery (Townley, 2015). Although past research suggests that receiving mental health care in the community …

Patients And Nurses And Doctors Oh My!: Nurse Retention From A Multi-Foci Aggression Perspective, Kevin Oliver Novak

Dissertations and Theses

Attrition is a serious issue in the nursing industry. One factor influencing rates of attrition in nursing is aggression victimization at work (Estryn-Behar et al., 2010). However, there is little research in the aggression literature that examines how aggression from different sources affects attrition (both job and career turnover) differently. This study attempts to better understand the linkages between aggression victimization and nursing attrition; specifically how aggression from different sources (i.e. patients/patients’ families, coworkers, and licensed independent practitioners) differentially affects retention factors (i.e. job satisfaction, turnover intentions, and career commitment). This study also attempts to understand the role that prosocial …