Medicine and Health Sciences Commons^™

A Pilot Study To Examine The Disparities In Water Quality Between Predominantly Haitian Neighborhoods And Dominican Neighborhoods In Two Cities In The Dominican Republic, Jessica Brown, Ryan Johnson, Dominique Smith, Kim Ramsey-White

Public Health Faculty Publications

Abstract: Worldwide, diarrheal disease is a leading cause of death affecting over 1.7 million individuals annually. Much of this can be attributed to lack of clean water, sanitation and hygiene. Nearly all of these deaths occur in countries with developing economies. This public health problem is apparent in the island of Hispaniola; the island that is shared by Haiti and the Dominican Republic. Significant gaps in income between the countries have resulted in Haitians migrating into the Dominican Republic. While there has been increased migration into the Dominican Republic, many of the neighborhoods remain segregated. A cross-sectional analysis was conducted …

Whooping Cough Dynamics In Chile (1932-2010): Diseasetemporal Fluctuations Across A North-South Gradient, Mauricio Lima, Sergio Estay, Rodrigo Fuentes, Paola Rubilar, Hélène Broutin, Gerardo Chowell

Public Health Faculty Publications

Background: The spatial-temporal dynamics of Bordetella pertussis remains as a highly interesting case in infectious disease epidemiology. Despite large-scale vaccination programs in place for over 50 years around the world, frequent outbreaks are still reported in many countries.

Methods: Here, we use annual time series of pertussis incidence from the thirteen different regions of Chile (1952–2010) to study the spatial-temporal dynamics of Pertussis. The period 1975–1995 was characterized by a strong 4 year cycle, while the last two decades of the study period (1990–2010) were characterized by disease resurgence without significant periodic patterns. Results: During the first decades, differences in …

Disaggregating Health Inequalities Within Rio De Janeiro, Brazil, 2002-2010, By Applying An Urban Health Inequality Index, Martin Botz, Megumi Kano, Heribert Ramroth, Christovam Barcellos, Scott R. Weaver, Richard Rothenberg, Monica Magalhães

Public Health Faculty Publications

An urban health index (UHI) was used to quantify health inequalities within Rio de Janeiro, Brazil, for the years 2002-2010. Eight main health indicators were generated at the ward level using mortality data. The indicators were combined to form the index. The distribution of the rank ordered UHI-values provides information on inequality among wards, using the ratio of the extremes and the gradient of the middle values. Over the decade the ratio of extremes in 2010 declined relative to 2002 (1.57 vs. 1.32) as did the slope of the middle values (0.23 vs. 0.16). A spatial division between the affluent …

Smoking Cessation For Chinese Men And Prevention For Women, Jeffrey Koplan, Michael Eriksen

Public Health Faculty Publications

No abstract provided.

Alcohol Policies And Alcoholic Cirrhosis Mortality In The United States, Scott E. Hadland, Ziming Xuan, Jason G. Blanchette, Timothy C. Heeren, Monica H. Swahn, Timothy S. Naimi

Public Health Faculty Publications

Introduction Stronger alcohol policies predict decreased alcohol consumption and binge drinking in the United States. We examined the relation- ship between the strength of states’ alcohol policies and alcoholic cirrhosis mortality rates.

Methods We used the Alcohol Policy Scale (APS), a validated assessment of policies of the 50 US states and Washington DC, to quantify the efficacy and implementation of 29 policies. State APS scores (the- oretical range, 0–100) for each year from 1999 through 2008 were compared with age-adjusted alcoholic cirrhosis death rates that oc- curred 3 years later. We used Poisson regression accounting for state-level clustering and adjusting …

Estimating The Risk Of Middle East Respiratory Syndrome (Mers) Death During The Course Of The Outbreak In The Republic Of Korea, Kenji Mizumoto, Masaya Saitoh, Gerardo Chowell, Nishiura H. Miyamatsu, Hiroshi Nishiura

Public Health Faculty Publications

Objectives: A large cluster of the Middle East respiratory syndrome (MERS) linked to healthcare setting occurred from May to July 2015 in the Republic of Korea. The present study aimed to estimate the case fatality ratio (CFR) by appropriately taking into account the time delay from illness onset to death. We then compare our estimate against previously published values of the CFR for MERS, i.e., 20% and 40%. Methods: Dates of illness onset and death of the MERS outbreak in the Republic of Korea were extracted from secondary data sources. Using the known distribution of time from illness onset to …

Real-Time Characterization Of Risks Of Death Associated With The Middle East Respiratory Syndrome (Mers) In The Republic Of Korea, 2015, Kenji Mizumoto, Akira Endo, Gerardo Chowell, Yuichiro Miyamatsu, Masaya Saitoh, Hiroshi Nishiura

Public Health Faculty Publications

Background: An outbreak of the Middle East respiratory syndrome (MERS), comprising 185 cases linked to healthcare facilities, occurred in the Republic of Korea from May to July 2015. Owing to the nosocomial nature of the outbreak, it is particularly important to gain a better understanding of the epidemiological determinants characterizing the risk of MERS death in order to predict the heterogeneous risk of death in medical settings. Methods: We have devised a novel statistical model that identifies the risk of MERS death during the outbreak in real time. While accounting for the time delay from illness onset to death, risk …

Mortality Rates And The Causes Of Death Related To Diabetes Mellitus In Shanghai Songjiang District: An 11-Year Retrospective Analysis Of Death Certificates, Meiying Zhu, Jiang Li, Zhiyuan Li, Wei Luo, Dajun Dai, Scott Weaver, Christine E. Stauber, Ruiyan Luo, Hua Fu

Public Health Faculty Publications

Background: China is one of the countries with the highest prevalence of diabetes in the world. We analysed all the death certificates mentioning diabetes from 2002 to 2012 in Songjiang District of Shanghai to estimate morality rates and examine cause of death patterns. Methods: Mortality data of 2654 diabetics were collected from the database of local CDC. The data set comprises all causes of death, contributing causes and the underlying cause, thereby the mortality rates of diabetes and its specified complications were analysed. Results: The leading underlying causes of death were various cardiovascular diseases (CVD), which collectively accounted for about …

Investigation Of E. Coli And Virus Reductions Using Replicate, Bench-Scale Biosand Filter Columns And Two Filter Media, Mark Elliott, Christine E. Stauber, Francis A. Digiano, Anna Fabiszewski De Aceituno, Mark Sobsey

Public Health Faculty Publications

The biosand filter (BSF) is an intermittently operated, household-scale slow sand filter for which little data are available on the effect of sand composition on treatment performance. Therefore, bench-scale columns were prepared according to the then-current (2006–2007) guidance on BSF design and run in parallel to conduct two microbial challenge experiments of eight-week duration. Triplicate columns were loaded with Accusand silica or crushed granite to compare virus and E. coli reduction performance. Bench-scale experiments provided confirmation that increased schmutzdecke growth, as indicated by decline in filtration rate, is the primary factor causing increased E. coli reductions of up to 5-log10. …

Protobacco Media Exposure And Youth Susceptibility To Smoking Cigarettes, Cigarette Experimentation, And Current Tobacco Use Among Us Youth, Erika B. Fulmer, Torsten B. Neilands, Shanta R. Dube, Nicole M. Kuiper, Rene A. Arrazola, Stanton A. Glantz

Public Health Faculty Publications

Purpose: Youth are exposed to many types of protobacco influences, including smoking in movies, which has been shown to cause initiation. This study investigates associations between different channels of protobacco media and susceptibility to smoking cigarettes, cigarette experimentation, and current tobacco use among US middle and high school students.
Methods: By using data from the 2012 National Youth Tobacco Survey, structural equation modeling was performed in 2013. The analyses examined exposure to tobacco use in different channels of protobacco media on smoking susceptibility, experimentation, and current tobacco use, accounting for perceived peer tobacco use.
Results: In 2012, 27.9% of respondents …

Psychosocial Stress And Changes In Estimated Glomerular Filtration Rate Among Adults With Diabetes Mellitus, Francis B. Annor, Katherine E. Masyn, Ike S. Okosun, Douglas W. Roblin, Michael Goodman

Public Health Faculty Publications

Background: Psychosocial stress has been hypothesized to impact renal changes, but this hypothesis has not been adequately tested. The aim of this study was to examine the relationship between psychosocial stress and estimated glomerular filtration rate (eGFR) and to examine other predictors of eGFR changes among persons with diabetes mellitus (DM).
Methods: Data from a survey conducted in 2005 by a major health maintenance organization located in the southeastern part of the United States, linked to patients’ clinical and pharmacy records (n ¼ 575) from 2005 to 2008, was used. Study participants were working adults aged 25–59 years, diagnosed with …

Assessing The Risk Of Observing Multiple Generations Of Middle East Respiratory Syndrome (Mers) Cases Given An Imported Case, Nishiura H. Miyamatsu, Y. Miyamatsu, Gerardo Chowell, M Saitoh

Public Health Faculty Publications

To guide risk assessment, expected numbers of cases and generations were estimated, assuming a case importation of Middle East respiratory syndrome (MERS). Our analysis of 36 importation events yielded the risk of observing secondary transmission events at 22.7% (95% confidence interval: 19.3–25.1). The risks of observing generations 2, 3 and 4 were estimated at 10.5%, 6.1% and 3.9%, respectively. Countries at risk should be ready for highly variable outcomes following an importation of MERS.

Multiple Trigger Points For Quantifying Heat-Health Impacts: New Evidence From A Hot Climate, Diana B. Petitti, David M. Hondula, Shuo Yang, Sharon L. Harlan, Gerardo Chowell

Public Health Faculty Publications

Background: Extreme heat is a public health challenge. The scarcity of directly comparable studies on the association of heat with morbidity and mortality and the inconsistent identification of threshold temperatures for severe impacts hampers the development of comprehensive strategies aimed at reducing adverse heat-health events.

Objectives: This quantitative study was designed to link temperature with mortality and morbidity events in Maricopa County, Arizona, USA with a focus on the summer season.

Methods: Using Poisson regression models that controlled for temporal confounders, we assessed daily temperature-health associations for a suite of mortality and morbidity events, diagnoses, and temperature metrics. Minimum risk …

Knowledge, Attitudes, And Practices Regarding Cervical Cancer And Screening Among Ethiopian Health Care Workers, Catherine M. Kress, Lisa Sharling, Ashli Owen-Smith, Dawit Desalegn, Henry M. Blumberg, Jennifer Goedken

Public Health Faculty Publications

Background: Though cervical cancer incidence has dramatically decreased in resource rich regions due to the implementation of universal screening programs, it remains one of the most common cancers affecting women worldwide and has one of the highest mortality rates. The vast majority of cervical cancer-related deaths are among women that have never been screened. Prior to implementation of a screening program in Addis Ababa University-affiliated hospitals in Ethiopia, a survey was conducted to assess knowledge of cervical cancer etiology, risk factors, and screening, as well as attitudes and practices regarding cervical cancer screening among women’s health care providers.
Methods: Between …

United States Health Policies And Late-Stage Breast And Colorectal Cancer Diagnosis: Why Such Disparities By Age?, Lee R. Mobley, Tzy-Mey Kuo

Public Health Faculty Publications

Background: Colorectal and breast cancers are the second most common causes of cancer deaths in the US. Population cancer screening rates are suboptimal and many cancers are diagnosed at an advanced stage, which results in increased morbidity and mortality. Younger populations are more likely to be diagnosed at a later stage, and this age disparity is not well understood. We examine the associations between late-stage breast cancer (BC) and colorectal cancer (CRC) diagnoses and multilevel factors, focusing on individual state regulations of insurance and health practitioners, and interactions between such policies and age. We expect state-level regulations are significant predictors …

Compassionate Use Of Experimental Therapies: Who Should Decide?, Patricia J. Zettler

Public Health Faculty Publications

No abstract provided.

Disassortative Age-Mixing Does Not Explain Differences In Hiv Prevalence Between Young White And Black Msm: Findings From Four Studies, Jeremy Alexander Grey, Richard Rothenberg, Patrick S. Sullivan, Eli S. Rosenberg

Public Health Faculty Publications

Objective Age disassortativity is one hypothesis for HIV disparities between Black and White MSM. We examined differences in age mixing by race and the effect of partner age difference on the association between race and HIV status. Design We used data from four studies of MSM. Participants reported information about recent sexual partners, including age, race, and sexual behavior. Two studies were online with a US sample and two focused on MSM in Atlanta. Methods We computed concordance correlation coefficients (CCCs) by race across strata of partner type, participant HIV status, condom use, and number of partners. We used Wilcoxon …

Characteristics And Antibiotic Use Associated With Short-Term Risk Of Clostridium Difficile Infection Among Hospitalized Patients, Sol Del Mar Aldrete, Mathew J. Magee, Rachel J. Friedman-Moraco,, Austin W. Chan, Grier G. Banks, Eileen M. Burd, Colleen S. Craft

Public Health Faculty Publications

Objectives—Polymerase chain reaction (PCR) has been shown to have an excellent sensitivity and specificity for the detection of Clostridium difficile infection (CDI). Little is known about risk factors for CDI within 14 days of an initial negative test. We sought to determine the characteristics among hospitalized patients associated with risk of short-term acquisition of CDI. Methods—A case-control study was conducted. Cases were patients who converted from PCR negative to positive within 14 days. Each case was matched with three controls. Conditional logistic regression was used to estimate the association between patient characteristics and CDI. Results—Of the 30 patients in our …

Urban Health Indicators And Indices- Current Status,, Richard Rothenberg, Christine E. Stauber, Scott Weaver, Dajun Dai, Amit Prasad, Megumi Kano

Public Health Faculty Publications

Though numbers alone may be insufficient to capture the nuances of population health, they provide a common language of appraisal and furnish clear evidence of disparities and inequalities. Over the past 30 years, facilitated by high speed computing and electronics, considerable investment has been made in the collection and analysis of urban health indicators, environmental indicators, and methods for their amalgamation. Much of this work has been characterized by a perceived need for a standard set of indicators. We used publication databases (e.g. Medline) and web searches to identify compilations of health indicators and health metrics. We found 14 …

Commingling Effect Of Gynoid And Android Fat Patterns On Cardiometabolic Dysregulation In Normal Weight American Adults, Ike S. Okosun, Jp Seale, Rodney S. Lyn

Public Health Faculty Publications

AIM: To determine the independent and commingling effect of android and gynoid percent fat (measured using Dual Energy X-Ray Absorptiometry) on cardiometabolic dysregulation in normal weight American adults. METHODS: The 2005–2006 data (n = 1802) from the United States National Health and Nutritional Examination Surveys (NHANES) were used in this study. Associations of android percent fat, gynoid percent fat and their joint occurrence with risks of cardiometabolic risk factors were estimated using prevalence odds ratios from logistic regression analyses. RESULTS: Android-gynoid percent fat ratio was more highly correlated with cardiometabolic dysregulation than android percent fat, gynoid percent fat or body …

Changes In Georgia Restaurant And Bar Smoking Policies From 2006 To 2012, Rachna D. Chandora, Carrie L. Whitney, Scott R. Weaver, Michael P. Eriksen

Public Health Faculty Publications

Introduction The purpose of this study is to examine the change in smoking policy status among Georgia restaurants and bars from 2006 to 2012 and to identify restaurant and bar characteristics that are as- sociated with allowing smoking.

Methods Data were obtained from similar cross-sectional indoor air sur- veys conducted in 2006 and 2012 in Georgia. Both surveys were designed to gather information about restaurant and bar smoking policies. Weighted χ2 analyses were performed to identify changes in smoking policy status and other variables from 2006 to 2012. Weighted logistic regression analysis was used to test for signific- ant associations …

Tobacco Smoking And Tuberculosis Treatment Outcomes: A Prospective Cohort Study In Georgia, Medea Gegia, Mathew J. Magee, Russell R. Kempker, Iagor Kalandadze, Tsira Chakhaia, Jonathan E. Golub, Henry M. Blumberg

Public Health Faculty Publications

Objective To assess the effect of tobacco smoking on the outcome of tuberculosis treatment in Tbilisi, Georgia. Methods We conducted a prospective cohort study of adults with laboratory-confirmed tuberculosis from May 2011 to November 2013. History of tobacco smoking was collected using a standardized questionnaire adapted from the global adult tobacco survey. We considered tuberculosis therapy to have a poor outcome if participants defaulted, failed treatment or died. We used multivariable regressions to estimate the risk of a poor treatment outcome. Findings Of the 591 tuberculosis patients enrolled, 188 (31.8%) were past smokers and 271 (45.9%) were current smokers. Ninety …

Targeted Sequencing In Chromosome 17q Linkage Region Identifies Familial Glioma Candidates In The Gliogene Consortium, Ali Jalali, E. Susan Amirian, Matthew N. Bainbridge, Georgina N. Armstrong, Yanhong Liu, Spyros Tsavachidis, Shalini N. Jhangiani, Sharon E. Plon, Ching C. Lau, Elizabeth B. Claus, Jill S. Barnholtz-Sloan, Dora Il'yasova, Joellen Schildkraut, Francis Ali-Osman, Siegal Sadetzki, Christoffer Johansen, Richard S. Houlston, Robert B. Jenkins, Daniel Lachance, Sara H. Olson, Jonine L. Bernstein, Ryan T. Merrell, Margaret R. Wrensch, Faith G. Davis, Rose Lai, Sanjay Shete, Kenneth Aldape, Christopher I. Amos, Donna M. Muzny, Richard A. Gibbs, Beatrice S. Melin, Melissa L. Bondy

Public Health Faculty Publications

Glioma is a rare, but highly fatal, cancer that accounts for the majority of malignant primary brain tumors. Inherited predisposition to glioma has been consistently observed within non-syndromic families. Our previous studies, which involved non-parametric and parametric linkage analyses, both yielded significant linkage peaks on chromosome 17q. Here, we use data from next generation and Sanger sequencing to identify familial glioma candidate genes and variants on chromosome 17q for further investigation. We applied a filtering schema to narrow the original list of 4830 annotated variants down to 21 very rare (,0.1% frequency), non-synonymous variants. Our findings implicate the MYO19 and …

Prevalence And Risk Factors For Methicillin-Resistant Staphylococcus Aureus In An Hiv-Positive Cohort, Jason E. Farley, Matthew Hayat, Paul L. Sacamano, Tracy Ross, Karen Carroll

Public Health Faculty Publications

Background: Persons living with HIV (PLWH) are disproportionately burdened with methicillin-resistant Staphylococcus aureus (MRSA). Our objective was to evaluate prevalence and risks for MRSA colonization in PLWH. Methods: Adults were recruited from Johns Hopkins University AIDS Service in Baltimore, Maryland. A risk questionnaire and specimen collection from anatomic sites with culture susceptibility and genotyping were completed. Generalized estimating equation modeling identified MRSA colonization risk factors. Results: Of 500 participants,mostwere black (69%), on antiretroviral therapy (ART) (87%),with undetectable viral loads (73.4%). Median CD4 count was 487 cells/mm3 (interquartile range, 316-676.5 cells/mm3). MRSA prevalence was 15.4%, predominantly from the nares (59.7%). Forty …

The First Human Infection With Severe Fever With Thrombocytopenia Syndrome Virus In Shaanxi Province, China, Jing Wei, Shen Li, Jian-Hua Dong, Hui Tian, Gerardo Chowell, Huai-Yu Tian, Wen Lv, Zong-Qi Han, Bing Xu, Peng-Bo Yu, Jing-Jun Wang

Public Health Faculty Publications

Background: Severe fever with thrombocytopenia syndrome (SFTS) is an emerging infectious disease discovered in China in 2009. In July 2013, the first human infection with SFTS virus (SFTSV) was detected in Shaanxi Province, Western China. Methods: A seroprevalence study among humans was carried out in an SFTS endemic village; specifically, serum samples were collected from 363 farmers in an SFTS endemic village in Shaanxi Province. The presence of SFTSV antibodies in serum was determined using an ELISA. Results: SFTSV antibodies were found in a total of 20 people (5.51%), with no significant difference between males and females (6.93% and 4.42%, …

Characterizing The Transmission Dynamics And Control Of Ebola Virus Disease, Gerardo Chowell, Hiroshi Nishiura

Public Health Faculty Publications

Carefully calibrated transmission models have the potential to guide public health officials on the nature and scale of the interventions required to control epidemics. In the context of the ongoing Ebola virus disease (EVD) epidemic in Liberia, Drake and colleagues, in this issue of PLOS Biology, employed an elegant modeling approach to capture the distributions of the number of secondary cases that arise in the community and health care settings in the context of changing population behaviors and increasing hospital capacity. Their findings underscore the role of increasing the rate of safe burials and the fractions of infectious individuals who …

Temporal Heterogeneity Of Water Quality From Rural Water Supplies In Alabama, Jessica C. Wedgworth, Joe Brown, Julie B. Olson, Pauline D. Johnson, Mark Elliott, Phillip Grammer

Public Health Faculty Publications

Temporal and spatial trends for key water quality measures were evaluated in 12 rural drinking water systems within a threecounty study area in Alabama. The water systems varied in size from very small (25–500 people served) to large (10,001–100,000 people served). Large-volume water samples were collected from 10 diverse locations within each system on three sampling dates. Sampling locations were assigned to one of five location categories: well, post-treatment, post-storage, in-line, and endline. Water quality parameters (i.e., free and total chlorine, pH, turbidity, pressure, heterotrophic plate count) and microbial indicators (i.e., total coliforms, Escherichia coli, Enterococci, male-specific coliphages) were analyzed …

Notes2: Networks-Of-Traces For Epidemic Spread Simulations, Sicong Liu, Yash Garg, K. Selçuk Candan, Maria Luisa Sapino, Gerardo Chowell

Public Health Faculty Publications

Decision making and intervention against infectious diseases require analysis of large volumes of data, including demographic data, contact networks, agespecific contact rates, mobility networks, and healthcare and control intervention data and models. In this paper, we present our Networks-Of-Traces for Epidemic Spread Simulations (NOTES2) model and system which aim at assisting experts and helping them explore existing simulation trace data sets. NOTES2 supports analysis and indexing of simulation data sets as well as parameter and feature analysis, including identification of unknown dependencies across the input parameters and output variables spanning the different layers of the observation and simulation data.

Impact Of School Cycles And Environmental Forcing On The Timing Of Pandemic Influenza Activity In Mexican States, May-December 2009, James Tamerius, Cecile Viboud, Jeffrey Shaman, Gerardo Chowell

Public Health Faculty Publications

While a relationship between environmental forcing and influenza transmission has been established in inter-pandemic seasons, the drivers of pandemic influenza remain debated. In particular, school effects may predominate in pandemic seasons marked by an atypical concentration of cases among children. For the 2009 A/H1N1 pandemic, Mexico is a particularly interesting case study due to its broad geographic extent encompassing temperate and tropical regions, well-documented regional variation in the occurrence of pandemic outbreaks, and coincidence of several school breaks during the pandemic period. Here we fit a series of transmission models to daily laboratory-confirmed influenza data in 32 Mexican states using …

Transmission Characteristics Of Mers And Sars In The Healthcare Setting: A Comparative Study, Gerardo Chowell, Fatima Abdirizak, Sunmi Lee, Jonggul Lee, Eunok Jung, Hiroshi Nishiura, Cecile Viboud

Public Health Faculty Publications

Background: The Middle East respiratory syndrome (MERS) coronavirus has caused recurrent outbreaks in the Arabian Peninsula since 2012. Although MERS has low overall human-to-human transmission potential, there is occasional amplification in the healthcare setting, a pattern reminiscent of the dynamics of the severe acute respiratory syndrome (SARS) outbreaks in 2003. Here we provide a head-to-head comparison of exposure patterns and transmission dynamics of large hospital clusters of MERS and SARS, including the most recent South Korean outbreak of MERS in 2015.

Methods: To assess the unexpected nature of the recent South Korean nosocomial outbreak of MERS and estimate the probability …