Medicine and Health Sciences Commons^™

(Video) Income-Related Inequalities In Utilization Of Health Services Among Private Health Insurance Beneficiaries In Brazil, Heitor Werneck

GW Research Days 2016 - 2020

Brazil’s 1988 health reform created the Unified Health System (SUS). SUS is a universal health system that emulates British National Health Service, featuring an open-ended benefit package and a major goal of health equity. An unforeseen consequence of the reform was that former beneficiaries of the social health insurance sought to sustain their privileged access to health services through private health insurance. Despite achievements in expanding healthcare access and improved health outcomes, recurring opinion polls suggest that Brazilians are skeptical about SUS’ capacity to delivery timely and quality health services, making private insurance a priority to most households. The literature …

(Video) Maternal Depression And Child Externalizing Behaviors, Julia Gruspier, Shannon Shisler, Rina C. Eiden

GW Research Days 2016 - 2020

About 10.97% of women with children aged 1 to 4 years old are identified with depression. Children of mothers with depression are more likely to exhibit externalizing behavior problems, and these problems have been reported to appear more frequently in male children. We examined the association between maternal depression and externalizing behavior in toddlers, and whether child sex moderated these effects, as previous studies have shown child behavior to be linked to both child sex and maternal depression. The sample included 186 mother/child dyads (95 male children) who were recruited in the first trimester of pregnancy from an urban hospital. …

Maternal Leisure-Time Physical Activity And Risk Of Preterm Birth: A Systematic Review Of The Literature, Mira Kahn, Loretta Dipietro, Kimberly Robien

GW Research Days 2016 - 2020

Background: Preterm birth is a leading cause of infant death and regular physical activity may reduce the risk for preterm birth because of its beneficial effects on pregnancy complications such as preeclampsia, excessive weight gain, and gestational diabetes. On average, however, pregnant women report lower levels of physical activity compared with those who are not pregnant. This systematic review examined low, moderate and vigorous leisure-time physical activity (LTPA) during pregnancy and the outcome of preterm birth.

Methods: Key words related to preterm birth and physical activity were used to search relevant databases (Medline, Cochrane, CINAHL, Sports Discuss and Scopus). Studies …

Racial And Ethnic Disparities In Health Care: An Examination Of State Inpatient Databases In The Utilization Of And Outcomes Following Total Knee Arthroplasty, Alexis W. Lan, Wei Zhang, Yan Ma

GW Research Days 2016 - 2020

Title: Racial and Ethnic Disparities in Health Care: An Examination of State Inpatient Databases in the Utilization of and Outcomes following Total Knee Arthroplasty

Background: The U.S. population is becoming more racially and ethnically diverse yet disparities in health care still exist. One area of medical care in which racial disparities have been identified is total knee arthroplasty (TKA)¬—an efficacious and cost-effective treatment option for individuals with advanced arthritis of the knee. Previous studies have documented that racial and ethnic minorities tend to have higher rates of adverse health outcomes and face more barriers utilizing the procedure. However, these studies …

Predictors Of Malnutrition In Different Geographic Regions Of Peru, Elizabeth Lacroix

GW Research Days 2016 - 2020

Malnutrition is responsible for over 3 million childhood deaths each year. Those who survive early nutritional deficiencies and the subsequent growth failure face life-long consequences, including long-term deficits in cognitive development, decreased academic achievement, and reduced economic opportunities later in life. Low height for age, or stunting, indicates chronic malnutrition, while low weight for height (wasting) indicates acute malnutrition. Caloric deficiencies, micronutrient deficiencies, intestinal parasites, and diarrheal diseases all directly contribute to acute and chronic undernutrition.

Peru is an ethnically and geographically diverse country that has experienced great economic growth and dramatic health improvements in the last decade. Nationally, stunting …

Promotion Of Drinking Water Among Latino Immigrant Youth, Nicole Barrett, Allison Elkins, Uriyoan Colón-Ramos, Ivonne Rivera, W. Douglas Evans, Mark Edberg

GW Research Days 2016 - 2020

Objective: To design an innovative intervention to increase drinking water behaviors among Latino immigrant youth.

Methods: We conducted two rounds of focus groups, totaling 10 sessions (n=61), with Latino immigrant youth, aged 6-18 years, living in Langley Park, Maryland. Participants were stratified into focus groups by age group (elementary, middle, and high school) and language preference (Spanish and English). A professional, bilingual-speaking moderator used a semistructured discussion guide to examine: (1) what youth preferred to drink in different settings and why, (2) their reactions to promotional messages, (3) slogans that would entice them to drink more water in school and …

Consumption Of Low-Calorie Sweeteners In The United States 2009-12, Yichen Jin, Allison C. Sylvetsky, Jean A. Welsh, Kristina I. Rother, Sameera A Talegawkar

GW Research Days 2016 - 2020

We have previously demonstrated that low-calorie sweetener (LCS) consumption increased in the United States (US) between 1999 and 2008 (from 9% to 15 % in kids and from 27% to 32% in adults), but little is known about current consumption. We therefore analyzed National Health and Nutrition Examination Survey (NHANES) data collected in 2011-12 and compared LCS consumption patterns across socio-demographic subgroups. Dietary sources of LCS were identified using NHANES food descriptions. Prevalence of consumption nationally and by age, race, gender, socio-economic status, educational attainment, were estimated using two 24-hour dietary recalls. F-tests were used to evaluate differences in consumption …

Smoking Characteristics And Psychiatric Comorbidities Of Pregnant Smokers: An Analysis Of Quit4baby Randomized Controlled Trial, Shawn Chiang, Lorien C. Abroms, Jennifer M. Schindler-Ruwisch, Leah E. Leavitt

GW Research Days 2016 - 2020

Background: Text messaging or short message service (SMS) programs have been shown to be effective in helping adult smokers quit smoking (Abroms et al., 2014). However, to our knowledge, no prior research has examined psychiatric comorbidities associated with smoking in the text messaging context. The risk of smoking has been shown to increase as a function of the number of psychiatric illnesses with which a person is diagnosed (Aubin, Rollema, Svensson, & Winterer, 2012). The current study examined this association and other correlates of smoking-psychiatric comorbidity in a sample of U.S. pregnant smokers enrolled in Quit4Baby, a smoking cessation text …

Is Androgen Excess Masked In Alopecia Areata Patients: A Retrospective Data Analysis Of 1,587 Patients, G. Cheyana Ranasinghe, Melissa Piliang, Wilma Bergfeld

GW Research Days 2016 - 2020

Studies on the pathophysiology and comorbidities associated with alopecia areata (AA) are limited. The purpose of this study was to determine the prevalence of androgen excess in AA and its subtypes, in relation to demographics and comorbidities. Medical records of 1,587 Patchy AA, AT, AU, and ophiasis patients seen in the Department of Dermatology at the Cleveland Clinic Foundation in Ohio between 2005 and 2015 were reviewed. Out of this cohort, 226 patients met the inclusion criteria. There is evidence that patients with AA had significantly greater prevalence of polycystic ovary syndrome (PCOS) than the general population (p<0.001). Androgen excess was identified in 42.5% (n=96) of the 226 patients with AA or any subtype (p<0.001). The androgen excess group was significantly more likely to present with irregular menses, hirsutism, adult acne, PCOS, and/or ovarian cysts (p<0.001). This study was limited by being retrospective. Our study demonstrated that AA is associated with androgen excess.

Is The Force Awakened? Publication Trends In Oncology Big Data As Phase Ii Cancerlinq Is Launched, Hind Rafei, Benjamin Viernes, Angelike P. Liappis, Dalia Abdelaziz Mobarek

GW Research Days 2016 - 2020

Background: The American Society of Clinical Oncology launched CancerLinQ project in 2010 to provide real-time data collection, mining and visualization, clinical decision support, and quality feedback. Creation of a big data software platform is currently underway to power the CancerLinQ in the phase II of the project. This would allow for evidence driven practice and rapid learning for cancer care providers. Additionally, adequate knowledge about the utility of Big Data to encourage provider utilization in high Impact Factor (IF) journals is needed. We aimed to assess trends and quality of Big Data published in Oncology.

Methods: Peer-reviewed English …

Perioperative Aspirin Recommendations In Children With Fenestrated Fontan Undergoing Adenotonsillectomy, Mariam Ashraf, Pamela A. Mudd, Jamie Mcelrath Schwartz, Karen Thompson

GW Research Days 2016 - 2020

Objective: Pediatric patients who have undergone the Fontan procedure are often on a long term aspirin regimen which can complicate perioperative management. In high risk procedures such as adenotonsillectomy, hemorrhage can be a significant complication and aspirin use may increase the risk. There is a need for evidence-based protocol on how to manage aspirin intake in the perioperative period for Fontan patients. We report the case of a patient with Fontan palliation who underwent adenotonsillectomy and presented with postoperative hemorrhage.

Methods: PubMed was searched for guidelines, case reports, and reviews on pediatric Fontan patients, adenotonsillectomy, and perioperative aspirin …

Optimizing Electrocardiogram Interpretation And Catheterization Laboratory Activation In St-Segment Elevation Myocardial Infarct, Alexander E. Sullivan, Mortada Shams, Marco A. Mercader, Jacob Varghese, Abudureyimu Shajidan, Bassel Hassouna, Vimala V. Jayanthi

GW Research Days 2016 - 2020

Background: To achieve the 90-minute reperfusion goal in ST-segment elevation myocardial infarction (STEMI) care, providers must diagnose STEMIs from electrocardiograms (ECGs) obtained upon emergency room arrival and appropriately activate the catheterization lab. To enhance early STEMI care, we sought to improve medical student STEMI recognition and diagnostic accuracy with a teaching module we designed and developed.

Methods: Through a literature review, we identified evidenced-based criteria for classic STEMI patterns, STEMI-equivalents with non-classic STEMI patterns including hyperacute T-waves, STEMI with existing left bundle branch block (LBBB) and Wellens’ syndrome and non-ischemic STEMI-mimics such as known LBBB, pericarditis, ventricular aneurysm, …

Circulating Mirna Biomarkers In Early Breast Cancer Detection Following Mammography, Alexa Lean, Jialu Lucy Yang, Xiaohui Tan, Christine B. Teal, Rachel F. Brem, Sidney W. Fu

GW Research Days 2016 - 2020

The currently accepted stepwise model of breast tumorigenesis assumes a gradual transition from normal breast epithelial cells to atypical ductal hyperplasia (ADH), to ductal carcinoma in situ (DCIS) and then to invasive ductal carcinoma (IDC). Percutaneous core needle biopsy (CNB) is the standard technique following an abnormal mammographic finding. However, CNB is less reliable in differentiating simple ADH (sADH) from ADH component coexisted with advanced lesions such as DCIS and/or IDC (cADH). Therefore, to identify and validate novel reliable molecular biomarkers is essential in order to improve the efficiency of therapeutic recommendations, as well as to minimize anxiety and unnecessary …

Teaching Internal Medicine Residents About Genetics: One Topic At A Time - Breast Cancer, Maria Henry, Andrew Nance, Charles Macri

GW Research Days 2016 - 2020

Background: Currently, the field of medicine is experiencing rapid changes in genetics and genomics information. While medical school curricula all include some genetics education, the content may vary from one school to another, leaving Internal Medicine (IM) residents with different skills and knowledge. In an IM residency where residents come from different medical schools, presenting an organized genetics curriculum may have value. Patients expect their physicians to be knowledgeable and current about their specific disease, including the genetic components and expect that they can inform them about terminology, inheritance, diagnostic testing, risks and benefits of testing. Physicians will need …

Using Biofeedback In Hiv+ Patients, Domenique Escobar, Mikhail Kogan, Randi Abramson

GW Research Days 2016 - 2020

Background - The prevalence of HIV in Washington, DC is estimated to be at least 3%, triple what the World Health Organization defines as an epidemic. Even at that conservative estimate, the number of people living with HIV in the District of Columbia is the highest in the nation. Individuals living with HIV face stigma, anxiety, stress and depression, among a host of other physical and mental effects. Stress has a significant impact on the immune system and a biofeedback program can be of benefit to patients undergoing any stress. Biofeedback is a technique that trains people to improve their …

Otolaryngology For Internal Medicine: Increasing Exposure To Otolaryngology Using Computer Assisted Instruction, Arielle Thal, Philip Zapanta

GW Research Days 2016 - 2020

It has been well identified in previous literature that there is a lack of otolaryngology teaching for general practitioners. There is not currently a standardized curriculum for otolaryngology in undergraduate medical education or during residency for those pursuing a general field such as Emergency Medicine, Internal Medicine, Pediatrics or Family Medicine. While the need for more exposure to otolaryngology within these fields has been well documented, as 25% of primary care complaints are otolaryngology related, little has been done to identify the best method for educational intervention. Important topics for inclusion in such a curriculum have been identified and methods …

Volume Averaging Of Spectral-Domain Optical Coherence Tomography Impacts Retinal Segmentation In Children, Carmelina Trimboli-Heidler, Kelly Vogt, Robert A. Avery

GW Research Days 2016 - 2020

Purpose: To determine the influence of volume averaging on retinal layer thickness measures acquired with spectral-domain optical coherence tomography (SD-OCT) in children.

Methods: Macular SD-OCT images were acquired using three different volume acquisition settings (i.e., ART 1, 3, and 9 volumes) in children enrolled in a prospective OCT study. Total retinal, retinal nerve fiber layer, ganglion cell layer, inner plexiform layer, inner nuclear layer, and outer plexiform layer thicknesses were measured around an ETDRS grid using beta version automated segmentation software for the Spectralis. The magnitude of manual segmentation required to correct the automated segmentation was classified as …

Medical Student Competency In Wound Care Guidelines, Sophia Akhiyat, Sean Mcnish, Kara S. Couch, Victoria K. Shanmugam

GW Research Days 2016 - 2020

Chronic wounds that have failed to heal after 3 months of appropriate wound care affect approximately 6.5 million people in the US with a prevalence of 1% and costs estimated at $25 billion per year. Medical students currently receive limited wound care training, yet to effectively manage chronic wounds, providers must both understand the biology of healing, and also remain up-to-date with wound care guidelines published by the Agency for Healthcare Research and Quality (AHRQ). The purpose of this student-led project was to investigate medical students' knowledge and comfort with wound care guidelines.

Severity Of Pain Is Not Associated With Urgency Of Diagnosis In Ed Patients With Abdominal Pain, Ryan Brunetti, Caitlin David, Lorna Richards, Melissa J. Mccarthy, Andrew C. Meltzer

GW Research Days 2016 - 2020

Background

Abdominal Pain is the most common cause of visits to US Emergency Departments (EDs) and the causes range from urgent to non-urgent diagnoses. Distinguishing urgent versus non-urgent causes of abdominal pain is done through the use of clinical exam, lab studies and diagnostic imaging such as CT scans. There are no validated clinical decision rules to assist physicians in discriminating urgent from non-urgent causes of abdominal pain or which patient needs a CT scan. There is controversy regarding the use of CT scans for patients with abdominal pain due to the increased cost, radiation exposure and length of stay. …

Diet As A Risk Factor In Obstructive Sleep Apnea, Caitlin Bove, Vivek Jain, Naji Younes, Marijane Hynes

GW Research Days 2016 - 2020

Rationale: Obstructive sleep apnea (OSA) is a common disease affecting approximately 2% of women and 4% of men. It is independently associated with cardiovascular disease and metabolic syndrome. Established risk factors for OSA include obesity, male gender, post-menopausal state, smoking and increased neck circumference. Sleep deprivation, a common occurrence in OSA, is associated with weight gain and cravings for carbohydrates. Preference for fatty foods has been documented in sleep deprivation. Studies using mouse models have suggested that high fats diets increase the severity of sleep apnea independent of BMI (body mass index). We hypothesized that dietary habits, especially increased …

Comparing Emergency Department Resident And Patient Perspectives On Costs In Emergency Care, Stefanie Gilbert, Leana S. Wen, Jesse M. Pines

GW Research Days 2016 - 2020

Objectives: Costs of care are increasingly important in healthcare policy and, more recently, clinical care in the Emergency Department (ED). We compare ED resident and patient perceptions surrounding the costs of emergency care, compliance, communication, and education.

Methods: We conducted a mixed methods study using surveys and qualitative interviews in a single, urban academic ED. The first study population was a convenience sample of adult patients (>17 years of age), and the second was ED residents training at the same institution. Participants answered open- and closed-ended questions on costs, cost-related compliance, and communication. Residents answered additional questions …

Identifying Venous Thromboembolism In Cancer Patients Using Veterans Affairs Administrative Data, Noah Ravenborg, Najeebah A. Bade, Dalia Abdelaziz Mobarek

GW Research Days 2016 - 2020

Identifying Venous Thromboembolism in Cancer Patients Using Veterans Affairs Administrative Data

Noah Ravenborg1, Najeebah A. Bade, M.D.2, Dalia Abdelaziz Mobarek, M.D.1, 2, 3

1 George Washington University School of Medicine and Health Sciences, Washington, D.C. 2 Department of Medicine, Section of Hematology, Veterans Affairs Medical Center, Washington, D.C., 3 Department of Medicine, Section of Hematology & Medical Oncology, George Washington University Medical Center, Washington, D.C. Noah Ravenborg Cell phone: (310)-804-0848, Email: nravenborg@gwu.edu, MS2

IMPORTANCE: The validity of administrative data in identifying diagnoses within the Veterans Affairs (VA) database, including viral hepatitis, cirrhosis, H. pylori, and cancer metastasis has been reported. …

Micro-Rna And Mrna Profiles Associated With Ectopic Germinal Center Formation In Thymus Samples Of Patients With Autoimmune Myas, Manjistha Sengupta, Bi-Dar Wang, Norman H. Lee, Gary Cutter, Linda Louise Kusner, Henry J. Kaminski

GW Research Days 2016 - 2020

Myasthenia gravis (MG) is an autoimmune neuromuscular disorder caused by antibodies directed against proteins present at the post-synaptic surface of neuromuscular junction (NMJ). A characteristic pathology of patients with early onset MG is thymic hyperplasia with ectopic germinal centers (GC). However, mechanisms that trigger and maintain thymic hyperplasia are poorly characterized. Micro-RNAs (miRNA) are small, non-coding RNAs that are increasingly appreciated to be involved in the pathology of several autoimmune diseases. In order to determine the central mechanisms involved in the pathology, thymus samples from MG patients were assessed by histology and grouped based on appearance of GC compared to …

Pregnant Women’S Health Consequences Following Exposure To Pbdes, Alison Chiaramonte, Ami R. Zota

GW Research Days 2016 - 2020

PBDEs (Polybrominated diphenyl ethers) are chemicals introduced by industry in the 1970s to serve as flame-retardants on common consumer products like electronics, plastics, and foam in furniture. They are also suspected to disrupt thyroid activity during pregnancy, which is a time of increased demand on the thyroid gland. Maternal thyroid fluctuations and disease as a result of exposure to PBDEs are therefore a concern. This systematic review aimed to capture all of the relevant peer-reviewed literature investigating the association between PBDEs and maternal thyroid activity. Use of the PRISMA checklist (Preferred Reporting Items for Systematic Reviews and Meta-Analyses), a best …

Spectral Changes Caused By Radiofrequency Ablation Of Cardiac Tissue, Mohammed Aljishi, Huda Asfour, Luther Swift, Narine Muselimyan, Marco A. Mercader, Narine Sarvazyan

GW Research Days 2016 - 2020

New diagnostic catheters can be developed by delivering and acquiring light through a small fiberoptic bundle. This can provide a useful real time feedback guidance to observe tissue damage caused by thermal injury used to treat cardiac arrhythmias. Yet, little is known about the exact spectral changes caused by radiofrequency ablation (RFA) in different types of cardiac tissue. We hypothesized that the most sensitive optical ranges for characterizing thermal injury can be revealed by comparing spectral information from different areas of the heart before and after RF ablation. Freshly excised porcine hearts were used to acquire and analyze excitation emission …

A Systematic Review Of Coal Fired Power Plant Proximity And Local Socioeconomic Status Trends And Outcomes, Oshane Mcrae, Peter Lapuma

GW Research Days 2016 - 2020

Among the significant sources of energy, coal based energy bears the largest share (42%) of the electricity produced in the United States. Already existing coal fired power plants are the largest emitter of carbon dioxide emissions in the United States. Among the cumulative emissions contributed by the industrial sector, significant portions are from coal fired power plants. Coal-fired power plants emit 66% of sulfur oxides, 40% of carbon dioxide, 33% of mercury and 22% of nitrogen oxides in the U.S. and are linked as risk factors to respiratory diseases, cardiovascular diseases and other ailments shown to impact environmental and human …

Clinical Public Health Integration In Medical School Curriculum: Transitioning Medical Student Training From Medical Problems To Health Solutions, Ashtin Jeney, Bridget C. Huysman, Jamie Majdi, Kent Aje, Madeline Taskier, David K. Popiel, Lawrence R. Deyton, Karla Bartholomew

GW Research Days 2016 - 2020

The current chronic disease burden, growing health disparities, and evolution of our healthcare system require that medical students be equipped with basic public health education to effectively manage patients, navigate the healthcare system, and advocate for health(1,2,3,4,5,6). The Institute of Medicine and the AAMC emphasize the need for physicians to be trained in public health(1,8). The inaugural year of the revised curriculum at The George Washington University School of Medicine and Health Sciences (GW SMHS) represented a first step at the institution to integrate clinical public health into medical education. As part of this process, the Clinical Public Health (CLiPH) …

Assessing The Effectiveness Of Partners In Quitting, A Text Message-Based Smoking Cessation Program, Rachael Schoenbrun

GW Research Days 2016 - 2020

This presentation will discuss the implementation of Partners in Quitting, a new text message-based smoking cessation program. It will also provide preliminary data on client engagement rates, program effectiveness, and program challenges. Partners in Quitting is an outreach program that has been implemented at Bread for the City, a large DC hub for free health and social services. Partners in Quitting provides an evidence-based, easily accessible, and comprehensive smoking cessation program to the clients of Bread for the City.

Single Nucleotide Polymorphisms In Cldn14 And Smoc1 Affecting Bone Mineral Density Influence Other Musculoskeletal Traits, Christopher Payette, Courtney Sprouse, Cara Goerlich, Heather A. Gordish-Dressman, Thomas Lynch, Heather Flynn, Leticia M. Ryan, Eric P. Hoffman, Monica J. Hubal, Paul D. Thompson, Theodore J. Angelopoulos, Paul M. Gordon, Niall M. Moyna, Linda S. Pescatello, Paul S. Visich, Robert F. Zoeller, Laura L. Tosi

GW Research Days 2016 - 2020

Background: A recent genome-wide association study (GWAS) identified novel genes influencing bone mineral density (BMD). This three stage GWAS identified two novel loci: rs227425 in the SPARC-Related Modular Calcium Binding 1 gene (SMOC1) was significantly associated with BMD and rs170183 in the claudin 14 (CLDN14) gene was significantly associated with BMD in females.

Objective: The purpose of this study was to determine if two novel single nucleotide polymorphisms (SNPs) known to affect BMD are associated with other musculoskeletal traits.

Methods/Design :The Bone Health Cohort consists of 150 African-American participants enrolled at Children’s National Health System as part of …