Medicine and Health Sciences Commons^™

Insights And Blind Spots: A Qualitative Analysis Of Risk In Psychiatric Security Review Board Hearings, Abby Kealani Balfour

Dissertations and Theses

The prevalence and consequences of the insanity plea, titled "guilty except for insanity" in the State of Oregon, are fraught with misconceptions. The use of the plea requires a complex set of interactions between the mental health and criminal justice systems, and comes with severe costs for people who use it. Most of the research on the psychological aspects of the insanity plea emphasizes empirical validity in the form of risk assessment instruments and/or the biomedical model with its focus on disease and illness. This thesis analyzes from community psychology and critical theory perspectives the decision process of hearings held …

Health Behaviour Changes After Diagnosis Of Chronic Illness Among Canadians Aged 50 Or Older, Jason T. Newsom, Nathalie Huguet, Pamela L. Ramage-Morin, Michael Joseph Mccarthy, Julie Bernier, Mark S. Kaplan, Bentson H. Mcfarland

Community Health Faculty Publications and Presentations

Changes in health behaviors (smoking, physical activity, alcohol consumption, and fruit and vegetable consumption) after diagnosis of chronic health conditions (heart disease, cancer, stroke, respiratory disease, and diabetes) were examined among Canadians aged 50 or older. Results from 12 years of longitudinal data from the Canadian National Population Health Survey indicated relatively modest changes in behavior. Although significant decreases in smoking were observed among all groups except those with respiratory disease, at least 75% of smokers did not quit. No significant changes emerged in the percentage meeting physical activity recommendations, except those with diabetes, or in excessive alcohol consumption, except …

Lower Nutritional Status And Higher Food Insufficiency In Frail Older Us Adults, Ellen Smit, Kerri M. Winters-Stone, Paul D. Loprinzi, Alice M. Tang, Carlos J. Crespo

Community Health Faculty Publications and Presentations

Frailty is a state of decreased physical functioning and a significant complication of ageing. We examined frailty, energy and macronutrient intake, biomarkers of nutritional status and food insufficiency in US older adult (age ≥ 60 years) participants of the Third National Health and Nutrition Examination Survey (4731). Frailty was defined as meeting ≥ 2 and pre-frailty as meeting one of the following four-item criteria: (1) slow walking; (2) muscular weakness; (3) exhaustion and (4) low physical activity. Intake was assessed by 24 h dietary recall. Food insufficiency was self-reported as ‘sometimes’ or ‘often’ not having enough food to eat. Analyses …

Htlv-1 And -2 Infections Among 10 Indigenous Groups In The Peruvian Amazon, Isaac E. Alva, E. Roberto Orellana, Magaly M. Blas, Antonio Bernabe-Ortiz, Armando Cotrina, Marina Chiappe, Tadeusz J. Kochel, Cesar P. Cárcamo, Patricia J. García, Joseph R. Zunt, Anne L. Buffardi, Silvia M. Montano

School of Social Work Faculty Publications and Presentations

Infections with HTLV-1 and -2 were detected in 12 (1.9%) and 6 (0.9%) indigenous individuals living in 27 Amazonian villages in Peru. All infections occurred in Shipibo-Konibo people. HTLV was more common among participants living in villages distant from larger port cities and women with non-monogamous sexual partners.

System Dynamics Modeling Of Prescription Opioid Pain Reliever Abuse, Alexandra Nielsen

Systems Science Friday Noon Seminar Series

The nonmedical use of prescription opioid pain relievers and associated overdose deaths have been labeled an epidemic by the Centers of Disease Control and Prevention. While these medicines play an important role in the treatment of pain, the benefits of opioids for the treatment of pain need to be balanced against these very real risks. Alex has been working closely with Professor Wayne Wakeland, Teresa Schmidt, and Dr. Dennis McCarty (OHSU) to create a dynamic systems-level model of opioid use, abuse, and diversion in order to give context to current research in this area and to provide a better understanding …

Body Mass Index And The Risk Of Prostate Cancer, Daniel Lee Mcgee, Carlos J. Crespo

Community Health Faculty Publications and Presentations

Background: This article presents cohort studies that use data from the National Health Information Survey from 1986 to 1994 and compares the effectiveness of Cox proportional hazards models that assume a linear relationship between body mass index (BMI) and the risk of prostate cancer with models that assume a J-shaped relationship. Methods and results: Our study found that for black males over 40 years of age, neither a linear nor a J-shaped relationship yielded a statistically significant model. With white males over 40 years, assuming a linear relationship did not yield a statistically significant model (P = 0.582). When we …

Family Aided Community Treatment As An Intervention For The Treatment Of Early Psychosis: A Proof Of Concept Study, Ryan P. Melton

Regional Research Institute for Human Services

Major psychotic disorders are one of the leading causes of disability worldwide, having severe impacts on the people who suffer from the conditions, their families and society. There is evidence that if these conditions are identified and treated early, the prognosis is improved. The purpose of this study is to produce findings related to the use of year long trial of family aided community treatment (FACT) with individuals who are experiencing a first episode psychosis as defined by the SIPS. Using a proof of concept design with multiple repeated measure t tests, this study focused on first-episode psychotic disorder participants …

Variation In Genes Related To Cochlear Biology Is Strongly Associated With Adult-Onset Deafness In Border Collies, Jennifer S. Yokoyama, Ernst T. Lam, Alison L. Ruhe, Carolyn A. Erdman, Kathryn R. Robertson, Aubrey A. Webb, D. Colette Williams, Melanie L. Chang, Marjo K. Hytönen, Hannes Lohi, Steven P. Hamilton, Mark W. Neff

Anthropology Faculty Publications and Presentations

The domestic dog offers a unique opportunity to study complex disorders similar to those seen in humans, but within the context of the much simpler genetic backgrounds of pure breeds, which represent closed populations. We performed a whole-genome search for genetic risk factors of adult-onset deafness in the Border Collie, a breed of herding dog that relies on acute hearing to perceive and respond to commands while working. Adult-onset deafness in Border Collies typically begins in early adulthood and is similar to age-related hearing loss in humans. This earlier onset has particular impact on the utility of working Border Collies …

Optimizing Network Connectivity For Mobile Health Technologies In Sub-Saharan Africa, Mark J. Siedner, Alexander J. Lankowski, Derrick Musinga, Jonathan Jackson, Conrad Muzoora, Peter W. Hunt, Jeffrey N. Martin, David Bangsberg, Jessica E. Haberer

OHSU-PSU School of Public Health Faculty Publications and Presentations

Background: Mobile health (mHealth) technologies hold incredible promise to improve healthcare delivery in resourcelimited settings. Network reliability across large catchment areas can be a major challenge. We performed an analysis of network failure frequency as part of a study of real-time adherence monitoring in rural Uganda. We hypothesized that the addition of short messaging service (SMS+GPRS) to the standard cellular network modality (GPRS) would reduce network disruptions and improve transmission of data.

Methods: Participants were enrolled in a study of real-time adherence monitoring in southwest Uganda. In June 2011, we began using Wisepill devices that transmit data each time the …

The Effects Of Yoga Therapy On The Quality Of Life For A Paraplegic Individual, Allison Renee Purdy

Dissertations and Theses

The purpose of this study was to document the effects that a regular yoga therapy practice has on the quality of life for a paraplegic individual. Due to the unique nature of spinal cord injury (SCI), this was a case study with one participant. For 5 weeks the subject practiced a standardized yoga routine three times a week with a yoga teacher, receiving private instruction. Interview questions were asked before and after the intervention to document the participant's quality of life. Each week, the subject completed a modified SF-36 questionnaire as well as Cohen's Perceived Stress Survey. Perceived pain and …

System Dynamics Modeling Of Medical Use, Nonmedical Use And Diversion Of Prescription Opioid Analgesics, Wayne W. Wakeland, Teresa D. Schmidt, J. David Haddox

Wayne W. Wakeland

A dramatic rise in the nonmedical of pharmaceutical opioids has presented the United States with a substantial public health problem. Nonmedical use of prescription pain relievers has become increasingly prevalent in the US over the last two decades, and diversion of medicines obtained by prescription is assumed to be a major source of supply for nonmedical opioid use. Policymakers striving to protect population health by ameliorating the adverse outcomes of nonmedical use of opioid analgesics could benefit from a systems-level model which reflects the complexity of the system and incorporates the full range of available data. To address this need, …

From Portland To Paris: Clinical Perspectives On Supporting Young People Suffering From Early Psychosis, Craigan Usher, Ryan P. Melton, Sarah Lynch

Regional Research Institute for Human Services

This workshop examines the Early Detection and Prevention of Psychosis Program (EDIPPP) that focuses on reducing the incidence of major psychotic disorders in a defined population, by early detection and treatment.

System Dynamics Modeling Of Medical Use, Nonmedical Use And Diversion Of Prescription Opioid Analgesics, Wayne Wakeland, Alexandra Nielsen, Teresa D. Schmidt

Systems Science Faculty Publications and Presentations

The objective of the study was to develop a system dynamics model of the medical use of pharmaceutical opioids to treat pain, and the associated diversion and nonmedical use of these drugs. The model was used to test the impact of simulated interventions in this complex system. The study relied on secondary data obtained from the literature and from other public sources for the period 1995 to 2008. In addition, an expert panel provided recommendations regarding model parameters and model structure. The behavior of the resulting systems level model compared favorably with reference behavior data (R2=.95). After the base model …

Predictors Of Parent–Child Communication Among A Nationally Representative Sample In Nigeria, Christina J. Sun, Kristina Berg, Stella Babalola

Community Health Faculty Publications and Presentations

This study explores what constructs are associated with parent–adolescent communication about AIDS/sexually transmitted infections (STIs) and sexual relationships in Nigeria. The analyses use data from the 2007 National HIV/AIDS and Reproductive Health Survey on 2593 men and women who had at least one child over the age of 12 years. The respondents were classified as low, medium, or high communicators. Low communicators were parents who did not talk to their child about either AIDS/STIs or sexual relationships. Medium communicators were parents who discussed only one topic with at least one child. High communicators were parents who discussed both topics with …

High Acceptability For Cell Phone Text Messages To Improve Communication Of Laboratory Results With Hiv-Infected Patients In Rural Uganda: A Cross-Sectional Survey Study, Mark J. Siedner, Jessica E. Haberer, Mwebesa B. Bwana, Norma C. Ware, David Bangsberg

OHSU-PSU School of Public Health Faculty Publications and Presentations

Background: Patient-provider communication is a major challenge in resource-limited settings with large catchment areas. Though mobile phone usership increased 20-fold in Africa over the past decade, little is known about acceptability of, perceptions about disclosure and confidentiality, and preferences for cell phone communication of health information in the region.

Methods: We performed structured interviews of fifty patients at the Immune Suppression Syndrome clinic in Mbarara, Uganda to assess four domains of health-related communication: a) cell phone use practices and literacy, b) preferences for laboratory results communication, c) privacy and confidentiality, and d) acceptability of and preferences for text messaging to …

Rethinking The “Pre” In Pre-Therapy Counseling: No Benefit Of Additional Visits Prior To Therapy On Adherence Or Viremia In Ugandans Initiating Arvs, Mark J. Siedner, Alexander J. Lankowski, Jessica E. Haberer, Annet Kembabazi, Nneka Emenyonu, Alexander C. Tsai, Conrad Muzoora, Elvin H. Geng, Jeffrey N. Martin, David Bangsberg

OHSU-PSU School of Public Health Faculty Publications and Presentations

Background: Many guidelines recommend adherence counseling prior to initiating antiretrovirals (ARVs), however the additional benefit of pre-therapy counseling visits on early adherence is not known. We sought to assess for a benefit of adherence counseling visits prior to ARV initiation versus adherence counseling during the early treatment period.

Methods: We performed a secondary analysis of data from a prospective cohort of HIV-infected patients in Mbarara, Uganda. Adults were enrolled upon initiation of ARVs. Our primary exposure of interest was ARV adherence counseling prior to initiating therapy (versus concurrent with initiation of therapy). Our outcomes of interest were: 1) average adherence …

Mean Cd4 Cell Count Changes In Patients Failing A First-Line Antiretroviral Therapy In Resource-Limited Settings, Alexandra Calmy, Eric Balestre, Fabrice Bonnet, Andrew Boulle, Eduardo Sprinz, Robin Wood, Eric Delaporte, Eugène Messou, James Mcintyre, Kamal Marhoum El Filali, Mauro Schechter, N. Kumarasamy, David Bangsberg, Patrick Mcphail, Stefaan Van Der Borght, Carlos Zala, Matthias Egger, Rodolphe Thiébaut, François Dabis, Art-Linc Of Iedea Collaboration (Asia, South America, East, Southern And West Africa)

OHSU-PSU School of Public Health Faculty Publications and Presentations

Background: Changes in CD4 cell counts are poorly documented in individuals with low or moderate-level viremia while on antiretroviral treatment (ART) in resource-limited settings. We assessed the impact of on-going HIV-RNA replication on CD4 cell count slopes in patients treated with a first-line combination ART.

Method: Naïve patients on a first-line ART regimen with at least two measures of HIV-RNA available after ART initiation were included in the study. The relationships between mean CD4 cell count change and HIV-RNA at 6 and 12 months after ART initiation (M6 and M12) were assessed by linear mixed models adjusted for gender, age, …

Motivating Men Who Have Sex With Men To Get Tested For Hiv, Magaly M. Blas, Luis A. Menacho, Isaac E. Alva, E. Roberto Orellana

School of Social Work Faculty Publications and Presentations

Although men who have sex with men (MSM) have the highest HIV prevalence in Peru, they are underserved by traditional preventive programs. Interestingly, in Peru the Internet and cell-phones have emerged as a convenient tool to reach this population.

Social And Contextual Factors That Influence Hiv Risk Behaviors Among Indigenous Msm In The Peruvian Amazon, Isaac E. Alva, E. Roberto Orellana

School of Social Work Faculty Publications and Presentations

Men who have sex with men (MSM) face a significantly higher risk of HIV infection than the general population around the globe. In Peru, HIV prevalence among MSM range from 14% to 23%, with Lima, the capital, and port cities in the Amazonian region being the most affected. Recent studies found that indigenous MSM who leave their villages for cities along the Amazon River and its tributaries, engage in high risk behaviors such as high alcohol consumption and unprotected sex with mestizo (non- indigenous) MSM. This study examined social and contextual factors associated with risky behaviors among indigenous MSM in …

Family Psychoeducation In Clinical High Risk And First- Episode Psychosis, William R. Mcfarlane, Sarah Lynch, Ryan P. Melton

Regional Research Institute for Human Services

Seventy percent of those who will have an episode of psychosis will have done so by age 25. Data from clinical trials of intervention during the clinical high risk period of psychosis have determined that the mean age is in mid-adolescence, 16-18 years of age. For those reasons, early intervention inherently involves adolescents, and by extension their parents and other family members and supports. Regarding the type of intervention, it is relevant that the current empirically-derived standard of treatment for schizophrenia, as concluded by the Agency for Health Care Policy and Research survey of the treatment outcome literature, includes family …

Safety And Adherence To Intermittent Pre-Exposure Prophylaxis (Prep) For Hiv-1 In African Men Who Have Sex With Men And Female Sex Workers, Gaudensia Mutua, Eduard J. Sanders, Peter Mwangi Mugo, Omu Anzala, Jessica E. Haberer, David R. Bangsberg, Burc Barin, James F. Rooney, David Mark, Paramesh Chetty, Patricia Fast, Frances H. Priddy

OHSU-PSU School of Public Health Faculty Publications and Presentations

Background: Little is known about safety of and adherence to intermittent HIV PrEP regimens, which may be more feasible than daily dosing in some settings. We present safety and adherence data from the first trial of an intermittent PrEP regimen among Kenyan men who have sex with men (MSM) and female sex workers (FSW).

Methods/Principal Findings: MSM and FSW were randomized to daily oral FTC/TDF or placebo, or intermittent (Monday, Friday and within 2 hours after sex, not to exceed one dose per day) oral FTC/TDF or placebo in a 2:1:2:1 ratio; volunteers were followed monthly for 4 months. Adherence …

Social, Structural And Behavioral Determinants Of Overall Health Status In A Cohort Of Homeless And Unstably Housed Hiv-Infected Men, Elise D. Riley, Torsten B. Neilands, Kelly Moore, Jennifer Cohen, David Bangsberg, Diane Havler

OHSU-PSU School of Public Health Faculty Publications and Presentations

Background: Previous studies indicate multiple influences on the overall health of HIV-infected persons; however, few assess and rank longitudinal changes in social and structural barriers that are disproportionately found in impoverished populations. We empirically ranked factors that longitudinally impact the overall health status of HIV-infected homeless and unstably housed men.

Methods and Findings: Between 2002 and 2008, a cohort of 288 HIV+ homeless and unstably housed men was recruited and followed over time. The population was 60% non-Caucasian and the median age was 41 years; 67% of study participants reported recent drug use and 20% reported recent homelessness. At baseline, …

Associations Between The Quality Of The Residential Built Environment And Pregnancy Outcomes Among Women In North Carolina, Marie Lynn Miranda, Lynne C. Messer, Gretchen L. Kroeger

Community Health Faculty Publications and Presentations

Background: The built environment, a key component of environmental health, may be an important contributor to health disparities, particularly for reproductive health outcomes.Objective: In this study we investigated the relationship between seven indices of residential built environment quality and adverse reproductive outcomes for the City of Durham, North Carolina (USA).

Methods: We surveyed approximately 17,000 residential tax parcels in central Durham, assessing > 50 individual variables on each. These data, collected using direct observation, were combined with tax assessor, public safety, and U.S. Census data to construct seven indices representing impor­tant domains of the residential built environment: housing damage, property disorder, …

Understanding Qualitative And Quantitative Research Paradigms In Academic Medicine, Laura Castillo-Page, Sue Bodilly, Sarah Bunton

University Studies Faculty Publications and Presentations

Qualitative research is becoming more prominent in academic medicine and health care fields, and an increasing number of publications using qualitative methods are featured in prominent journals; thus, recognizing the different available approaches can benefit researchers of all types. While a debate may wage between proponents of qualitative versus quantitative research, both sets of methods—and often a blend of the two—offer important insights into the problems the academic medicine community faces.

Potential For False Positive Hiv Test Results With The Serial Rapid Hiv Testing Algorithm, Steven Baveewo, Moses R. Kamya, Harriet Mayanja-Kizza, Robin Fatch, David Bangsberg, Thomas J. Coates, Judith A. Hahn, Rhoda K. Wanyenze

OHSU-PSU School of Public Health Faculty Publications and Presentations

Background: Rapid HIV tests provide same-day results and are widely used in HIV testing programs in areas with limited personnel and laboratory infrastructure. The Uganda Ministry of Health currently recommends the serial rapid testing algorithm with Determine, STAT-PAK, and Uni-Gold for diagnosis of HIV infection. Using this algorithm, individuals who test positive on Determine, negative to STAT-PAK and positive to Uni-Gold are reported as HIV positive. We conducted further testing on this subgroup of samples using qualitative DNA PCR to assess the potential for false positive tests in this situation.

Results: Of the 3388 individuals who were tested, 984 were …

Reversed Chloroquine Molecules As A Strategy To Overcome Resistance In Malaria, David H. Peyton

Chemistry Faculty Publications and Presentations

This short review tells the story of how Reversed Chloroquine drugs (RCQs) were developed. These are hybrid molecules, made by combining the quinoline nucleus from chloroquine (CQ) with moieties which are designed to inhibit efflux via known transporters in the membrane of the digestive vacuole of the malaria parasite. The resulting RCQ drugs can have potencies exceeding that of CQ, while at the same time having physical chemical characteristics that may make them favorable as partner drugs in combination therapies. The need for such novel antimalarial drugs will continue for the foreseeable future.

Neuroscience Of Personality: Principles Of The Psyche As A Living System, Dario Nardi

Systems Science Friday Noon Seminar Series

The brain is a complex living system. Using colorful slides and anecdotes, Dario Nardi, PhD will overview his hands-on research of the past 5 years in his social neuroscience lab using EEG technology to better understand the neocortex. He spends 2 to 3 hours with each subject, offering a variety of tasks from solo activities like meditating, drawing, and recalling to social activities like poker and speed-dating. The results are in. The neocortex relies upon a dynamic of modules, circuits, and holistic modes to continuously coordinate with the environment in both a top-down and a bottom-up manner. Moreover, individual differences …

A Cross-Sectional Study Of Us Rural Adults’ Consumption Of Fruits And Vegetables: Do They Consume At Least Five Servings Daily?, M. Nawal Lutfiyya, Linda F. Chang, Martin S. Lipsky

Community Health Faculty Publications and Presentations

Background: Rural residents are increasingly identified as being at greater risk for health disparities. These inequities may be related to health behaviors such as adequate fruits and vegetable consumption. There is little national-level population-based research about the prevalence of fruit and vegetable consumption by US rural population adults. The objective of this study was to examine the prevalence differences between US rural and non-rural adults in consuming at least five daily servings of combined fruits and vegetables.

Methods: Cross-sectional analysis of weighted 2009 Behavioral Risk Factor Surveillance Survey (BRFSS) data using bivariate and multivariate techniques. 52,259,789 US adults were identified …

A Novel Tool For Assessing And Summarizing The Built Environment, Gretchen L. Kroeger, Lynne C. Messer, Sharon E. Edwards, Marie Lynn Miranda

Community Health Faculty Publications and Presentations

Background: A growing corpus of research focuses on assessing the quality of the local built environment and also examining the relationship between the built environment and health outcomes and indicators in communities. However, there is a lack of research presenting a highly resolved, systematic, and comprehensive spatial approach to assessing the built environment over a large geographic extent. In this paper, we contribute to the built environment literature by describing a tool used to assess the residential built environment at the tax parcel-level, as well as a methodology for summarizing the data into meaningful indices for linkages with health data. …

A Counselor’S Role In Diagnosing The Proposed Dsm-5 Attenuated Psychosis Syndrome: A Pathway To Early Intervention Or Iatrogenic Consequences?, Vanessa Jung Tirman, Ryan P. Melton

Regional Research Institute for Human Services

Psychosis in general, and schizophrenia specifically, are among the most debilitating and difficult to treat disorders in mental health (Correll, Hauser, Auther, & Cornblatt, 2010). Identifying a patient with at-risk symptoms before the first episode of schizophrenia can be invaluable to the patient, clinician, and the community because the patient is treated early in the course of the disease where treatment is highly effective. After years of research it has been confirmed that at-risk symptoms for schizophrenia generally precede the first episode of psychosis, which results in the diagnosis of schizophrenia (Correll et al., 2010). At present however, the assessment …