Public Health Commons^™

Calcium Phosphate As A Key Material For Socially Responsible Tissue Engineering, Vuk Uskoković, Victoria M. Wu

Pharmacy Faculty Articles and Research

Socially responsible technologies are designed while taking into consideration the socioeconomic, geopolitical and environmental limitations of regions in which they will be implemented. In the medical context, this involves making therapeutic platforms more accessible and affordable to patients in poor regions of the world wherein a given disease is endemic. This often necessitates going against the reigning trend of making therapeutic nanoparticles ever more structurally complex and expensive. However, studies aimed at simplifying materials and formulations while maintaining the functionality and therapeutic response of their more complex counterparts seldom provoke a significant interest in the scientific community. In this review …

Prevalence Of Chronic Health Conditions Among Latinos In The United States Between 1990 And 2011, Amanda Mia Marín-Chollom

Center for Latin American, Caribbean, and Latino Studies

Introduction: This study examines the prevalence of five major chronic health conditions – heart disease, stroke, cancer, arthritis, and diabetes – among adults 18 years of age and older in the United States between 1999 and 2011.

Methods: The data used in this report come from the Center for Disease Control and Prevention’s (CDC) National Center for Health Statistics, Health Data Interactive tables. Patterns were examined by age structure among the four largest race/ethnic groups in the U.S., and among the two largest Latino subgroups in the U.S. (Mexicans and Puerto Ricans)

Results: Latinos had higher rates of diabetes than …

The Frequency Of Influenza And Bacterial Co-Infection: A Systematic Review And Meta-Analysis., Eili Y. Klein, Bradley Monteforte, Alisha Gupta, Wendi Jiang, Larissa May, Yu-Hsiang Hsieh, Andrea Freyer Dugas

Emergency Medicine Faculty Publications

AIM: Co-infecting bacterial pathogens are a major cause of morbidity and mortality in influenza. However, there remains a paucity of literature on the magnitude of co-infection in influenza patients.

METHOD: A systematic search of MeSH, Cochrane Library, Web of Science, SCOPUS, EMBASE, and PubMed was performed. Studies of humans in which all individuals had laboratory confirmed influenza, and all individuals were tested for an array of common bacterial species, met inclusion criteria.

RESULTS: Twenty-seven studies including 3,215 participants met all inclusion criteria. Common etiologies were defined from a subset of eight articles. There was high heterogeneity in the results (I(2) …

Human Papillomavirus Infection In Rwanda At The Moment Of Implementation Of A National Hpv Vaccination Programme, Fidele Ngabo, Silvia Franceschi, Iacopo Baussano, M. Chantal Umulisa, Peter Snijders, Anne Uyterlinde, Fulvio Lazzarato, Vanessa Tenet, Maurice Gatera, Agnes Binagwaho, Gary Clifford

Dartmouth Scholarship

Cervical cancer is the most common female cancer in Rwanda that, in 2011, became the first African country to implement a national vaccination programme against human papillomavirus (HPV). To provide a robust baseline for future evaluations of vaccine effectiveness, cervical cell specimens were obtained from 2508 women aged 18–69 years from the general population in Kigali, Rwanda, during 2013/14. 20 % of women were HIV-positive. Samples were used for liquid-based cytology and HPV testing (44 types) with GP5+/6+ PC.

Toward A Common Secure Future: Four Global Commissions In The Wake Of Ebola, Lawrence O. Gostin, Oyewale Tomori, Suwit Wibulpolprasert, Ashish K. Jha, Julio Frenk, Suerie Moon, Joy Phumaphi, Peter Piot, Barbara Stocking, Victor J. Dzau, Gabriel M. Leung

Georgetown Law Faculty Publications and Other Works

The world is becoming increasingly vulnerable to pandemics resulting from globalization, urbanization, intense human/animal interchange, and climate change. A series of global health crises have emerged since 2000, ranging from Severe Acute Respiratory Syndrome (SARS) and its phylogenetic cousin Middle East Respiratory Syndrome (MERS), to pandemic Influenza A (H1N1), Ebola, and the ongoing Zika virus epidemic. The Ebola epidemic gave rise to four global commissions proposing a bold new agenda for global health preparedness and response for future infectious disease threats.

Four global commissions reviewing the recent Ebola virus disease epidemic response consistently recommended strengthening national health systems, consolidating and …

A Yellow Fever Epidemic: A New Global Health Emergency?, Lawrence O. Gostin, Daniel Lucey

Georgetown Law Faculty Publications and Other Works

The worst yellow fever epidemic in Angola since 1986 is rapidly spreading, including the capital, Luanda. In Angola, the epidemic began in December 2015 and the laboratory-confirmed outbreak was reported to the World Health Organization (WHO) on January 21, 2016. Angola has had 2023 suspected cases and 258 deaths as of April 26, 2016. China, the Democratic Republic of Congo, and Kenya also have reported cases arising from infected travelers from Angola. Namibia and Zambia also share a long border with Angola, with considerable population movement between the countries. Similar to other recent epidemics, quick and effective action to stop …

Routine Screening For Abdominal Aortic Aneurysm: Is It For Everyone?, Catherine E. Nowak

Physician Assistant Capstones, 2016 to 2019

Objective: Determine whether routine abdominal ultrasound screening in all men ages 65 and over, not just those who are symptomatic or at risk, would be beneficial in reducing the mortality rate from abdominal aortic aneurysms (AAA). Design: Systematic literature review. Methods: The clinical question investigated is whether routine ultrasound screening of AAA for men over age 65 reduces AAA-related mortality as compared to not routinely screening. Searches were done through PubMed using the keywords: screening, abdominal aortic aneurysm, reduce, and mortality. Citations used by the USPSTF AAA screening guidelines were also added to the literature search. In PubMed, further limitations …

Epidemiological Characteristics Of Clinically-Confirmed Cases Of Chikungunya In Teculutan, Guatemala, Annaly Aldana

Senior Honors Projects

As no vaccine currently exists for the Chikungunya virus (CHKV), mosquito control and efficient public health campaigns are crucial for the prevention of disease propagation. The purpose of this research project is to identify populations particularly at-risk for acquiring Chikungunya, and to explore the role that cultural attitudes may play in impacting mosquito-borne disease. Due to its geographical structure and climate, Guatemala is an ideal territory for the spread of emerging and re-emerging mosquito-borne diseases. This project was developed by collaborating with the public governmental health clinic in the municipal town of Teculután, in the department of Zacapa in Guatemala. …

Health Behaviors And Their Correlates Among Participants In The Continuing To Confront Copd International Patient Survey, Hana Müllerová, Sarah H. Landis, Zaurbek Aisanov, Kourtney J. Davis, Masakazu Ichinose, David M. Mannino, Joe Maskell, Ana M. Menezes, Thys Van Der Molen, Yeon-Mok Oh, Maggie Tabberer, Meilan K. Han

Preventive Medicine and Environmental Health Faculty Publications

Background and aims: We used data from the Continuing to Confront COPD International Patient Survey to test the hypothesis that patients with COPD who report less engagement with their disease management are also more likely to report greater impact of the disease.

Methods: This was a population-based, cross-sectional survey of 4,343 subjects aged ≥ 40 years from 12 countries, fulfilling a case definition of COPD based on self-reported physician diagnosis or symptomatology. The impact of COPD was measured with COPD Assessment Test, modified Medical Research Council Dyspnea Scale, and hospital admissions and emergency department visits for COPD in the prior …

Factors Associated With Initiation Of Antiretroviral Therapy In The Advanced Stages Of Hiv Infection In Six Ethiopian Hiv Clinics, 2012 To 2013, Denis Nash, Olga Tymejczyk, Tsigereda Gadisa, Sarah Gorrell Kulkarni, Susie Hoffman, Muluneh Yigzaw, Batya Elul, Robert H. Remien, Maria Lahuerta, Shalo Daba, Wafaa El Sadr, Zenebe Melaku

Publications and Research

Introduction: Most HIV-positive persons in sub-Saharan Africa initiate antiretroviral therapy (ART) with advanced infection (late ART initiation). Intervening on the drivers of late ART initiation is a critical step towards achieving the full potential of HIV treatment scale-up. This study aimed to identify modifiable factors associated with late ART initiation in Ethiopia.

Methods: From 2012 to 2013, Ethiopian adults (n=1180) were interviewed within two weeks of ART initiation. Interview data were merged with HIV care histories to assess correlates of late ART initiation (CD4+ count <150 cells/mL or World Health Organization Stage IV).

Results: The median CD4 count at enrolment in HIV care was 263 cells/mL (interquartile range …

Neglect Amidst The Zika Epidemic: A Case Study On The Reach Of Government Campaigns And Resources In Quilombo Community Praia Grande, Bahia, Jenna Sherman

Independent Study Project (ISP) Collection

In response to the ongoing Zika epidemic in Brazil, a nationwide campaign has recently been launched targeting the eradication of mosquitoes, preventing the contraction of Zika, and deterring pregnancies. Many remote areas of Brazil, however, may not be being reached by these campaigns or resources to the same extent as more urban or affluent areas of Brazil—despite the existence of the universal healthcare system Sistema Único de Saúde (SUS). My objective, therefore, is to assess which media and on-ground campaigns regarding Zika have reached the minute island town of Praia Grande—a rural fishing Quilombo community of approximately 2,000 occupants off …

Tools And Methods For Zika Prevention In Cachoeira, Bahia, Florence Tesha

Independent Study Project (ISP) Collection

Zika virus, which is mainly transmitted by Aedes aegypti and Aedes albopictus mosquitoes, has become a major health threat in Brazil and other Latin American countries. Brazil is the country that is being most impacted with zika virus in addition to the existing mosquito-borne diseases of dengue and chikungunya. With the increase in zika virus infections, there have also been increasing numbers of infant brain abnormalities such as microcephaly associated to zika. International and local health institutions are working together to control and prevent zika transmission. This project aimed to investigate the various tools and methods employed by the Center …

The Feminization Of Hiv/Aids In Yunnan, China, Leah Pinckney

Independent Study Project (ISP) Collection

The feminization of HIV is a global phenomenon in which more women are becoming HIV-positive. This not only has tragic consequences for those women but also signifies how HIV transmission in China is changing. Increased sexual transmission has given HIV the ability to move from at-risk groups, such as intravenous drug users and commercial sex workers, to the general population. Despite China’s improved health policies and programs about HIV, this situation poses a serious public health issue allowed to perpetuate because of societal problems surrounding gender. These problems are compounded by socioeconomic inequality brought upon by economic change. While much …

Asessing The Implementation Of Hiv/Aids Programs Amongst Youth Fisherfolk: The Case Of Mbita, Kenya, Edward Ham

Independent Study Project (ISP) Collection

Homa Bay, Nyanza Province has the highest HIV/AIDS prevalence rate in Kenya (25.7%). Risky sexual behaviors are especially prevalent in fishing communities within this area. This study was conducted in Mbita, a sub-county of Homa Bay. The main objective was to determine which factors influence the implementation of HIV/AIDS programs amongst youth fisherfolk (ages 18-24) within beaches around Mbita. Data was collected through survey administration, key-informant interviews, and in depth interviews. The results highlight some interesting correlations, as well as a disturbing picture of the inequities females face within these fishing communities. Furthermore, a novel microclinic peer education HIV/AIDS program …

Educación Del Paciente Para El Auto Cuidado De La Diabetes En El Centro De Salud De Primaria Atención: Villa Verde En Partido De Pilar, Buenos Aires, Ethan Leigner

Independent Study Project (ISP) Collection

Vivir con diabetes cambia toda la vida de una persona. Sin el conocimiento de su autocuidado, el paciente tiene poca oportunidad de seguir viviendo la vida que desean. Sin educación adecuada, los diabéticos probablemente desarrollarán complicaciones que pueden conducir a problemas de salud muy graves y costosos. La prevalencia de diabetes ha ido en aumento en Argentina, y una estrategia efectiva para educar a los pacientes en el autocuidado es más necesaria ahora que nunca. Con un proceso eficiente de orientar a los pacientes a través del autocuidado, Argentina puede manejar mejor a largo plazo el efecto de diabetes y …

Paediatric Tuberculosis In Bhopal, Madhya Pradesh, India: Dots, Diagnosis, And Determinants, Emma Klein

Independent Study Project (ISP) Collection

Tuberculosis (TB) is one of the world’s largest public health challenges, and it has a disproportionate impact on India. In children, TB is a serious but understudied illness due to the complexity of case-notification and relative lack of public health importance. This study took place over the course of one month in Bhopal, Madhya Pradesh, India. In a mixed method study consisting of 53 quantitative patient interviews and qualitative interviews with healthcare providers, social determinants of TB in this setting were investigated as well as challenges faced at all stages of healthcare delivery. Malnutrition and housing were the most severe …

Women’S Views On The Challenges And Solutions In Preventing The Gendered Spread Of Hiv In Masxha, Cato Manor, Paige Mcmahon

Independent Study Project (ISP) Collection

Despite numerous national prevention efforts, South Africa remains at the epicenter of the HIV/AIDS epidemic. The burden of the epidemic is extremely heterogeneous, with province, race, gender, age, and socioeconomic status serving as key variables in determining HIV prevalence rates. Black African women are disproportionately affected by the epidemic, with those between the ages of 20 and 34 having an HIV prevalence rate of 31.6%, the highest in the country (Shisana et al., 2014). The purpose of this study was to engage with black African women about the challenges they believe women face in protecting themselves against HIV, and potential …

Re-Inventing Adherence: Toward A Patient-Centered Model Of Care For Drug-Resistant Tuberculosis And Hiv, Max R. O'Donnell, A. Daftary, M. Frick, Y. Hirsch-Moverman, K. R. Amico, M. Senthilingam, A. Wolf, J. Z. Metcalfe, P. Isaakidis, J. L. Davis, J. R. Zelnick, J.C.M. Brust, N. Naidu, M. Garretson, David Bangsberg, N. Padayatchi, G. Friedland

OHSU-PSU School of Public Health Faculty Publications and Presentations

BACKGROUND—Despite renewed focus on molecular tuberculosis (TB) diagnostics and new antimycobacterial agents, treatment outcomes for patients co-infected with drug-resistant TB and human immunodeficiency virus (HIV) remain dismal, in part due to lack of focus on medication adherence as part of a patient-centered continuum of care.

OBJECTIVE—To review current barriers to drug-resistant TB-HIV treatment and propose an alternative model to conventional approaches to treatment support.

DISCUSSION—Current national TB control programs rely heavily on directly observed therapy (DOT) as the centerpiece of treatment delivery and adherence support. Medication adherence and care for drug-resistant TB-HIV could be improved by fully implementing team-based patient-centered …

Treatment And Prevention Of Human Rotavirus (Hrv) In Developing Countries: The Potential Of Avian Immunoglobulin Y, Christa Brown

Senior Honors Theses

Rotavirus gastroenteritis is a leading cause of childhood mortality, killing ~1400 children younger than five daily, primarily through severe diarrheal dehydration. Eighty-five percent of this mortality occurs in developing countries where rotavirus vaccines are not widely implemented and are only partially effective. In those countries, it has proven difficult to implement the recommended supportive therapies like oral rehydration therapy (ORT) on a wide scale due to lack of both medical infrastructure and private economic investment combined with cultural bias against ORT. IgY targeting human rotavirus (anti-HRV IgY) shows potential as a passive immunotherapy that reduces rotavirus-associated morbidity and mortality, augments …

Expression Of Complement And Toll-Like Receptor Pathway Genes Is Associated With Malaria Severity In Mali: A Pilot Case Control Study, Rafal S. Sobota, Antoine Dara, Jessica E. Manning, Amadou Niangaly

Dartmouth Scholarship

Background: The host response to infection by Plasmodium falciparum, the parasite most often responsible for severe malaria, ranges from asymptomatic parasitaemia to death. The clinical trajectory of malaria is influenced by host genetics and parasite load, but the factors determining why some infections produce uncomplicated malaria and some proceed to severe disease remain incompletely understood.

Methods: To identify molecular markers of severe falciparum malaria, human gene expression patterns were compared between children aged 6 months to 5 years with severe and uncomplicated malaria who were enrolled in a case–control study in Bandiagara, Mali. Microarrays were used to obtain expression …

Parasitic Diseases Of The Central Nervous System: Lessons For Clinicians And Policy Makers, Arturo Carpio, Matthew L. Romo, R.M.E. Parkhouse, Brooke Short, Tarun Dua

Publications and Research

Parasitic diseases of the central nervous system are associated with high mortality and morbidity, especially in resource-limited settings. The burden of these diseases is amplified as survivors are often left with neurologic sequelae affecting mobility, sensory organs, and cognitive functions, as well as seizures/epilepsy. These diseases inflict suffering by causing lifelong disabilities, reducing economic productivity, and causing social stigma. The complexity of parasitic life cycles and geographic specificities, as well as overlapping clinical manifestations in the host reflecting the diverse pathogenesis of parasites, can present diagnostic challenges. We herein provide an overview of these parasitic diseases and summarize clinical aspects, …

Development Of A Spirometry T-Score In The General Population, Sei Won Lee, Hyun Kuk Kim, Seunghee Baek, Ji-Ye Jung, Young Sam Kim, Jae Seung Lee, Sang-Do Lee, David M. Mannino, Yeon-Mok Oh

Preventive Medicine and Environmental Health Faculty Publications

Background and objective: Spirometry values may be expressed as T-scores in standard deviation units relative to a reference in a young, normal population as an analogy to the T-score for bone mineral density. This study was performed to develop the spirometry T-score.

Methods: T-scores were calculated from lambda-mu-sigma-derived Z-scores using a young, normal age reference. Three outcomes of all-cause death, respiratory death, and COPD death were evaluated in 9,101 US subjects followed for 10 years; an outcome of COPD-related health care utilization (COPD utilization) was evaluated in 1,894 Korean subjects followed for 4 years.

Results: The …

Spatial Distribution And Cluster Analysis Of Retail Drug Shop Characteristics And Antimalarial Behaviors As Reported By Private Medicine Retailers In Western Kenya: Informing Future Interventions, Andria Rusk, Linda Highfield, J. Michael Wilkerson, Melissa Harrell, Andrew Obala, Benjamin Amick

Collected Faculty and Staff Scholarship

Background

Efforts to improve malaria case management in sub-Saharan Africa have shifted focus to private antimalarial retailers to increase access to appropriate treatment. Demands to decrease intervention cost while increasing efficacy requires interventions tailored to geographic regions with demonstrated need. Cluster analysis presents an opportunity to meet this demand, but has not been applied to the retail sector or antimalarial retailer behaviors. This research conducted cluster analysis on medicine retailer behaviors in Kenya, to improve malaria case management and inform future interventions.

Methods

Ninety-seven surveys were collected from medicine retailers working in the Webuye Health and Demographic Surveillance Site. Survey …

A Model For Hiv Disclosure Of A Parent's And/Or A Child's Illness, Gary J. Burkholder Jr, Grace Gachanja

Walden Faculty and Staff Publications

HIV prevalence in Kenya remains steady at 5.6% for adults 15 years and older, and 0.9% among children aged below 14 years. Parents and children are known to practice unprotected sex, which has implications for continued HIV spread within the country. Additionally, due to increased accessibility of antiretroviral therapy, more HIV-positive persons are living longer. Therefore, the need for HIV disclosure of a parent's and/or a child's HIV status within the country will continue for years to come. We conducted a qualitative phenomenological study to understand the entire process of disclosure from the time of initial HIV diagnosis of an …

Your Heart And Diabetes, Rodney Richmond

College of Pharmacy Faculty Research ​and Publications

No abstract provided.

Models For Hsv Shedding Must Account For Two Levels Of Overdispersion, Amalia Magaret

UW Biostatistics Working Paper Series

We have frequently implemented crossover studies to evaluate new therapeutic interventions for genital herpes simplex virus infection. The outcome measured to assess the efficacy of interventions on herpes disease severity is the viral shedding rate, defined as the frequency of detection of HSV on the genital skin and mucosa. We performed a simulation study to ascertain whether our standard model, which we have used previously, was appropriately considering all the necessary features of the shedding data to provide correct inference. We simulated shedding data under our standard, validated assumptions and assessed the ability of 5 different models to reproduce the …

Determinants Of Inconsistent Condom Use Among Hiv Serodiscordant Couples In Cambodia, Sovannary Tuot, Khuondyla Pal, Kouland Thin, Chrysanta Patio, Kelly Allbritton, Christie Blondek, Siyan Yi

Background: Globally, heterosexual transmission within serodiscordant relationships is a significant source of new HIV infections. In 2012, there were an estimated 1,350 incident cases of HIV in Cambodia, of which 37% were between heterosexual couples and 30% among sex workers. In combination with antiretroviral therapy (ART), consistent condom use can significantly reduce HIV transmission risk among serodiscordant couples. This study explored determinants of inconsistent condom use among serodiscordant couples in Cambodia. Methods: A cross-sectional study was conducted in Battambang, Pursat and Takeo provinces in September 2013. A structured questionnaire was used to collect data on condom use and …

Acceptability Study On Hiv Self-Testing Among Transgender Women, Men Who Have Sex With Men, And Female Entertainment Workers In Cambodia: A Qualitative Analysis, Khuondyla Pal, Chanrith Ngin, Sovannary Tuot, Pheak Chhoun, Cheaty Ly, Srean Chhim, Siyan Yi

Background: In Cambodia, HIV prevalence is high while HIV testing rates remain low among transgender women (TG women), men who have sex with men (MSM), and female entertainment workers (FEW). Introducing self-testing for HIV to these key populations (KPs) could potentially overcome the under-diagnosis of HIV and significantly increase testing rates and receipt of the results, and thus could decrease transmission. Therefore, this study aimed to determine the acceptability of HIV self-testing (HIVST) among these three categories of KPs.

Methods: This study was conducted through focus group discussions (FGDs) with TG women, MSM, and FEW in Phnom Penh …

A Pilot Study For Plant The Seed: A Nutrition Education Program Using Local Food Environment To Put Theory Into Action, Yeon Bai, Shahla M. Wunderlich, Karen A. Lee

Department of Nutrition and Food Studies Scholarship and Creative Works

The purpose of this study is to implement Plant the Seed, a garden-based nutrition education program designed to reconnect children with locally grown food, food environments of the past and present, and the benefits of eating seasonal foods. The pilot study investigates the environmental context and theory variables known to influence healthy food choice behavior. Social Cognitive Theory (SCT) provided a framework for the program’s curriculum and evaluation. The target audience is middle school students. Plant the Seed is a two-part program. In Part 1 (classroom), students participate in practical, interactive activities based on specific educational objectives that target …

Newly Developed And Validated Eosinophilic Esophagitis Histology Scoring System And Evidence That It Outperforms Peak Eosinophil Count For Disease Diagnosis And Monitoring, Margaret H. Collins, Lisa J. Martin, Eileen Steinle Alexander, J Todd Boyd, Rachel Sheridan, Hua He, Scott Pentiuk, Philip E. Putnam, J Pablo Abonia, Vincent A. Mukkada, James P. Franciosi, Marc E. Rothenberg

Faculty Scholarship

Eosinophilic esophagitis is diagnosed by symptoms, and at least 15 intraepithelial eosinophils per high power field in an esophageal biopsy. Other pathologic features have not been emphasized. We developed a histology scoring system for esophageal biopsies that evaluates eight features: eosinophil density, basal zone hyperplasia, eosinophil abscesses, eosinophil surface layering, dilated intercellular spaces, surface epithelial alteration, dyskeratotic epithelial cells and lamina propria fibrosis. Severity (grade) and extent (stage) of abnormalities were scored using a 4 point scale (0 normal; 3 maximum change). Reliability was demonstrated by strong to moderate agreement among 3 pathologists who scored biopsies independently (p≤0.008). Several features …