Public Health Commons^™

Barriers To Prevention And Treatment Of Type 2 Diabetes Mellitus: A Qualitative Analysis Of Women In East Sikkim, India, Emily Applewhite

Independent Study Project (ISP) Collection

Diabetes Mellitus is a metabolic disorder that affects more people in India than anywhere else in the world (Ramachandran et. al., 2010). A recent national study concluded that Sikkim, a small northeastern state in the Himalayas, has the highest prevalence of Diabetes Mellitus compared to any other state in India. In order to determine why this is so, this study looks at the barriers women face when attempting to prevent and treat Type 2 Diabetes Mellitus (T2DM) in East Sikkim. Fieldwork for this study was facilitated by The Volunteer Health Association of Sikkim, and took place in Gangtok and a …

Shining The Spotlight On Diabetes, Rodney Richmond

College of Pharmacy Faculty Research ​and Publications

No abstract provided.

Thirty Day Hospital Re-Admissions In Patients With Non St-Segment Elevation Acute Myocardial Infarction, Mayra Tisminetzky, David Mcmanus, Nathaniel Erskine, Jane Saczynski, Jorge Yarzebski, Edgard Granillo, Joel Gore, Robert Goldberg

Jorge L. Yarzebski

BACKGROUND: Limited data exist about relatively recent trends in the magnitude and characteristics of patients who are rehospitalized shortly after admission for a non ST-segment elevation acute myocardial infarction (NSTEMI). This observational study describes decade-long trends (1999-2009) in the magnitude and characteristics of patients readmitted to the hospital within 30 days of hospitalization for an incident (initial) episode of NSTEMI.

METHODS: We reviewed the medical records of 2,249 residents of the Worcester (MA) metropolitan area who were hospitalized for an initial NSTEMI in 6 biennial periods between 1999 and 2009 at 3 central MA medical centers.

RESULTS: The average age …

Television Watching, Diet Quality, And Physical Activity And Diabetes Among Three Ethnicities In The United States, Fatma G. Huffman, Joan A. Vaccaro, Joel C. Exebio, Gustavo C. Zarini, Timothy Katz, Zisca Dixon

Joan A. Vaccaro

Diabetes is a world-wide epidemic associated with multiple environmental factors. Prolonged television viewing (TV) time has been related to increased risk of obesity and type 2 diabetes in several studies. TV viewing has been positively associated with cardiovascular disease risk factors, lower energy expenditure, over-eating high-calorie and high-fat foods. The objective of this study was to assess the associations of hours of TV viewing with dietary quality, obesity and physical activity for three ethnic minorities with and without type 2 diabetes. Diet quality and physical activity were inversely related to prolonged TV viewing. African Americans and participants with type 2 …

Healthy Eating Index And Alternate Healthy Eating Index Among Haitian Americans And African Americans With And Without Type 2 Diabetes, Fatma G. Huffman, Mauricio De La Cera, Joan A. Vaccaro, Gustavo C. Zarini, Joel C. Exebio, Deva Gundupalli, Lamya Shaban

Joan A. Vaccaro

Ethnicities within Black populations have not been distinguished in most nutrition studies. We sought to examine dietary differences between African Americans (AA) and Haitian Americans (HA) with and without type 2 diabetes using the Healthy Eating Index, 2005 (HEI-05), and the Alternate Healthy Eating Index (AHEI). The design was cross-sectional (225 AA, 246 HA) and recruitment was by community outreach. The eating indices were calculated from data collected with the Harvard food-frequency questionnaire. African Americans had lower HEI-05 scores (−8.67, 13.1); , than HA. Haitian American females and AA males had higher AHEI than AA females and HA males, respectively, …

Medical Advice And Diabetes Self-Management Reported By Mexican-American, Black- And White-Non-Hispanic Adults Across The United States, Joan A. Vaccaro, Daniel J. Feaster, Sandra L. Lobar, Marianna K. Baum, Marcia Magnus, Fatma G. Huffman

Joan A. Vaccaro

Background

Diabetes has reached epidemic proportions in the United States, particularly among minorities, and if improperly managed can lead to medical complications and death. Healthcare providers play vital roles in communicating standards of care, which include guidance on diabetes self-management. The background of the client may play a role in the patient-provider communication process. The aim of this study was to determine the association between medical advice and diabetes self care management behaviors for a nationally representative sample of adults with diabetes. Moreover, we sought to establish whether or not race/ethnicity was a modifier for reported medical advice received and …

Strengthening The Detection Of And Early Response To Public Health Emergencies: Lessons From The West African Ebola Epidemic, Mark J. Siedner, Lawrence O. Gostin, Hilarie H. Cranmer, John D. Kraemer

Georgetown Law Faculty Publications and Other Works

Background

In the year since the World Health Organization (WHO) notified of an Ebola outbreak in West Africa, more than 24,000 cases have been reported and over 10,000 individuals have died. Moreover, countless non-Ebola deaths have occurred as a result of health system closings and an international aid effort in the $USD billions has been invested in control efforts. While the international response to the West African Ebola virus disease epidemic eventually exemplified the great potential of the global public health community, the protracted early response also revealed critical gaps, which likely resulted in exacerbation of the epidemic. It is …

Cost-Effectiveness Of Coronary Artery Calcium Testing For Coronary Heart And Cardiovascular Disease Risk Prediction To Guide Statin Allocation: The Multi-Ethnic Study Of Atherosclerosis (Mesa), Khurram Nasir

All Publications

BACKGROUND: The Multi-Ethnic Study of Atherosclerosis (MESA) showed that the addition of coronary artery calcium (CAC) to traditional risk factors improves risk classification, particularly in intermediate risk asymptomatic patients with LDL cholesterol levels /dL. However, the cost-effectiveness of incorporating CAC into treatment decision rules has yet to be clearly delineated.OBJECTIVE: To model the cost-effectiveness of CAC for cardiovascular risk stratification in asymptomatic, intermediate risk patients not taking a statin. Treatment based on CAC was compared to (1) treatment of all intermediate-risk patients, and (2) treatment on the basis of United States guidelines.METHODS: We developed a Markov model of first coronary …

Prevalence Of Obesity And Estimated Medical And Work Loss Costs Attributable To High Bmi: The Baptist Health South Florida Employee Study, Khurram Nasir, Emir Veledar, Chukwuemeka Osondu, Ehimen Aneni, Oluseye Ogunmoroti, Sankalp Das, Maribeth Rouseff, Thinh Tran, Don Parris, Leah Holzwarth, Henry Guzman, Theodore Feldman, Michael Ozner, Jonathan Fialkow, Bernie Fernandez, Jack Ziffer, Arthur Agatston

All Publications

No abstract provided.

Obesity And Metabolic Phenotypes (Metabolically Healthy And Unhealthy Variants) Are Significantly Associated With Prevalence Of Elevated C-Reactive Protein And Hepatic Steatosis In A Large Healthy Brazilian Population, Sameer Shaharyar, Lara Roberson, Omar Jamal, Adnan Younus, Shozab Ali, Arthur Agatston, Khurram Nasir Baptist Health Medical Group

All Publications

BACKGROUND:Among the obese, the so-called metabolically healthy obese (MHO) phenotype is thought to confer a lower CVD risk as compared to obesity with typical associated metabolic changes. The present study aims to determine the relationship of different subtypes of obesity with inflammatory-cardiometabolic abnormalities.METHODS:We evaluated 5,519 healthy, Brazilian subjects (43 ± 10 years, 78% males), free of known cardiovascular disease. Those with (MRF) were considered metabolically healthy, and those with BMI ≥ 25 kg/m(2) and/or waist circumference meeting NCEP criteria for metabolic syndrome as overweight/obese (OW). High sensitivity C reactive protein (hsCRP) was measured to assess underlying inflammation and hepatic steatosis …

Vaccine Introduction In The Democratic People's Republic Of Korea., F Marks, B Nyambat, Zy Xu, V Von Kalckreuth, Paul E. Kilgore, Hj Seo, Y Du, Se Park, J Im, F Konings, Cg Meyer, Tf Wierzba

Paul E. Kilgore

The feasibility of mass vaccination campaigns for Japanese encephalitis and Haemophilus influenzae type b infections was explored in the Democratic People's Republic of Korea using pilot vaccination studies. The experiences from these initial studies were then used to support larger vaccination campaigns in children at risk of these infections. We discuss the challenges and requirements for the inclusion of additional vaccines into the existing expanded program on immunization in the country.

Sociocultural And Structural Factors Contributing To Delays In Treatment For Children With Severe Malaria: A Qualitative Study In Southwestern Uganda, Radhika Sundararajan, Juliet Mwanga-Amumpaire, Harriet Adrama, Jackline Tumuhairwe, Sheilla Mbabazi, Kenneth Mworozi, Ryan W. Carroll, David Bangsberg, Yap Boum Ii, Norma C. Ware

OHSU-PSU School of Public Health Faculty Publications and Presentations

Malaria is a leading cause of pediatric mortality, and Uganda has among the highest incidences in the world. Increased morbidity and mortality are associated with delays to care. This qualitative study sought to characterize barriers to prompt allopathic care for children hospitalized with severe malaria in the endemic region of southwestern Uganda. Minimally structured, qualitative interviews were conducted with guardians of children admitted to a regional hospital with severe malaria. Using an inductive and content analytic approach, transcripts were analyzed to identify and define categories that explain delayed care. These categories represented two broad themes: sociocultural and structural factors. Sociocultural …

Preconception And Early Pregnancy Air Pollution Exposures And Risk Of Gestational Diabetes Mellitus, Candace Robledo, Pauline Mendola, Edwina H. Yeung, Tuija Männistö, Rajeshwari Sundaram, Danping Liu, Qi Ying, Seth Sherman, Katherine Grantz

School of Medicine Publications and Presentations

Background: Air pollution has been linked to gestational diabetes mellitus (GDM) but no studies have evaluated impact of preconception and early pregnancy air pollution exposures on GDM risk.

Methods: Electronic medical records provided data on 219,952 singleton deliveries to mothers with (n=11,334) and without GDM (n=208,618). Average maternal exposures to particulate matter (PM) ≤ 2.5μm (PM2.5) and PM2.5 constituents, PM ≤ 10μm (PM10), nitrogen oxides (NOx), carbon monoxide, sulfur dioxide (SO2) and ozone (O3) were estimated for the 3-month preconception window, first trimester, and gestational weeks 1-24 based on modified Community Multiscale Air Quality models for delivery hospital referral regions. …

Emerging Infectious Diseases And Public Health Policy: Insights From Cambodia, Hong Kong And Indonesia, Sophal Ear

Sophal Ear

The Clinical Breast Examination: A Useful Screening Tool?, Jennifer Lo

Journal of Patient-Centered Research and Reviews

The standardization of the clinical breast examination as a screening tool for breast cancer has been a topic of controversy. Current recommendations vary significantly from organization to organization without consensus. There currently does not seem to be sufficient evidence regarding overall survival benefit of the clinical breast exam. However, as adjunct screening with mammography, it may help find earlier breast cancers and the up to 5–10% of cancers missed by mammography. The most appropriate standardized protocol may be that the clinical breast exam can be performed at the discretion of the provider and patient, with more inclination toward use in …

What Are The Recommended Timing And Screening Modalities For Women At Higher Risk Of Developing Breast Cancer? A Clin-Iq, Summer Jatala, Shawn Fitzgerald, Pamela Tietze, Kalyanakrishnan Ramakrisnan, Laine H. Mccarthy, Elizabeth Wickersham

Journal of Patient-Centered Research and Reviews

Early detection of breast cancer is desirable to prevent progression to advanced disease. This subject has been one of significant study and debate for women at normal risk, and recommendations continue to evolve. However, with regard to women at high risk, the recommendations from various health care professional organizations, including the U.S. Preventive Services Task Force, are different and also inconsistent concerning when to begin screening and which modalities should be used. We review several randomized controlled trials and consensus opinions regarding when to begin screening for breast cancer and how to best screen women at high risk. Specifically, we …

Common Threads: An Integrated Hiv Prevention And Vocational Development Intervention For African American Women Living With Hiv/Aids, Liza Marie Conyers, Yung-Chen Chiu, Aisha Shamburger-Rousseau, Vanessa Johnson, Mark Misrok

Journal of Health Disparities Research and Practice

Current policies and initiatives call for the integration of social determinants of health into HIV/AIDS prevention and care interventions. According to the World Health Organization’s Commission on Social Determinants of Health, the lower a person’s socioeconomic status, the worse the health outcomes. One way to alleviate poverty among African American women with HIV/AIDS is to help foster their vocational development and economic empowerment. The National HIV/AIDS Strategy Implementation Plan specifically directs federal agencies to find ways to integrate people living with HIV/AIDS into broader employment initiatives. The purpose of this manuscript is to examine medical, psychosocial, financial/legal and vocational social …

Lessons Learned: Exploratory Study Of A Hiv/Aids Prevention Intervention For African American Women Who Have Experienced Intimate Partner Violence, Michele A. Rountree

Journal of Health Disparities Research and Practice

Given the prevalence and co-occurring nature of HIV and intimate partner violence among African American women there is a need for a risk reduction intervention. This study explored the results from an exploratory study of an HIV/AIDS prevention intervention for African-American women who have experienced intimate partner violence. The emphasis of this study is to identify lessons learned to guide future research.

Recruitment for the feasibility study was done in two waves over a period of three months. During the first wave, 22 participants were recruited for the intervention group, and in the second wave, 25 participants were in the …

Editors' Notes-Women Of Color Sexual Health Across The Lifespan, Marya Shegog, Melva Thompson-Robinson

Journal of Health Disparities Research and Practice

No abstract provided.

Editors' Notes: Men Of Color Sexual Health Across The Lifespan, Marya Shegog, Melva Thompson-Robinson

Journal of Health Disparities Research and Practice

No abstract provided.

Vaccine-Preventable Diseases In Travelers, Edith Mirzaian, Jeffery Goad, Ani Amloian, Fady Makar

Jeff Goad

Travel to the developing world is increasing among those from developed countries, placing them at risk for vaccine preventable and non-vaccine preventable diseases. From 2007-2011, the GeoSentinel Network reported 737 returned travelers with a vaccine preventable disease. While it is essential that clinicians use vaccines when available for a disease of risk, they should also be aware that the vast majority of diseases acquired by travelers are non-vaccine preventable. The vaccine preventable diseases can be divided into routine travel vaccines, special travel vaccines and routine vaccines used for travel. The routine travel vaccines include Hepatitis A and B, typhoid; special …

The Relationship Between Cancer Incidence, Stage, And Poverty In The United States, Francis P. Boscoe, Kevin A. Henry, Recinda L. Sherman, Christopher J. Johnson

Epidemiology & Biostatistics Faculty Scholarship

We extend a prior analysis on the relation between poverty and cancer incidence in a sample of 2.90 million cancers diagnosed in 16 U.S. states plus Los Angeles over the 2005-2009 period by additionally considering stage at diagnosis. Recognizing that higher relative disparities are often found among less-common cancer sites, our analysis incorporated both relative and absolute measures of disparities. Fourteen of the 21 cancer sites analyzed were found to have significant variation by stage; in each instance, diagnosis at distant stage was more likely among residents of high-poverty areas. If the incidence rates found in the lowest-poverty areas for …

Geographic Variation In Antidiabetic Agent Adherence And Glycemic Control Among Patients With Type 2 Diabetes, Eleanora Tan, Wenya Yang, Bo Pang, Mingliang Dai, F. Ellen Loh, Paul Hogan

Touro College of Pharmacy (New York) Publications and Research

BACKGROUND: Medication nonadherence is an imperative public health concern. Among patients with type 2 diabetes mellitus (T2DM), poor adherence to antidiabetic agents is strongly associated with suboptimal glycemic control. Poor adherence and hyperglycemia greatly increase diabetes-related morbidity and mortality. At a national level, diabetes drug adherence using average proportion of days covered (PDC) is estimated to range between 36% and 81%, with an estimated range for diabetes control between 38% and 47%. At a state level no such studies exist.

OBJECTIVE: To estimate the level of medication adherence to antidiabetic agents and of diabetes control, and their association among patients …

Multiplexed Loop-Mediated Isothermal Amplification Of The 16s Rrna Gene For The Diagnosis Of Neonatal Sepsis In Resource-Limited Environments, Griffin T. Sonaty

Inquiry: The University of Arkansas Undergraduate Research Journal

Sepsis, or dysregulated inflammation caused by bacterial infection, places a disproportionately high burden on newborns in developing countries. This is due in part to a lack of diagnostic tools suitable for sustainable use in resource-limited nurseries. One potential vehicle for a new diagnostic assay is loop-mediated isothermal amplification (LAMP), a high-yield DNA amplification method. LAMP has previously been used to detect genes from single species of bacteria in blood serum samples to aid in sepsis diagnosis. LAMP could be adapted to detect a broad set of bacteria, while retaining a degree of specificity that allows clinicians to begin directed antimicrobial …

The Cost-Effectiveness Of Diabetes Prevention: Results From The Diabetes Prevention Program And The Diabetes Prevention Program Outcomes Study, William Herman

GW Biostatistics Center

Background

The Diabetes Prevention Program (DPP) was a randomized, controlled clinical trial. It demonstrated that among high-risk individuals with impaired glucose tolerance, diabetes incidence was reduced by 58 % with lifestyle intervention and 31 % with metformin compared to placebo. During the Diabetes Prevention Program Outcomes Study (DPPOS), all DPP participants were unmasked to their treatment assignments, the original lifestyle intervention group was offered additional lifestyle support, the metformin group continued metformin, and all three groups were offered a group-implemented lifestyle intervention. Over the 10 years of combined DPP/DPPOS follow-up, diabetes incidence was reduced by 34 % in the lifestyle …

Cardiovascular Disease Risk Factors In Structural Firefighters, Nicholas W. Trubee

Theses and Dissertations--Kinesiology and Health Promotion

This dissertation is composed of two manuscripts assessing cardiovascular disease (CVD) risk in structural firefighters. Study 1 compared traditional CVD risk factors and health-related behaviors between professional and volunteer firefighters. Online questionnaires were sent to approximately 4000 firefighters in the state of Kentucky. The results indicated that 90% of volunteer and 58% of professional firefighters were classified as moderate-to-high CVD risk. Volunteer firefighters were significantly (p < 0.001) older and more likely (p = 0.026) to be current cigarette smokers. The mean body mass index among all firefighters in the sample was 30.8 kg·m^-2. Nearly 60% of volunteer firefighters were obese. Obese firefighters were more likely (p < 0.05) to have been diagnosed as diabetic or pre-diabetes compared to overweight and normal weight firefighters. These results indicate that volunteer firefighters may be at a greater CVD risk compared to professional firefighters.

Study 2 investigated the association of cardiorespiratory fitness (CRF) and body fat with arterial stiffness in professional firefighters. Forty-six …

Evaluating The Effectiveness Of A Heart Improvement Toolkit Program: A Pilot Project, Cheryl L. Mitchell

Doctor of Nursing Practice Projects

Heart failure (HF) is a chronic, debilitating disease resulting in over one million hospitalizations with an estimated 30.7 million dollars in total health care cost per year (Go et al., 2014). Evidence shows that HF education programs that promote adherence to pharmacological and non-pharmacological provider recommendations are effective in reducing 30-day HF recidivism rates, increasing self-care behavior, and decreasing adverse clinical events. The purpose of this evidence-based project was to implement the Heart Improvement Toolkit (HIT) Program which is a one-on-one, comprehensive HF-specific education program, for patients with a HF diagnosis who have been admitted to non-cardiac specialty units. Program …

Climate, Environmental And Socio-Economic Change: Weighing Up The Balance In Vector-Borne Disease Transmission, Paul E. Parham, Joanna Waldock, George K. Christophides, Deborah Hemming, Folashade Agusto, Katherine J. Evans, Nina Fefferman, Holly Gaff, Abba Gumel, Shannon Ladeau

Biological Sciences Faculty Publications

Arguably one of the most important effects of climate change is the potential impact on human health. While this is likely to take many forms, the implications for future transmission of vector-borne diseases (VBDs), given their ongoing contribution to global disease burden, are both extremely important and highly uncertain. In part, this is owing not only to data limitations and methodological challenges when integrating climate-driven VBD models and climate change projections, but also, perhaps most crucially, to the multitude of epidemiological, ecological and socio-economic factors that drive VBD transmission, and this complexity has generated considerable debate over the past 10-15 …

Improving Education Opportunity, Health, And Quality Of Life Of Orphans And Vulnerable Children: The Sustainable Action Against Hiv And Aids In Communities (Sahacom), Siyan Yi, Pheak Chhoun, Samantha Brant, Kelley Kita, Sovannary Tuot

Aims: This study evaluated the impact of the Sustainable Action against HIV and AIDS in Communities (SAHACOM) project in improving education opportunity, health, and quality of life of orphans and vulnerable children (OVC) in Cambodia.

Study Design: Operational intervention study.

Place and Duration of the Study: Five provinces in Cambodia, from 2010 to 2014.

Methodology: A two-stage cluster sampling method was used to select 756 OVC at midterm and 785 OVC at end line for face-to-face interviews. Outcome indicators from end line (2014) were compared to those obtained at midterm (2012). Where possible, the data were also compared with data …

Aids-Related Stigma And Mental Disorders Among People Living With Hiv: A Cross-Sectional Study In Cambodia, Siyan Yi, Pheak Chhoun, Samedy Suong, Carinne M. Brody, Sovannary Tuot

Background: AIDS-related stigma and mental disorders are the most common conditions in people living with HIV (PLHIV). We therefore conducted this study to examine the association of AIDS-related stigma and discrimination with mental disorders among PLHIV in Cambodia.

Methods: A two-stage cluster sampling method was used to select 1,003 adult PLHIV from six provinces. The People Living with HIV Stigma Index was used to measure stigma and discrimination, and a short version of general health questionnaire (GHQ-12) was used to measure mental disorders. Multivariate logistic regression analysis was conducted.

Results: The reported experiences of discrimination in communities …