Public Health Commons^™

Accelerated Resolution Therapy For Treatment Of Pain Secondary To Symptoms Of Combat-Related Posttraumatic Stress Disorder, Kevin E. Kip, Laney Rosenzweig, Diego F. Hernandez, Amy Shuman, David M. Diamond, Sue Ann Girling, Kelly L. Sullivan, Trudy R. Wittenberg, Ann M. Witt, Cecile A. Lengacher, Brian Anderson, Susan C. Mcmillan

Kelly L. Sullivan

Background: As many as 70% of veterans with chronic pain treated within the US Veterans Administration (VA) system may have posttraumatic stress disorder (PTSD), and conversely, up to 80% of those with PTSD may have pain. We describe pain experienced by US service members and veterans with symptoms of PTSD, and report on the effect of Accelerated Resolution Therapy (ART), a new, brief exposure-based therapy, on acute pain reduction secondary to treatment of symptoms of PTSD.
Methods: A randomized controlled trial of ART versus an attention control (AC) regimen was conducted among 45 US service members/veterans with symptoms of combat-related …

Treatment Of Neurodegenerative Ataxias With Intravenous Immune Globulin, Theresa A. Zesiewicz, Seok Hun Kim, Kelly L. Sullivan, Jeannie Stephenson, Israt Jahan, Susan L. Perlman, Jessica D. Shaw, Tuan Vu, Clifton L. Gooch

Kelly L. Sullivan

Background: Neurodegenerative ataxias, including spinocerebellar ataxias (SCAs), are progressive diseases without effective treatment. There is preclinical evidence that inflammation may contribute to neuronal injury in several neurodegenerative ataxias. Intravenous immune globulin (IVIG) is a therapeutic modality that is used as treatment of several autoimmune and inflammatory disorders.
Methods: The primary objective of this open-label pilot study was to assess the effect of IVIG on neurodegenerative ataxias as measured by total scale for the assessment and rating of ataxia (SARA) score. Three patients received IVIG (2 g/kg of body weight, divided over 5 days) once monthly for 3 months, and were …

Premorbid Personality And The Risk Of Parkinson's Disease, Kelly L. Sullivan, James A. Mortimer, Wei Wang, Theresa A. Zesiewicz, James H. Brownlee Jr., Amy R. Borenstein

Kelly L. Sullivan

Background: Previous studies support the hypothesis that premorbid personality characteristics may be associated with the risk of Parkinson’s disease (PD). However, most of these relied upon subjective reports of premorbid personality earlier in life, which may be subject to recall bias. The objective of the current study was to evaluate the association of PD with risk-taking, routinization, smoking and alcohol consumption in early-adult life as indicators of premorbid personality.
Methods: In-person interviews were conducted with 89 PD patients and 99 controls from a university-based medical center. Associations between indicators of early-adult personality and risk of PD were examined using logistic …

Modeling The Effect Of Water, Sanitation, And Hygiene And Oral Cholera Vaccine Implementation In Haiti, Isaac Chun-Hai Fung, David L. Fitter, Rebekah H. Borse, Martin I. Meltzer, Jordan W. Tappero

Isaac Chun-Hai Fung

In 2010, toxigenic Vibrio cholerae was newly introduced to Haiti. Because resources are limited, decisionmakers need to understand the effect of different preventive interventions. We built a static model to estimate the potential number of cholera cases averted through improvements in coverage in water, sanitation and hygiene (WASH) (i.e., latrines, point-of-use chlorination, and piped water), oral cholera vaccine (OCV), or a combination of both. We allowed indirect effects and non-linear relationships between effect and population coverage. Because there are limited incidence data for endemic cholera in Haiti, we estimated the incidence of cholera over 20 years in Haiti by using …

Brief Treatment Of Co-Occurring Post-Traumatic Stress And Depressive Symptoms By Use Of Accelerated Resolution Therapy®, Kevin E. Kip, Kelly L. Sullivan, Cecile A. Lengacher, Laney Rosenzweig, Diego F. Hernandez, Rejendra P. Kadel, Frank A. Kozel, Amy Shuman, Sue Ann Girling, Marian J. Hardwick, David M. Diamond

Kelly L. Sullivan

This uncontrolled prospective cohort study evaluated the use of accelerated resolution therapy (ART) for treatment of comorbid symptoms of post-traumatic stress disorder (PTSD) and major depressive disorder. Twenty-eight adult subjects, mean age of 41 years (79% female, 36% Hispanic), received a mean of 3.7 ± 1.1 ART treatment sessions (range 1-5). ART is a new exposure-based psychotherapy that makes use of eye movements. Subjects completed a range of self-report psychological measures before and after treatment with ART including the 17-item PCL-C checklist (symptoms of PTSD) and 20-item Center for Epidemiologic Studies Depression Scale (CES-D). For the PCL-C, the pre-ART mean …

How To Minimize The Attack Rate During Multiple Influenza Outbreaks In A Heterogeneous Population, Isaac Chun-Hai Fung, Rustom Antia, Andreas Handel

Isaac Chun-Hai Fung

Background: If repeated interventions against multiple outbreaks are not feasible, there is an optimal level of control during the first outbreak. Any control measures above that optimal level will lead to an outcome that may be as sub-optimal as that achieved by an intervention that is too weak. We studied this scenario in more detail.
Method: An age-stratified ordinary-differential-equation model was constructed to study infectious disease outbreaks and control in a population made up of two groups, adults and children. The model was parameterized using influenza as an example. This model was used to simulate two consecutive outbreaks of the …

Sustained Medication Reduction Following Unilateral Vim Thalamic Stimulation For Essential Tremor, Andrew S. Resnick, Michael S. Okun, Teresita Malapira, Donald A. Smith, Fernando L. Vale, Kelly L. Sullivan, Amber M. Miller, Israt Jahan, Theresa A. Zesiewicz

Kelly L. Sullivan

Background: Deep brain stimulation (DBS) is an increasingly utilized therapeutic modality for the management of medication refractory essential tremor (ET). The aim of this study was to determine whether DBS allowed for anti-tremor medication reduction within the year after the procedure was performed.
Methods: We conducted a retrospective chart review and telephone interviews on 34 consecutive patients who had been diagnosed with ET, and who had undergone unilateral DBS surgery.
Results: Of the 34 patients in our cohort, 31 patients (91%) completely stopped all anti-tremor medications either before surgery (21 patients, 62%) or in the year following DBS surgery (10 …

Prevalence Of Colorectal Cancer Screening Among A Multimorbid Rural Appalachian Population, Steven T. Fleming, Nancy E. Schoenberg, Yelena N. Tarasenko, Kevin A. Pearce

Yelena N. Tarasenko

Objectives: The purpose of this study was to determine the relation among multiple morbidities and the prevalence of colorectal cancer (CRC) screening among older adult Appalachian residents of Kentucky. This is the first known study to address multiple morbidities exclusively with a health-disparities population.

Methods: This was a cross-sectional study of 1153 subjects, aged 50 to 76 years, from Appalachian Kentucky.

Results: White race, post-high school education, and perception of having more than enough income on which to survive were associated with higher rates of any guideline concordant CRC screening. Statistically significant trends in the outcome of …

The Role Of Social Support In Multiple Morbidity Self-Management Among Rural Residents, Shoshana Bardach, Yelena N. Tarasenko, Nancy E. Schoenberg

Yelena N. Tarasenko

Social support generally is considered a valuable asset that may compensate for health service deficiencies among rural populations. Employing a mixed methods approach, we explored how vulnerable rural residents described social support in the context of self-management for multiple chronic conditions. Participants generally felt support was available, though emotional/ informational support was perceived as less available than other types of support. Participants did not rely heavily on informal support to help them manage their multiple morbidities, preferring to call on their doctor and their own resources. We discuss implications of these findings for meeting this vulnerable population’s self-management needs.

Quantitative Tremor Analysis In Welders: Comparison With Idiopathic Parkinson's Disease And Essential Tremor, Juan Sanchez-Ramos, Dacy Reimer, Theresa A. Zesiewicz, Kelly L. Sullivan, Paul A. Nausieda

Kelly L. Sullivan

Background: Workers chronically exposed to manganese in welding fumes may develop an extra-pyramidal syndrome with postural and action tremors.
Objectives: To determine the utility of tremor analysis in distinguishing tremors among workers exposed to welding fumes, patients with Idiopathic Parkinson’s Disease (IPD) and Essential Tremor (ET).
Methods: Retrospective study of recorded tremor in subjects from academic Movement Disorders Clinics and Welders. Quantitative tremor analysis was performed and associated with clinical status.
Results: Postural tremor intensity was increased in Welders and ET and was associated with visibly greater amplitude of tremor with arms extended. Mean center frequencies (Cf) of welders and …

The Emergency Department As A Potential Intervention Recruitment Venue Among Vulnerable Rural Residents, Yelena N. Tarasenko, Nancy E. Schoenberg, Keisa L. Bennett

Yelena N. Tarasenko

Meeting the health care needs of rural residents is complicated by their substantial medical burdens that frequently outstrip patient and community resources. Nowhere is this more evident than in central Appalachia. Preventive procedures are often sacrificed as patients and providers attend to more pressing medical issues. We report the results of a pilot study designed to explore the need for and appropriateness of a potential intervention placed in an emergency department (ED), with the eventual goal of using the ED to link traditionally underserved patients to preventive services. We used a convenience sample of 49 ED patients to explore their …

Overview Of The Essential Tremor, Theresa A. Zesiewicz, Abinaya Chari, Israt Jahan, Amber M. Miller, Kelly L. Sullivan

Kelly L. Sullivan

Essential tremor (ET) is one of the most common movement disorders in the world. Despite this, only one medication (propranolol) is approved by the Food and Drug Administration (FDA) to treat it. Fortunately, recent studies have identified some additional medications as treatment of ET. Surgical procedures, such as deep brain stimulation of the ventral intermediate nucleus of the thalamus, offer treatment for refractory tremor. The epidemiology, pathogenesis, and medical and surgical treatment of ET will be discussed in this paper.

Interventions To Improve Excreta Disposal For Preventing Diarrhoea, Thomas F. Clasen, Kristof Bostoen, Wolf-Peter Schmidt, Sophie Boisson, Isaac Chun-Hai Fung, Marion W. Jenkins, Beth Scott, Steven Sugden, Sandy Cairncross

Isaac Chun-Hai Fung

Background: Diarrhoeal diseases are a leading cause of mortality and morbidity, especially among young children in low-income countries, and are associated with exposure to human excreta.
Objectives: To assess the effectiveness of interventions to improve the disposal of human excreta for preventing diarrhoeal diseases.
Search Strategy: We searched the Cochrane Infectious Disease Group Specialized Register; the Cochrane Central Register of Controlled Trials (CENTRAL), published in The Cochrane Library; MEDLINE; EMBASE; LILACS; the metaRegister of Controlled Trials (mRCT); and Chinese-language databases available under the Wan Fang portal, and the China National Knowledge Infrastructure (CNKI-CAJ). We also handsearched relevant conference proceedings, and …

Reduction Of Circulating Endothelial Cells In Peripheral Blood Of Als Patients, Svitlana Garbuzova-Davis, Robert L. Woods Iii, Michael K. Louis, Theresa A. Zesiewicz, Nicole Kuzmin-Nichols, Kelly L. Sullivan, Amber M. Miller, Diana G. Hernandez-Ontiveros, Paul R. Sanberg

Kelly L. Sullivan

Background: Amyotrophic Lateral Sclerosis (ALS) treatment is complicated by the various mechanisms underlying motor neuron degeneration. Recent studies showed that the blood-brain barrier (BBB) and blood-spinal cord barrier (BSCB) are compromised in an animal model of ALS due to endothelial cell degeneration. A later study demonstrated a loss of endothelium integrity in the spinal cords of ALS patients. Since circulating endothelial cells (CECs) in the peripheral blood are associated with endothelium damage, being detached dysfunctional endothelial cells, we hypothesized that CEC levels may reflect endothelium condition in ALS patients.
Methodology/Principal Findings: CEC levels were estimated in whole blood smears from …

Water, Sanitation And Hygiene For The Prevention Of Diarrhoea, Sandy Cairncross, Caroline Hunt, Sophie Boisson, Kristof Bostoen, Val Curtis, Isaac Chun-Hai Fung, Wolf-Peter Schmidt

Isaac Chun-Hai Fung

Background: Ever since John Snow's intervention on the Broad St pump, the effect of water quality, hygiene and sanitation in preventing diarrhoea deaths has always been debated. The evidence identified in previous reviews is of variable quality, and mostly relates to morbidity rather than mortality.
Methods: We drew on three systematic reviews, two of them for the Cochrane Collaboration, focussed on the effect of handwashing with soap on diarrhoea, of water quality improvement and of excreta disposal, respectively. The estimated effect on diarrhoea mortality was determined by applying the rules adopted for this supplement, where appropriate.
Results: The striking effect …

Sleep Disorders In Parkinson's Disease, Israt Jahan, Robert A. Hauser, Kelly L. Sullivan, Amber M. Miller, Theresa A. Zesiewicz

Kelly L. Sullivan

Sleep disorders occur commonly in Parkinson’s disease (PD), and reduce quality of life. Sleep-related problems in PD include insomnia, restless legs syndrome, rapid eye movement sleep behavior disorder, sleep apnea, parasomnias, excessive daytime sleepiness, and sleep attacks. This article reviews sleep disorders and their treatment in PD.

Chinese Journals: A Guide For Epidemiologists, Isaac Chun-Hai Fung

Isaac Chun-Hai Fung

Chinese journals in epidemiology, preventive medicine and public health contain much that is of potential international interest. However, few non-Chinese speakers are acquainted with this literature. This article therefore provides an overview of the contemporary scene in Chinese biomedical journal publication, Chinese bibliographic databases and Chinese journals in epidemiology, preventive medicine and public health. The challenge of switching to English as the medium of publication, the development of publishing bibliometric data from Chinese databases, the prospect of an Open Access publication model in China, the issue of language bias in literature reviews and the quality of Chinese journals are discussed. …

Citation Of Non-English Peer Review Publications – Some Chinese Examples, Isaac Chun-Hai Fung

Isaac Chun-Hai Fung

Articles published in English language journals with citations of non-English peer reviewed materials are not very common today. However, as epidemiologists are becoming more aware of data and information being readily available and accessible in the non-English literature, the question of whether non-English materials can be cited in English language journals and if so, how should they be cited, has become an increasingly important issue. Bringing together personal insights from the author's familiarity with both the English and Chinese language epidemiological literature and results from a survey on the use of citations of non-English peer reviewed materials across a sample …

Seek, And Ye Shall Find: Accessing The Global Epidemiological Literature In Different Languages, Isaac Chun-Hai Fung

Isaac Chun-Hai Fung

The thematic series 'Beyond English: Accessing the global epidemiological literature' in Emerging Themes in Epidemiology highlights the wealth of epidemiological and public health literature in the major languages of the world, and the bibliographic databases through which they can be searched and accessed. This editorial suggests that all systematic reviews in epidemiology and public health should include literature published in the major languages of the world and that the use of regional and non-English bibliographic databases should become routine.

Does Language Matter? A Case Study Of Epidemiological And Public Health Journals, Databases And Professional Education In French, German And Italian, Iacopo Baussano, Patrick Brzoska, Ugo Fedeli, Claudia Larouche, Oliver Razum, Isaac Chun-Hai Fung

Isaac Chun-Hai Fung

Epidemiology and public health are usually context-specific. Journals published in different languages and countries play a role both as sources of data and as channels through which evidence is incorporated into local public health practice. Databases in these languages facilitate access to relevant journals, and professional education in these languages facilitates the growth of native expertise in epidemiology and public health. However, as English has become the lingua franca of scientific communication in the era of globalisation, many journals published in non-English languages face the difficult dilemma of either switching to English and competing internationally, or sticking to the native …

Open Access For The Non-English-Speaking World: Overcoming The Language Barrier, Isaac Chun-Hai Fung

Isaac Chun-Hai Fung

This editorial highlights the problem of language barrier in scientific communication in spite of the recent success of Open Access Movement. Four options for English-language journals to overcome the language barrier are suggested: 1) abstracts in alternative languages provided by authors, 2) Wiki open translation, 3) international board of translator-editors, and 4) alternative language version of the journal. The Emerging Themes in Epidemiology announces that with immediate effect, it will accept translations of abstracts or full texts by authors as Additional files.

Modelling The Impact And Cost-Effectiveness Of The Hiv Intervention Programme Amongst Commercial Sex Workers In Ahmedabad, Gujarat, India, Isaac Chun-Hai Fung, Lorna Guinness, Peter Vickerman, Charlotte Watts, Gangadhar Vannela, Jagdish Vadhvana, Anna M. Foss, Laxman Malodia, Meena Gandhi, Gaurang Jani

Isaac Chun-Hai Fung

Background: Ahmedabad is an industrial city in Gujarat, India. In 2003, the HIV prevalence among commercial sex workers (CSWs) in Ahmedabad reached 13.0%. In response, the Jyoti Sangh HIV prevention programme for CSWs was initiated, which involves outreach, peer education, condom distribution, and free STD clinics. Two surveys were performed among CSWs in 1999 and 2003. This study estimates the cost-effectiveness of the Jyoti Sangh HIV prevention programme.
Methods: A dynamic mathematical model was used with survey and intervention-specific data from Ahmedabad to estimate the HIV impact of the Jyoti Sangh project for the 51 months between the two CSW …

Physician Colorectal Cancer Screening Recommendations: An Explanation Based On Informed Decision-Making, Yelena N. Tarasenko, Sarah B. Wackerbarth, Jennifer M. Joyce, Steven A. Haist

Yelena N. Tarasenko

Objective: The purpose of this research was to examine the content of physicians’ colorectal cancer screening recommendations. More specifically, using the framework of informed decision making synthesized by Braddock and colleagues, we conducted a qualitative study of the content of recommendations to describe how physicians are currently presenting this information to patients.

Methods: We conducted semi-structured interviews with 65 primary care physicians. We analyzed responses to a question designed to elicit how the physicians typically communicate their recommendation.

Results: Almost all of the physicians (98.5%) addressed the “nature of decision” element. A majority of physicians discussed “uncertainties …