Digital Commons Network^™

The Integration Of Traditional And Western Medicine In Ngaoundéré, Cameroon, Alison Hardy

Independent Study Project (ISP) Collection

The purpose of this study was to examine how patients in Ngaoundéré Cameroon integrate traditional and Western medicine, and how they perceive such integration on the part of their health care providers. Interviews were conducted with thirty-five patients of the Hôpital Provincial and of traditional medical practitioners in the neighbourhood of Yarmbang. Both modern and traditional health care providers were also interviewed. Patients generally believe that the two types of medicine have different strengths related to cost, accessibility, accuracy of diagnosis and treatment, ability to treat certain illnesses, and practitioners’ understanding of patients’ culture. Patients decide whether to use modern …

Health As A Basic Human Right: Efficacy Of Quality Assurance For Healthcare In Uganda, Ally Pregulman

Independent Study Project (ISP) Collection

Quality of health care is an important aspect of health services delivery because of its ability to maximize outputs within given resource constraints. Quality assurance programs for health care are paramount to the realization of good quality health care because of their ability to identify gaps in service provision. The Ministry of Health and other stakeholders in health care have created quality assurance supervision and support programs for the health sector, yet there is a disconnect between the programs and the operational realities of the sector. The health-related Millennium Development Goals (MDGs) are far from being achieved within Uganda and …

Characteristics Of A Spina Bifida Population Including North American Caucasian And Hispanic Individuals, Kit Sing Au, Phong X Tran, Chester C Tsai, Michelle R O'Byrne, Jone-Ing Lin, Alanna C Morrison, Amy W Hampson, Paul Cirino, Jack M Fletcher, Kathryn K Ostermaier, Gayle H Tyerman, Sabine Doebel, Hope Northrup

Faculty, Staff and Student Publications

BACKGROUND: Meningomyelocele (MM) is a common human birth defect. MM is a disorder of neural development caused by contributions from genes and environmental factors that result in the NTD and lead to a spectrum of physical and neurocognitive phenotypes.

METHODS: A multidisciplinary approach has been taken to develop a comprehensive understanding of MM through collaborative efforts from investigators specializing in genetics, development, brain imaging, and neurocognitive outcome. Patients have been recruited from five different sites: Houston and the Texas-Mexico border area; Toronto, Canada; Los Angeles, California; and Lexington, Kentucky. Genetic risk factors for MM have been assessed by genotyping and …

A Concentrated Look At Hiv/Aids: Transmission To Low Risk Women Through Intravenous Drug Users And Female Sex Workers In Da Nang City, Vietnam, Danielle A. Depeau

Independent Study Project (ISP) Collection

Female sex workers (FSW) and intravenous drug users (IDU) whom were living in Da Nang City, Vietnam, along with the women and children associated with these individuals, were interviewed to study the effects of Human Immunodeficiency Virus (HIV) and Acquired Immune Deficiency Syndrome (AIDS). In addition, an understanding how the epidemic was spreading from high-risk populations to the general population was explored. This was achieved by learning the history of sexual behaviors in regards to sexual partners and regularity of condom use, as well as drug injection practices, HIV/AIDS education, treatment, gender status and socio-demographic characteristics.

Informal interviews were conducted …

Economics, Epidemics & Eradication: A Case Study Of Malaria In Madagascar, Kathleen Minton

Independent Study Project (ISP) Collection

Despite effective techniques for preventing and treating malaria, the malaria burden in Madagascar remains quite high, particularly in rural areas where poor villagers are more isolated from health services, and less likely to be able to afford prevention methods or treatment. In response to this challenge, Madagascar’s government has made malaria eradication a high priority, stating that it hopes to reduce the incidence of malaria from its current level of 1,234,520 to 320,000 by 2012, and to eliminate the disease entirely by 2018. Ultimately, though, it remains to be seen if their efforts will be sufficient to meet these ambitious …

Does Place Explain Racial Health Disparities? Quantifying The Contribution Of Residential Context To The Black/White Health Gap In The United States, Brian K. Finch, D. Phuong Do, Ricardo Basurto-Davila, Chloe E. Bird, José J. Escarce, Nicole Lurie

Faculty Publications

The persistence of the black health disadvantage has been a puzzling component of health in the United States in spite of general declines in rates of morbidity and mortality over the past century. Studies that have focused on well-established individual-level determinants of health such as socio-economic status and health behaviors have been unable to fully explain these disparities. Recent research has begun to focus on other factors such as racism, discrimination, and segregation. Variation in neighborhood context - socio-demographic composition, social aspects, and built environment - has been postulated as an additional explanation for racial disparities, but few attempts have …

Outcomes Of Safety And Effectiveness In A Multicenter Randomized, Controlled Trial Of Whole-Body Hypothermia For Neonatal Hypoxic-Ischemic Encephalopathy, Seetha Shankaran, Athina Pappas, Abbott R Laptook, Scott A Mcdonald, Richard A Ehrenkranz, Jon E Tyson, Michelle Walsh, Ronald N Goldberg, Rosemary D Higgins, Abhik Das

Faculty, Staff and Student Publications

BACKGROUND: Whole-body hypothermia reduced the frequency of death or moderate/severe disabilities in neonates with hypoxic-ischemic encephalopathy in a randomized, controlled multicenter trial.

OBJECTIVE: Our goal was to evaluate outcomes of safety and effectiveness of hypothermia in infants up to 18 to 22 months of age.

DESIGN/METHODS: A priori outcomes were evaluated between hypothermia (n = 102) and control (n = 106) groups.

RESULTS: Encephalopathy attributable to causes other than hypoxia-ischemia at birth was not noted. Inotropic support (hypothermia, 59% of infants; control, 56% of infants) was similar during the 72-hour study intervention period in both groups. Need for blood transfusions …

Impact Of Chlamydia And Gonorrhea In Georgia: An Urban / Rural Comparison (2000-2004), Swati Raychowdhury, Stuart H. Tedders, Sarah K. Jones

Journal of the Georgia Public Health Association

Background: In 2005, 33,562 cases of chlamydia and 15,860 cases of gonorrhea were reported in the State of Georgia, respectively corresponding to 3.4% and 4.7% of all cases reported nationally (CDC, 2005). Disparities of infection with respect to race and gender are evident for both diseases. The objective of this study was to determine the magnitude of chlamydia and gonorrhea in rural Georgia compared to urban areas of the state.

Methods: County level data necessary for analysis were acquired using the Georgia Division of Public Health’s Online Analytical Statistical Information System database (GDHR, 2007). Rates of infection by gender and …

Assessing The Validity Of Statistical Inferences In Public Health Research: An Evidence-Based, ‘Best-Practices’ Approach, Karl E. Peace, Anthony V. Parrillo, Charles J. Hardy

Journal of the Georgia Public Health Association

Like many fields, public health has embraced the process of evidence-based practice to inform practice decisions and to guide policy development. Evidence-based practice is typically dependent upon generalizations made on the bases of the existing body of knowledge – assimilations of the research literature on a particular topic. The potential utility of scientific evidence for guiding policy and practice decisions is grounded in the validity of the research investigations upon which such decisions are made. However, the validity of inferences made from the extant public health research literature requires more than ascertaining the validity of the statistical methods alone; for …

Designation Of Medically Underserved And Health Professional Shortage Areas: Analysis Of The Public Comments On The Withdrawn Proposed Regulation, Emily Jones, Leighton C. Ku, Joseph Lippi, Ramona Whittington, Sara J. Rosenbaum

Geiger Gibson/RCHN Community Health Foundation Research Collaborative

In February 2008, the Health Resources and Services Administration (HRSA) proposed new regulations that would have modified and combined the Health Professional Shortage Area (HPSA) and Medically Underserved Area/Population (MUA/P) designation processes. The comment period was extended twice in response to the large volume of comments, through June 30th. On July 23rd, HRSA effectively withdrew the proposed rule, announcing that in light of its preliminary review of comments, the agency had elected to develop a new proposal. This Research Brief highlights some of the salient issues surrounding the proposed rule, based on an analysis of the public comments by researchers …

Cancer In American Indian And Alaska Native Young Adults (Ages 20–44 Years): Us, 1999–2004, Hannah K. Weir, Melissa Jim, Loraine D. Marrett, Temeika L. Fairley

United States Public Health Resources

BACKGROUND. An examination of cancer incidence patterns in American Indians and Alaska Native (AI/AN) young adults may provide insight into their present and future cancer burden.

METHODS. To reduce racial misclassification, incidence data were linked with the Indian Health Service (IHS) patient services database. Age-adjusted cancer incidence rates per 100,000 (AAR) and corresponding rate ratios (RR) for young adults (ages 20-44 years) were compared across IHS regions and for selected cancers within Contract Health Service Delivery Area counties by race (AI/AN vs non-Hispanic whites [NHW]) and sex.

RESULTS. The all-sites cancer incidence rate was lower for AI/ANs …

Breast Cancer Screening Disparities In Japanese-American Women, Theodora Stratis

Loma Linda University Electronic Theses, Dissertations & Projects

Cancer screening disparities in ethnic minority women have received much research attention in the last several years due to a marked increase in ethnic minority cancer incidence and poor survival rates (Miller, Kollnel, Bernstein, Young Swanson, West et ah, 1996). Breast cancer is the leading cause of death for Asian American women (Asian American Network for Cancer Awareness, Research & Training, 2002) and, although their incidence and mortality rates are lower than Caucasian women, these rates continue to increase every year. This increasing mortality rate is likely due to the underutilization of breast cancer screening by Asian American women. Asian …

Shea/Apic Guideline: Infection Prevention And Control In The Long-Term Care Facility, Philip W. Smith, Gail Bennett, Suzanne Bradley, Paul Drinka, Ebbing Lautenbach, James Marx, Lona Mody, Lindsay Nicolle, Kurt Stevenson

United States Department of Veterans Affairs: Publications

Long-term care facilities (LTCFs) may be defined as institutions that provide health care to people who are unable to manage independently in the community.¹ This care may be chronic care management or short-term rehabilitative services. The term nursing home is defined as a facility licensed with an organized professional staff and inpatient beds that provides continuous nursing and other services to patients who are not in the acute phase of an illness. There is considerable overlap between the 2 terms.

More than 1.5 million residents reside in United States (US) nursing homes. In recent years, the acuity of illness …

The Effectiveness Of Treatment In An Inpatient And Outpatient Psychiatric Facility, Timothy Quan Tran

Loma Linda University Electronic Theses, Dissertations & Projects

The present study is aimed at examining treatment outcome in a large psychiatric facility that provides both inpatient and outpatient services to a broad range of patients. Not only will patient outcomes be assessed at a facility-wide level, but patient outcomes on the various units/programs in the facility will also be assessed and compared. It is expected that, facility wide, patients will show significant improvement on the outcome measure from admission to discharge, but that patient outcomes will differ across the various units/programs in the facility. In sum, the results of the paired-sample t-test and effect size obtained in this …

A Metastasis Or A Second Independent Cancer? Evaluating The Clonal Origin Of Tumors Using Array-Cgh Data, Irina Ostrovnaya, Adam Olshen, Venkatraman E. Seshan, Irene Orlow, D G. Albertson, Colin B. Begg

Memorial Sloan-Kettering Cancer Center, Dept. of Epidemiology & Biostatistics Working Paper Series

When a cancer patient develops a new tumor it is necessary to determine if this is a recurrence (metastasis) of the original cancer, or an entirely new occurrence of the disease. This is accomplished by assessing the histo-pathology of the lesions, and it is frequently relatively straightforward. However, there are many clinical scenarios in which this pathological diagnosis is difficult. Since each tumor is characterized by a genetic fingerprint of somatic mutations, a more definitive diagnosis is possible in principle in these difficult clinical scenarios by comparing the fingerprints. In this article we develop and evaluate a statistical strategy for …

Comorbidities Of Patients With Hypertension Admitted To Emergency Departments In Florida Hospitals

Florida Public Health Review

Although essential hypertension (EHT) tends to coexist with other conditions, few studies have focused on comorbidities and symptoms among patients admitted to emergency departments (ED). The objective was to compare the characteristics, comorbidities and symptoms among patients with three types (unspecified, benign, or malignant) of EHT in Florida. A public use data set of ED patients from the Florida Agency for Health Care Administration (AHCA) from 2005 was used. Records included those with primary diagnosis of three types of EHT based on the International Classification of Diseases, 9th edition (ICD-9) code. Group comparisons were made using Chi square tests and …

Effect Of The California Tobacco Control Program On Personal Health Care Expenditures, James M. Lightwood, Alexis Dinno, Stanton A. Glantz

Community Health Faculty Publications and Presentations

Background: Large state tobacco control programs have been shown to reduce smoking and would be expected to affect health care costs. We investigate the effect of California's large-scale tobacco control program on aggregate personal health care expenditures in the state. Methods and Findings: Cointegrating regressions were used to predict (1) the difference in per capita cigarette consumption between California and 38 control states as a function of the difference in cumulative expenditures of the California and control state tobacco control programs, and (2) the relationship between the difference in cigarette consumption and the difference in per capita personal health expenditures …

Effects Of Hypoxic-Ischemic Encephalopathy And Whole-Body Hypothermia On Neonatal Auditory Function: A Pilot Study, Ulrike Mietzsch, Nehal A Parikh, Amber L Williams, Seetha Shankaran, Robert E Lasky

Faculty, Staff and Student Publications

We assessed the effects of hypoxic-ischemic encephalopathy (HIE) and whole-body hypothermia therapy on auditory brain stem evoked responses (ABRs) and distortion product otoacoustic emissions (DPOAEs). We performed serial assessments of ABRs and DPOAEs in newborns with moderate or severe HIE, randomized to hypothermia ( N = 4) or usual care ( N = 5). Participants were five boys and four girls with mean gestational age (standard deviation) of 38.9 (1.8) weeks. During the first week of life, peripheral auditory function, as measured by the DPOAEs, was disrupted in all nine subjects. ABRs were delayed but central transmission was intact, suggesting …

Truck Drivers In Fatal Crashes After Substance Use, Kentucky Injury Prevention And Research Center

Kentucky Haz Alerts--Motor Vehicle

To prevent truck crashes due to substance use:

• Employers should implement and enforce a policy that prohibits commercial drivers who are ill or taking over-the-counter medications with potential side effects for impaired driving from operating a commercial vehicle.
• Employers should implement and enforce a “reasonable suspicion” drug testing policy if a driver is suspected to be under the influence of drugs.
• Companies should conduct comprehensive new-hire prescreening and after-hire random drug testing for substance abuse.
• A nationwide data- base containing a record of all commercial driver positive drug tests in the last two years should be developed.

Bilateral Claudication Results In Alterations In The Gait Biomechanics At The Hip And Ankle Joints, Shing-Jye Chen, Iraklis Pipinos, Jason Johanning, Matija Radovic, Jessie M. Huisinga, Sara A. Myers, Nikolaos Stergiou

Health and Kinesiology Faculty Publications

Claudication is the most common symptomatic manifestation of peripheral arterial disease (PAD), producing significant ambulatory compromise. The purpose of this study was to use advanced biomechanical gait analysis to determine the gait alterations occurring in claudicating patients both before and after onset of claudication pain in their legs. Hip, knee, and ankle joint moments were measured in claudicating patients (age: 64.46±8.47 years; body mass: 80.70±12.64 kg; body height: 1.72±0.08 m) and were compared to gender–age–body mass–height-matched healthy controls (age 66.27±9.22 years; body mass: 77.89±10.65 kg; body height: 1.74±0.08 m). The claudicating patients were evaluated both before (pain-free (PF) condition) and …

The Association Of Maternal Intention To Breastfeed, Early Skin-To-Skin Mother/Infant Contact, And Exclusive Breastfeeding During The Maternity Hospital Stay, Leslie Mary Bramson

Loma Linda University Electronic Theses, Dissertations & Projects

Breastfeeding is the optimal method to nourish and nurture an infant. Exclusive breastfeeding rates in the United States have reached the goal of Healthy People 2010 that 75% of mother's breastfeed in the immediate postpartum period. Yet, less than 35% of San Bernardino county mothers and 47.7% of Riverside county mothers are exclusively breastfeeding during their maternity hospital stays, with as many as 50% of the infants being weaned from the breast in the first 14 days of life.

This prospective study examined archived data collected by Perinatal Services Network (PSN) of Loma Linda University Medical Center/Children's Hospital for the …

Recently Arrested Adolescents Are At High Risk For Sexually Transmitted Diseases, Steven Belenko, Richard Dembo, Doris Weiland, Matthew Rollie, Christopher Salvatore, Alexandra Hanlon, Kristina Childs

Department of Justice Studies Faculty Scholarship and Creative Works

Adolescent offenders may be at high risk for sexually transmitted diseases (STDs). With previous research and interventions focused on incarcerated adolescents, data are needed on STD prevalence and risk factors among newly arrested youth released to the community, a far larger subgroup.Participants were recruited from all arrested youth processed at the Hillsborough County, Florida Juvenile Assessment Center during the last half of 2006 (506 males, 442 females). Participants voluntarily providing urine samples for drug testing as part of standard protocol were also consented to having their specimens split and tested for chlamydia and gonorrhea, using an FDA-approved nucleic acid amplification …

Exposure To Smoking Imagery In Popular Films And Adolescent Smoking In Mexico, James F. Thrasher, Christine Jackson, Edna Arillo-Santillán, James D. Sargent

Faculty Publications

Background: Exposure to smoking imagery in films in consistently associated with smoking behavior and its psychological antecedents among adolescents in high-income countries, but its association with adolescent smoking in middle-income countries is unknown.

Methods: In 2006, a cross-sectional sample of 3876 Mexican adolescents in secondary school was surveyed on smoking behavior, smoking risk factors, and exposure to 42 popular films that contained smoking. Participants were classified into quartiles of exposure to smoking imagery across all films they reported having seen. Models were estimated to determine associations among quartiles of film-smoking exposure, smoking behavior, and the psychological antecedents of smoking, adjusting …

The Fundamentals Of Medicare Demonstrations, Amanda Cassidy

National Health Policy Forum

Demonstrations are experiments that test Medicare policy changes without permanently changing the Medicare program. They allow policymakers to learn about the potential impact and operational challenges of a proposed modification to Medicare, but in a more controlled environment and on a limited basis. Since demonstrations can affect hundreds of thousands of beneficiaries and providers and involve millions of dollars, they are often controversial. This paper describes the basics of Medicare demonstrations, including what they are, how they are initiated, and why they are undertaken. The paper also explores the relationship between demonstrations and other research projects. The primary challenges in …

Knowledge, Awareness And Practices Regarding Dengue Fever Among The Adult Population Of Dengue Hit Cosmopolitan., Ahmed Itrat, Abdullah Khan, Sunniya Javaid, Mahwash Kamal, Hassan Khan, Sannia Javed, Saira Kalia, Adil Haleem Khan, Muhammad Imran Sethi, Imtiaz Jehan

Community Health Sciences

Background: The World health Organization (WHO) declares dengue and dengue hemorrhagic fever to be endemic in South Asia. Despite the magnitude of problem, no documented evidence exists in Pakistan which reveals the awareness and practices of the country's adult population regarding dengue fever, its spread, symptoms, treatment and prevention. This study was conducted to assess the level of knowledge, attitudes and practices regarding dengue fever in people visiting tertiary care hospitals in Karachi, Pakistan.
Methods: A cross-sectional pilot study was conducted among people visiting tertiary care hospitals in Karachi. Through convenience sampling, a pre-tested and structured questionnaire was administered through …

Evaluating Patient Compliance: Effect Of Appointment Reminder Systems On Attendance, Jacquelyn D. Phillips

Master of Public Health Program Student Publications

Currently, rising health care cost is an important topic on many agendas and platforms. In 2007, health care spending in the United States reached $2.3 trillion, and was projected to reach $3 trillion in 2011 (NCHC, 2007). Increasing health care cost is in direct relationship with the rise in the ageing population, chronic illness, and the uninsured lower socioeconomic population as well. The research on medical compliance and attendance (missed/kept appointment) behavior is an important area to explore because it is critical for all aspects of successful treatment, disease prevention, and health promotions that have direct correlation with health care …

Prescriptions For Excellence In Health Care Summer 2008 Download Full Issue #4

Prescriptions for Excellence in Health Care Newsletter Supplement

No abstract provided.

Influence Of Prediction Approaches For Spatially-Dependent Air Pollution Exposure On Health Effect Estimation, Sun-Young Kim, Lianne Sheppard, Ho Kim

UW Biostatistics Working Paper Series

Background: Air pollution studies increasingly estimate individual-level exposures from area-based measurements by using exposure prediction methods such as nearest monitor and kriging predictions. However, little is known about the properties of these methods for health effects estimation. This simulation study explores how two common prediction approaches for fine particulate matter (PM2.5) affect relative risk estimates for cardiovascular events in a single geographic area.

Methods: We estimated two sets of parameters to define correlation structures from 2002 PM2.5 data in the Los Angeles (LA) area and selected additional parameters to evaluate different correlation features. For each structure, annual average PM2.5 was …

A Comparison Of Methods For Estimating The Causal Effect Of A Treatment In Randomized Clinical Trials Subject To Noncompliance, Rod Little, Qi Long, Xihong Lin

Harvard University Biostatistics Working Paper Series

No abstract provided.

Semiparametric Maximum Likelihood Estimation In Normal Transformation Models For Bivariate Survival Data, Yi Li, Ross L. Prentice, Xihong Lin

Harvard University Biostatistics Working Paper Series

No abstract provided.