Digital Commons Network^™

The Ecology Of Fecal Indicators, Dennis A. Gilfillan

Electronic Theses and Dissertations

Animal and human wastes introduce pathogens into rivers and streams, creating human health and economic burdens. While direct monitoring for pathogens is possible, it is impractical due to the sporadic distribution of pathogens, cost to identify, and health risks to laboratory workers. To overcome these issues, fecal indicator organisms are used to estimate the presence of pathogens. Although fecal indicators generally protect public health, they fall short in their utility because of difficulties in public health risk characterization, inconsistent correlations with pathogens, weak source identification, and their potential to persist in environments with no point sources of fecal pollution. This …

Trying To Cover The Sun With Your Thumb: A Critical Ethnography Of Maternity Care Provision In Rural Northern New Mexico, Abigail Reese

Nursing ETDs

Access to maternity care is disappearing for women across rural America. In the state of New Mexico, women often travel long distances to access hospitals and providers that offer childbirth services, as these resources are concentrated primarily in metropolitan areas. Although data on provider distribution is available, very few studies have explored the maternity care access crisis from the perspectives of the midwives and physicians who work in rural areas. The purpose of this critical ethnographic study was to explore barriers and facilitators to the provision of childbirth services from providers’ perspectives with the intent of informing policy debates around …

Population And Fertility By Age And Sex For 195 Countries And Territories, 1950-2017: A Systematic Analysis For The Global Burden Of Disease Study 2017, Gbd 2017 Population And Fertility Collaborators, Paul Evan Kilgore

Department of Pharmacy Practice

Background Population estimates underpin demographic and epidemiological research and are used to track progress on numerous international indicators of health and development. To date, internationally available estimates of population and fertility, although useful, have not been produced with transparent and replicable methods and do not use standardised estimates of mortality. We present single-calendar year and single-year of age estimates of fertility and population by sex with standardised and replicable methods.

Methods We estimated population in 195 locations by single year of age and single calendar year from 1950 to 2017 with standardised and replicable methods. We based the estimates on …

Racial/Ethnic And Geographic Differences In Access To A Usual Source Of Care That Follows The Patient-Centered Medical Home Model: Analyses From The Medical Expenditure Panel Survey Data, Zo Ramamonjiarivelo, Delawnia Comer-Hagans, Shamly Austin, Karriem Watson, Alicia Kaye Matthews

Patient Experience Journal

This study examined racial and geographic differences in access to a usual source of care (USC) and it further explored these differences among individuals who had a USC that followed the patient-centered medical home (PCMH) model. Using cross-sectional data from the Household Component of the Medical Expenditure Panel Survey (2008-2013), our sample consisted of non-institutionalized US civilians ages 18-85 (n= 146,233; weighted n = 229,487,016). Our analysis included weighted descriptive statistics and weighted logistic regressions. Although 76% of the respondents had a USC, only 11% of them had a USC that followed the PCMH model. Among respondents who had a …

Exploring Explicit Fanfiction As A Vehicle For Sex Education Among Adolescents And Young Adults, Donna Jeanne Barth

USF Tampa Graduate Theses and Dissertations

Fanfiction consists of works written by amateurs using pre-existing characters and plots, often shared online for free. Although fanfiction began long before the advent of the internet, the worldwide web has created a platform wherein fanfiction is allowed and encouraged to spread almost unconditionally, reaching new populations and rising slowly but surely into the public eye. As the internet has made fanfiction more accessible and public, it has also increased the number of children and young adults involved in the process. And in the unsupervised wilderness of the internet, sexual content is a common feature of fanfiction, with a varying …

Not Just An Ache: Examining The Rate Of Musculoskeletal Pain In City Bus Drivers, Jeremy Steele

Mineta Transportation Institute

This paper examines the rates of musculoskeletal discomfort in a sample of 957 city bus drivers at King County Metro, a public transportation agency serving the greater Seattle area. It also examines how often such pain prevented drivers from doing their normal work, needed treatment from a medical professional, or incited one or more worker’s compensation claims. To assess the level of musculoskeletal discomfort in city bus drivers, an anonymous survey was distributed to drivers at King County Metro, a public transportation agency serving the greater Seattle area. This survey consisted of a Nordic Questionnaire asking drivers whether or not …

Spatio-Temporal Distribution Of Negative Emotions In New York City After A Natural Disaster As Seen In Social Media, Oliver Gruebner, Sarah R. Lowe, Martin Sykora, Ketan Shankardass, Sv Subramanian, Sandro Galea

Department of Psychology Faculty Scholarship and Creative Works

Disasters have substantial consequences for population mental health. We used Twitter to (1) extract negative emotions indicating discomfort in New York City (NYC) before, during, and after Superstorm Sandy in 2012. We further aimed to (2) identify whether pre- or peri-disaster discomfort were associated with peri- or post-disaster discomfort, respectively, and to (3) assess geographic variation in discomfort across NYC census tracts over time. Our sample consisted of 1,018,140 geo-located tweets that were analyzed with an advanced sentiment analysis called ”Extracting the Meaning Of Terse Information in a Visualization of Emotion” (EMOTIVE). We calculated discomfort rates for 2137 NYC census …

Brownsfields To Greenfields: Environmental Justice Versus Environmental Gentrification, Juliana A. Maantay, Andrew Maroko

Publications and Research

Gentrification is a growing concern in many urban areas, due to the potential for displacement of lower-income and other vulnerable populations. This process can be accelerated when neighborhood “greening” projects are undertaken via governmental or private investor efforts, resulting in a phenomenon termed environmental or “green” gentrification. Vacant land in lower-income areas is often improved by the existing community through the creation of community gardens, but this contributes to these greening efforts and paradoxically may spur gentrification and subsequent displacement of the gardens’ stewards and neighbors. “Is proximity to community gardens in less affluent neighborhoods associated with an increased likelihood …

A Mobile Smoking Cessation Intervention For Mexico (Vive Sin Tabaco... ¡Decídete!): Single-Arm Pilot Study, Ana Paula Cupertino, Francisco Cartujano-Barrera, Mariana Ramírez, Rosibel Rodríguez-Bolaños, James F. Thrasher, Gloria Pérez-Rubio, Ramcés Falfán-Valencia, Edward F. Ellerbeck, Luz Myriam Reynales-Shigematsu

Faculty Publications

Background: Of the 14.3 million Mexicans who smoke, only a minority take advantage of evidence-based approaches to smoking cessation. Mobile health interventions have the potential to increase the reach of effective cessation interventions in Mexico.

Objective: This study aimed to assess the feasibility and acceptability of an innovative, personalized, and interactive smoking cessation mobile intervention developed for Mexican smokers.

Methods: We recruited 40 Mexican smokers to participate in Vive sin Tabaco... ¡Decídete!, a smoking cessation program that uses a tablet-based decision support software to drive a 12-week text messaging smoking cessation program and pharmacotherapy support. Outcome measures included participant text …

Using Digital Scholarship And Citizen Science To Reduce Lead Poisoning Risk In Indiana, Matthew L. Sisk 6317313

Bucknell University Digital Scholarship Conference

Lead exposure remains a prevalent public health issue in many communities. In some cases, the exposure risk comes from contaminated water, but in others it is from the legacy of lead-based paint or contaminated soils. Here, we report on recent work using digital scholarship techniques along side a citizen science model to increase awareness and reduce environmental hazards in the affected city of South Bend, Indiana. Over the past two years, we have worked closely with local community organizations, civic entities and concerned individuals to develop a home test kit that puts the tools to determine risk in the hands …

Kisumu County Hospital Patient Demographic Analysis: Looking Toward Universal Health Coverage, Lauren Scheffey

Independent Study Project (ISP) Collection

Universal health coverage is priority sought after by developed and developing nations alike, and Kenya sits on the list of countries seeking to achieve this goal in the coming years. The definition of “coverage” can vary by country, but three criteria are commonly found in the discussion of UHC globally: access, affordability, and quality. Affordability is determined by the state’s healthcare financing system; quality refers to the services provided by health facilities; and access, at least in part, concerns the geographic placement of health services providers in relation to the population they intend to serve. This geographic element is the …

Maxent Estimation Of Aquatic Escherichia Coli Stream Impairment, Dennis Gilfillan, Timothy Andrew Joyner, Phillip R. Scheuerman

ETSU Faculty Works

Background: The leading cause of surface water impairment in United States’ rivers and streams is pathogen contamination. Although use of fecal indicators has reduced human health risk, current approaches to identify and reduce exposure can be improved. One important knowledge gap within exposure assessment is characterization of complex fate and transport processes of fecal pollution. Novel modeling processes can inform watershed decision-making to improve exposure assessment.

Methods: We used the ecological model, Maxent, and the fecal indicator bacterium Escherichia coli to identify environmental factors associated with surface water impairment. Samples were collected August, November, February, and May for 8 …

Maxent Estimation Of Aquatic Escherichia Coli Stream Impairment, Dennis Gilfillan, Timothy A. Joyner, Phillip Scheuerman

ETSU Faculty Works

Background.The leading cause of surface water impairment in United States’ rivers and streams is pathogen contamination. Although use of fecal indicators has reduced human health risk, current approaches to identify and reduce exposure can be improved. One important knowledge gap within exposure assessment is characterization of complex fate and transport processes of fecal pollution. Novel modeling processes can inform watershed decision-making to improve exposure assessment.

Patient Safety And The Ageing Physician: A Qualitative Study Of Key Stakeholder Attitudes And Experiences, Andrew A. White, William M. Sage, Paulina H. Osinska, Monica J. Salgaonkar, Thomas H. Gallagher

Faculty Scholarship

Background Unprecedented numbers of physicians are practicing past age 65. Unlike other safety-conscious industries, such as aviation, medicine lacks robust systems to ensure late-career physician (LCP) competence while promoting career longevity.

Objective To describe the attitudes of key stakeholders about the oversight of LCPs and principles that might shape policy development.

Design Thematic content analysis of interviews and focus groups.

Participants 40 representatives of stakeholder groups including state medical board leaders, institutional chief medical officers, senior physicians (>65 years old), patient advocates (patients or family members in advocacy roles), nurses and junior physicians. Participants represented a balanced sample from …

The Urban Food Desert As A Model For The Urban Health Care Desert: Fundamental Causes And Economic Considerations, Estevan A. Garcia

Dissertations and Theses

Introduction: A “health care desert” is a part of the country where needed medical, behavioral, mental, dental, and/or pharmaceutical health care services are extremely limited or altogether unavailable. This terminology is based on the concept of a “food desert,” which describes an area where people have limited access to affordable and healthy foods, and which, together with the negative health consequences of eating lower-quality foods, is well described in public health literature. The application of this terminology to an urban environment with ready access to transportation has been limited and is controversial. However, the recent increase in urban hospital closures …

Burden Of Lipohypertrophy Among Insulin Dependent Diabetes Mellitus Patients In China: An Analysis Of Outcomes And Impact Of Pen Needle Reimbursement Policy, Arthi Chandran

Dissertations and Theses

Background

Diabetes is a global epidemic and with an aging population accompanied by rapid urbanization China ranks highest in disease prevalence and associated burden. Independent of diabetes type, insulin is an eventual and costly requirement for disease management. The consequences of insulin administration however are poorly understood. Lipohypertrophy (LH) is one such consequence. It is hypothesized that method of insulin delivery and poor delivery technique are significant risk factors for this condition which is believed to alter insulin pharmacodynamics. Subsequently, insulin pen needles are a critical component of care however access to pen needles varies across China.

Objective

The objective …

Evaluation Of A Competency-Based Health Policy Training Program, Jim P. Stimpson, Kathleen Brandert, Brandon Grimm, Fernando A. Wilson

Reports: Center for Health Policy

An academic and practice partnership was formed to create and implement a competency-based training program for local health departments in health policy. We evaluated if the training program improved the policy knowledge and competency of participants.

Participants exhibited significant increases for self-assessed policy competency, including substantial improvements in “Critique the feasibility and expected outcomes of potential policy options”, “Identify and assess the strengths and motivations of key stakeholders and potential resistors”, and “Recommend a specific policy change”.

The policy competency instrument developed in this report could be used to measure policy knowledge and competency in future training implementations.

Evaluation Of A Competency-Based Health Policy Training Program, Jim P. Stimpson, Kathleen Brandert, Brandon Grimm, Fernando A. Wilson

Reports: Center for Health Policy

No abstract provided.

A Multi-Level Assessment Of Healthcare Facilities Readiness, Willingness, And Ability To Adopt And Sustain Telehealth Services, Jamie Larson

Theses & Dissertations

Telehealth technologies are becoming more pervasive throughout the healthcare system as a way to provide services to patients that would otherwise have difficulty with access. Currently, little is known about the current state of telehealth use within clinics and hospital in the US. Most studies evaluating telehealth programs are feasibility or small patient outcome studies from one location. Utilizing a hybrid framework combining the levels of complex socio-technical systems with the theory of ready, willing and able. The theory of ready, willing, and able is founded on the basis that these three preconditions need to be met for a change …

Pubh 7090-B Spatial Analysis And Health, Jeffery A. Jones

College of Public Health: Faculty Syllabi (2014-2021)

This course will introduce students to geographic information systems (GIS) to map and spatially analyze public health and demographic data. Students will learn the fundamentals of the ArcMap software system and ways to integrate cartography into biomedical informatics practice. Beyond use of GIS for cartography, this course will also examine ethical issues and methods of analyzing demographic and spatial health patterns using GIS and demography analysis methods. The versatility of GIS in a public health setting will be examined and will include exercises involving GIS applications in health marketing, demography, epidemiology, and health care systems. For example, we will look …

Quantifying Spatial Potential Access Equity In An Agent Based Simulation Model Of Buprenorphine Treatment Policy In The United States, Alexandra Elizabeth Nielsen

Dissertations and Theses

Opioid dependence and opioid related deaths are a public health problem which the United States Centers of Disease Control have declared an epidemic. While opioid agonist therapy for opioid addiction has been accepted as the most effective treatment for opioid dependence among academics, and office based buprenorphine treatment has been available in the Unites States for over 10 years, OB buprenorphine faces many barriers to widespread adoption. Empirical data on the geographic distribution of physicians able to prescribe buprenorphine and the prescribing patterns of those physicians show considerable unevenness in access and utilization of treatment services.

Federal-level policies have recently …

Alternative Financial Services And Health Status In U.S. Metropolitan Statistical Areas, Courtney Hundley, Richard W. Wilson 8520196, John Chenault

Journal of Health Disparities Research and Practice

Abstract

Alternative financial services (AFS) such as, payday lenders, pawn brokers, tax refund loans, and check cashers are more prevalent in minority and lower income neighborhoods. These are neighborhoods also found to have disparities in health, compared to more affluent neighborhoods and communities. The focus of this paper is to determine if any relationship exists between use of AFS and health disparities.

Using data from a survey performed by the Federal Deposit Insurance Corporation (FDIC), we compared four banking variables to several measures of health for 85 metropolitan statistical areas (MSA) across the nation. The four banking variables all related …

Pubh 4234 – International Development In Health, Nandi A. Marshall

College of Public Health: Faculty Syllabi (2014-2021)

This course will describe key cultural, social, and economic issues and methods in global health, and thus provide essential background for other core courses. The course is interdisciplinary, emphasizing the fields of anthropology, sociology, public health, global health, and critical global health studies. This course explores aspects of health inequalities and demonstrates how the sources of health inequalities (including globalization, the impact of social, economic, and political systems, the local and global economy, transnational organizations, culture, race, class, gender, and sexuality) are rooted in injustices that create and sustain the conditions that lead to disparities in health status and health …

Social Determinants Of Health And A Grounded Mixed-Methods Approach To Explain Declining Life Expectancy In Eastern Kentucky : 1980 – 2014., William Renda

Electronic Theses and Dissertations

Trends in life expectancy for the United States from 1980-2014 suggest general improvement overall. However, eastern Kentucky stands out with a cluster of counties experiencing declining life expectancy. Given that life expectancy is an excepted indicator of overall population health, this anomaly in eastern Kentucky warrants investigation. This thesis uses a grounded mixed methods approach to explore this trend across the greater Appalachian region. Content and discourse analysis of interviews with public health and medical professionals in the study area revealed key themes perceived as being related to declining life expectancy, which informed variable selection for regression analysis. Regression models …

Title X Family Planning Secondary Data Analysis Needs Assessment, Laura Triplett

Capstone Experience: Master of Public Health

The goal of the Title X Needs Assessment is to ‘Provide individuals the information and means to exercise personal choice in determining the number and spacing of their children', prevent unintended pregnancies, and reduce the number of abortions.’ Objectives include but are not limited to family involvement, abstinence and safer sex practice, intimate partner violence, human trafficking, contraceptive services, pregnancy testing and counseling, achieving pregnancy, basic infertility services, preconception health, STI/STD testing and treatment and HIV testing, Well Women/Men Exams; screening for breast cancer, cervical cancer, and testicular cancer in males. Sexual health education and reproductive life planning will be …

The Effect Of Lowering Public Insurance Income Limits On Hospitalizations For Low-Income Children., Jessica L. Bettenhausen, Matt Hall, Jeffrey D. Colvin, Henry T. Puls, Paul J. Chung

Manuscripts, Articles, Book Chapters and Other Papers

Background and objectives: Thirty million children are currently covered by public insurance; however, the future funding and structure of public insurance are uncertain. Our objective was to determine the number, estimated costs, and demographic characteristics of hospitalizations that would become ineligible for public insurance reimbursement under 3 federal poverty level (FPL) eligibility scenarios.

Methods: In this retrospective cohort study using the 2014 State Inpatient Databases, we included all pediatric (age

Results: In 775 460 publicly reimbursed hospitalizations in 14 states, reductions in eligibility limits to 300%, 200%, or 100% of the FPL would have resulted in large numbers of newly …

Changing Health Care Policy By Utilizing Kingdon's Policy Stream Theory, Brittney Welch

Graduate Theses, Dissertations, and Capstones

The purpose of this paper is to describe the policy process of changing current regulations regarding rural health clinics (RHCs). Using Kingdon’s Policy Stream Theory for guidance, the change project was designed to amend current regulations regarding the directorship of the RHCs, consequently allowing Nurse Practitioners (NP) to act as medical directors for rural health clinics (RHCs). This change fulfills the Institute of Medicine’s charge to have nurses work to the highest level of their education, as well as a defined need to fill a gap in the health care system by decreasing rural health disparities. The Rural Health Care …

Global Trends In Typhoidal Salmonellosis: A Systematic Review, Daina Als, Amruta Radhakrishnan, Paul Arora, Michelle F. Gaffey, Susan Campisi, Russanthy Velummailum, Farhana Zareef, Zulfiqar Ahmed Bhutta

Department of Paediatrics and Child Health

Typhoid and paratyphoid fever continue to significantly contribute to global morbidity and mortality. Disease burden is higher in low-and middle-income settings where surveillance programs are rare and little systematic information exists at population level. This review evaluates national, regional, and global trends in the incidence of typhoid fever and of related morbidity and mortality. A literature search in Medline, Embase, and Web of Science was conducted in June 2016, followed by screening and data extraction in duplicate. Studies reporting blood culture estimates of typhoid or paratyphoid morbidity and mortality were included in the analysis. Five thousand five hundred sixty-three unique …

Geographical, Racial And Socio-Economic Variation In Life Expectancy In The Us And Their Impact On Cancer Relative Survival, Angela B. Mariotto, Zhaohui Zou, Christopher J. Johnson, Steve Scoppa, Hannah K. Weir, Bin Huang

Markey Cancer Center Faculty Publications

Purpose

Despite gains in life expectancy between 1992 to 2012, large disparities in life expectancy continue to exist in the United States between subgroups of the population. This study aimed to develop detailed life tables (LT), accounting for mortality differences by race, geography, and socio-economic status (SES), to more accurately measure relative cancer survival and life expectancy patterns in the United States.

Methods

We estimated an extensive set of County SES-LT by fitting Poisson regression models to deaths and population counts for U.S. counties by age, year, gender, race, ethnicity and county-level SES index. We reported life expectancy patterns and …

Socioeconomic Determinants Of Broadband Non-Adoption Among Consumer Households In South Carolina, Usa, Lori Dickes, Elizabeth L. Crouch, Thomas Walker

Faculty Publications

he policy environment around broadband technology in the United States is shifting again and there are concerns about the impact these proposed changes will have on the future of rural bro- adband deployment and access. Similar to the Obama administration’s discussion of net neutrality, reclas- sifying high-speed internet is again receiving growing media and policy attention at the federal and state level in the United States. Globally, it is argued that affordable high-speed internet access is imperative to rural and regional economic development success. The global digital divide and challenges of non-adoption impact both developing and developed nations. While many …