Digital Commons Network^™

Integrating Care: Improving Overall Health By Integrating Behavioral/Mental Health Care Into Primary Care, Macaran A. Baird

Center for Policy Research

Hippocrates noted that the patient must be attended in light of “his” diet, work, home, and community setting. Since that time, we have struggled with the dilemma of how to put the patient’s presenting problems in the context of the patient’s life circumstances. That goal has proven elusive. So how do we sort out where to put the emphasis with our healing arts?

Refining The Global Spatial Limits Of Dengue Virus Transmission By Evidence-Based Consensus, Oliver J. Brady, Peter W. Gething, Samir Bhatt, Jane P. Messina, John S. Brownstein, Anne G. Hoen

Dartmouth Scholarship

Background: Dengue is a growing problem both in its geographical spread and in its intensity, and yet current global distribution remains highly uncertain. Challenges in diagnosis and diagnostic methods as well as highly variable national health systems mean no single data source can reliably estimate the distribution of this disease. As such, there is a lack of agreement on national dengue status among international health organisations. Here we bring together all available information on dengue occurrence using a novel approach to produce an evidence consensus map of the disease range that highlights nations with an uncertain dengue status.

Methods/Principle Findings: …

Epidemiological Characteristics And Underlying Risk Factors For Mortality During The Autumn 2009 Pandemic Wave In Mexico, Gerardo Chowell, Santiago Echevarria-Zuno, Cecile Viboud, Lone Simonsen, Mark A. Miller, Irma Fernandez-Garate, Cesar Gonzalez-Bonilla, Víctor H. Borja Aburto

Global Health Faculty Publications

Background

Elucidating the role of the underlying risk factors for severe outcomes of the 2009 A/H1N1 influenza pandemic could be crucial to define priority risk groups in resource-limited settings in future pandemics.

Methods

We use individual-level clinical data on a large series of ARI (acute respiratory infection) hospitalizations from a prospective surveillance system of the Mexican Social Security medical system to analyze clinical features at presentation, admission delays, selected comorbidities and receipt of seasonal vaccine on the risk of A/H1N1-related death. We considered ARI hospitalizations and inpatient-deaths, and recorded demographic, geographic, and medical information on individual patients during August-December, 2009. …

A Geographical Analysis Of Hiv/Aids Infection In Nigeria, 1991-2001, Chinekwu Azuka Obidoa, Robert G. Cromley

Journal of Social, Behavioral, and Health Sciences

Abstract

Objectives: Within the gradually accumulating literature on the Acquired Immune Deficiency Syndrome (AIDS) in Nigeria, investigations concerning the spatial dimensions of the infection are virtually non-existent. An understanding of the spatial dimensions of the epidemic is central in the development and implementation of appropriate intervention strategies. This study is a geographic analysis of HIV/AIDS infection in Nigeria from 1991 – 2001. The three objectives of this study were: 1) to examine the geographic pattern of the epidemic, 2) to examine the spatial-temporal trend and diffusion pattern of the epidemic, and 3) to explore the factors associated with the spatial …

Analysis Of Variable Effects On Presence Of Cryptosporidium Oocysts And Giardia Cysts In Effluent Water From Wastewater Treatment Utilities In Florida From 1998 To 2010, Katherine Jane Barkan

USF Tampa Graduate Theses and Dissertations

The concern of a Cryptosporidium or Giardia waterborne outbreak due to treated wastewater has had water treatment utilities using some of the highest water cleansing technologies available. Cryptosporidiosis and Giardiasis are severe diarrheal diseases which can lead to death, thus it is important that appropriate steps are taken to assure these parasites are not present in the effluent of treated wastewater. This study examined the results of 863 assays for Giardia and Cryptosporidium on the effluent of wastewater treatment facilities and found that county of collection, watershed of collection, and laboratory analyzing the sample have the most significant impact on …

Keeneland Conference Plenary Sessions: Harvey V. Fineberg, Harvey V. Fineberg

Frontiers in Public Health Services and Systems Research

Healthy communities are essential for healthy individuals. Healthy communities can only exist when preventive measures are taken. When prevention programs are implemented, negative health outcomes can be avoided before they even start. A necessary part of these successful prevention methods requires great research and evidence based practice. Dr. Harvey Fineberg, president of the Institute of Medicine and keynote speaker at the Keeneland Conference, addressed the audience on why good science is imperative to the public health community. It cannot just left up to chance on whether an intervention will work or not; rather it needs to be thoroughly reasoned, grounded …

An O’Neill Institute Briefing Paper: The Supreme Court’S Landmark Decision On The Affordable Care Act: Healthcare Reform’S Ultimate Fate Remains Uncertain, Emily W. Parento, Lawrence O. Gostin

O'Neill Institute Papers

The Supreme Court’s decision on the constitutionality of the Patient Protection and Affordable Care Act (ACA) is a landmark on the path toward ensuring universal access to health care in the United States. In a 5-4 decision written by Chief Justice Roberts, the Court upheld the law in its entirety with the sole exception that Congress may not revoke existing state Medicaid funding to penalize states that decline to participate in the Medicaid expansion under the ACA. In this O’Neill Institute Briefing, we explain and analyze the Court’s decision, focusing on the individual purchase mandate and the Medicaid expansion, while …

Responsiveness Of The Federal Health System To The Needs Of 18-45 Year Old Adults With Physical Disabilities In Islamabad, Pakistan, Shaista Habibullah

USF Tampa Graduate Theses and Dissertations

Abstract

The health system has been defined as all people, institutions and resources that undertake actions with the primary intent of improving health, while responsiveness of the health system refers to its objective of responding to the legitimate expectations of the population it serves. Although responsiveness is a non-health objective of the health system, it affects the health status of the population by influencing treatment compliance, patient-provider communication and health services utilization. Furthermore, responsiveness has a fundamental value as it concerns basic human rights of the individuals being served by the health system.

This study was undertaken to determine how …

Food Deserts And Their Association With Obesity And Diabetes In Ohio, Alexis Holmes, Detra Thompson

Master of Public Health Program Student Publications

Objective- The purpose of this study was to explore the association of food access, and availability, on prevalence of diabetes and obesity in Ohio census tracts designated as food deserts.

Methods- County and census tract-level data were combined from the USDA Food Environment Atlas and USDA Food Desert Locator respectively. Statistical analysis was conducted using IBM Statistical Package for Social Sciences (SPSS). Non-normally distributed variables were assessed using the Mann-Whitney nonparametric U-test and Spearman’s correlation coefficient. Significance was considered at the p

Results- The mean rate of obesity and diabetes in Ohio in food deserts are 29.5% and 10.7%, when …

Two Boundaries Separate Borrelia Burgdorferi Populations In North America, Gabriele Margos, Jean I. Tsao, Santiago Castillo-Ramirez, Yvette A. Girard, Anne G. Hoen

Dartmouth Scholarship

Understanding the spread of infectious diseases is crucial for implementing effective control measures. For this, it is important to obtain information on the contemporary population structure of a disease agent and to infer the evolutionary processes that may have shaped it. Here, we investigate on a continental scale the population structure of Borrelia burgdorferi, the causative agent of Lyme borreliosis (LB), a tick-borne disease, in North America. We test the hypothesis that the observed d population structure is congruent with recent population expansions and that these were preceded by bottlenecks mostly likely caused by the near extirpation in the 1900s …

The Hiv/Aids Pandemic In African American Msm: Targets For Intervention, Kelly Neff

Journal of Health Disparities Research and Practice

The Centers for Disease Control and Prevention estimated in 2005 that 46% of African American men who have sex with men (MSM) are HIV positive. This review explores the unique factors that contribute to risky sexual behavior and the spread of HIV within this population, suggesting that the disparate prevalence of HIV among African American MSM is rooted in experiences of stigmatization from multiple sources and lack of social support from society at large as well as from within the African American community. Beliefs in HIV conspiracy myths are also thought to hinder HIV education, awareness and prevention for African …

Expanding The Evidence Base For Accreditation And Qi: Progress In Practice-Based Research Networks, Glen P. Mays

Health Management and Policy Presentations

Studies that examine the implementation and impact of quality improvement strategies in public health are underway through the Public Health Practice-Based Research Networks.

Cumulative Risk And A Call For Action In Environmental Justice Communities, H. P. Hynes, Russ Lopez

Journal of Health Disparities Research and Practice

Health disparities, social inequalities, and environmental injustice cumulatively affect individual and community vulnerability and overall health; yet health researchers, social scientists and environmental scientists generally study them separately. Cumulative risk assessment in poor, racially segregated, economically isolated and medically underserved communities needs to account for their multiple layers of vulnerability, including greater susceptibility, greater exposure, less preparedness to cope, and less ability to recover in the face of exposure. Recommendations for evidence-based action in environmental justice communities include: reducing pollution in communities of highest burden; building on community resources; redressing inequality when doing community-based research; and creating a screening framework …

Correlates Of Poor Health Among Orphans And Abandoned Children In Less Wealthy Countries: The Importance Of Caregiver Health, Nathan Thielman, Jan Ostermann, Kathryn Whetten, Rachel Whetten, Karen O’Donnell, Positive Outcomes For Orphans (Pofo) Research Team

Faculty Publications

Background: More than 153 million children worldwide have been orphaned by the loss of one or both parents, and millions more have been abandoned. We investigated relationships between the health of orphaned and abandoned children (OAC) and child, caregiver, and household characteristics among randomly selected OAC in five countries.

Methodology: Using a two-stage random sampling strategy in 6 study areas in Cambodia, Ethiopia, India, Kenya, and Tanzania, the Positive Outcomes for Orphans (POFO) study identified 1,480 community-living OAC ages 6 to 12. Detailed interviews were conducted with 1,305 primary caregivers at baseline and after 6 and 12 months. Multivariable logistic …

Increasing Rate Of Pneumonia Hospitalizations Among Older American Indian And Alaska Native Adults, Robert C. Holman, Krista L. Yorita, Rosalyn J. Singleton, James E. Cheek, Edna L. Paisano, Jay C. Butler, Larry J. Anderson, Alicia M. Fry

Journal of Health Disparities Research and Practice

Objective: To examine rates and trends of pneumonia hospitalization among older American Indian and Alaska Native (AI/AN) adults.

Methods: Pneumonia hospitalizations for older AI/AN adults ≥65 years of age living in the Alaska and Southwest Indian Health Service (IHS) regions during 1988 through 2002 from the IHS hospital discharge data were analyzed.

Results: The average annual hospitalization rate for first-listed pneumonia for older AI/AN adults in both the Alaska and the Southwest regions has increased (15.3 and 23.0 in 1988-1990 to 25.9 and 28.8 in 2000-2002 per 1,000 population, respectively), with the greatest increase seen among older AI/AN adults in …

All-Cause Gastroenteritis And Rotavirus-Coded Hospitalizations Among Us Children, 2000–2009, Rishi Desai, Aaron T. Curns, Claudia A. Steiner, Jacqueline E. Tate, Manish M. Patel, Umesh D. Parashar

United States Public Health Resources

Background. Rotavirus vaccine was recommended for US infants in 2006. We estimated baseline prevaccine burden and monitored postvaccine trends in gastroenteritis-coded and rotavirus-coded hospitalizations among US children.

Methods. We analyzed data from the State Inpatient Databases (SID) for 29–44 US states over a 10-year period (2000–2009) to calculate gastroenteritis and rotavirus-coded hospitalization rates by age group, sex, and region, among children <5 years of age. By extrapolating observed pre- and postvaccine gastroenteritis hospitalization rates to the US population <5 years and based on the 2009 cost of a diarrhea hospitalization, we estimated national reductions in diarrhea hospitalizations and associated treatment costs.

Results. The prevaccine (2000–2006) annual average gastroenteritis-coded hospitalization rate among children <5 years of age was 74 per 10 000 (annual range, 71–82 per 10 000), and declined to 51 and 50 per 10 000 in 2008 and 2009, respectively (P < .001). The prevaccine (2000–2006) annual average rotavirus-coded hospitalization rate among children <5 years of age was 15 per 10 000 (annual range, 13–18 per 10 000), and declined to 5 and 6 per 10 000 in 2008 and 2009, respectively (P < .001). The decreases in rotavirus-coded hospitalization rates in 2008 and 2009 compared with rates in prevaccine years were observed among all age groups and US regions. Nationally, during 2008 and 2009 combined, we estimated a reduction of approximately 77 000 diarrhea hospitalizations and approximately $242 million in hospital costs.

Conclusions. Since implementation of the US rota-virus vaccination program, a marked reduction in diarrhea hospitalizations and related hospital charges has occurred among US children.

Selective Impact Of Hiv Disease Progression On The Innate Immune System In The Human Female Reproductive Tract., Timothy Lahey, Mimi Ghosh, John V. Fahey, Zheng Sheng, Lucy R. Mukura, Yan Song, Susan Cu-Uvin, Kenneth H. Mayer, Peter F. Wright, John C. Kappes, Christina Ochsenbauer, Charles R. Wira

Epidemiology Faculty Publications

Background

We have previously demonstrated intrinsic anti-HIV activity in cervicovaginal lavage (CVL) from HIV-infected women with high CD4 counts and not on antiretroviral therapy. However, the impact of HIV disease progression on CVL innate immune responses has not been delineated.

Methods

CVL from 57 HIV-infected women not on antiretroviral therapy were collected by washing the cervicovaginal area with 10 ml of sterile normal saline. We characterized subject HIV disease progression by CD4 count strata: >500 cells/µl, 200–500 cells/µl, or <200 cells/µl of blood. To assess CVL anti-HIV activity, we incubated TZM-bl cells with HIV plus or minus CVL. Antimicrobials, cytokines, chemokines and anti-gp160 HIV IgG antibodies were measured by ELISA and Luminex.

Results

CVL exhibited broad anti-HIV activity against multiple laboratory-adapted and transmitted/founder (T/F) viruses, with anti-HIV activity ranging from 0 to 100% …

Foodborne Illness Outbreak Response: A Snapshot Of Ohio, Calen Wherry

Master of Public Health Program Student Publications

Biosurveillance is one of the primary roles of local Public health offices. As the all-hazards (biological, chemical, and radiation emergencies) approach adds to the responsibilities already performed in foodborne illness outbreak response, it is crucial to assess the capabilities and robustness of the local public health Foodborne Illness (FBI) response. By surveying the most populated counties in Ohio with a checklist based on the 2009 Council for Improvement of Foodborne Outbreak Response (CIFOR) guidelines, it was possible to obtain a snapshot of the current outbreak response capabilities. Though only one county reported 100% compliance with the checklist, the overall average …

Rickettsia Felis In Ctenocephalides Felis From Guatemala And Costa Rica, Adriana Troyo, Danilo Alvarez, Lizeth Taylor, Gabriela Abdalla, Olger Calderon-Arguedas, Maria L. Zambrano, Gregory A. Dasch, Kim A. Lindblade, Laya Hun, Marina Eremeeva, Alejandra Estevez

Environmental Health Sciences: Faculty Publications

Rickettsia felis is an emerging human pathogen associated primarily with the cat flea Ctenocephalides felis. In this study, we investigated the presence of Rickettsia felis in C. felis from Guatemala and Costa Rica. Ctenocephalides felis were collected directly from dogs and cats, and analyzed by polymerase chain reaction for Rickettsia-specific fragments of 17-kDa protein, OmpA, and citrate synthase genes. Rickettsia DNA was detected in 64% (55 of 86) and 58% (47 of 81) of flea pools in Guatemala and Costa Rica, respectively. Sequencing of gltA fragments identified R. felis genotype URRWXCal2 in samples from both countries, and genotype Rf2125 in …

High Acceptability For Cell Phone Text Messages To Improve Communication Of Laboratory Results With Hiv-Infected Patients In Rural Uganda: A Cross-Sectional Survey Study, Mark J. Siedner, Jessica E. Haberer, Mwebesa B. Bwana, Norma C. Ware, David Bangsberg

OHSU-PSU School of Public Health Faculty Publications and Presentations

Background: Patient-provider communication is a major challenge in resource-limited settings with large catchment areas. Though mobile phone usership increased 20-fold in Africa over the past decade, little is known about acceptability of, perceptions about disclosure and confidentiality, and preferences for cell phone communication of health information in the region.

Methods: We performed structured interviews of fifty patients at the Immune Suppression Syndrome clinic in Mbarara, Uganda to assess four domains of health-related communication: a) cell phone use practices and literacy, b) preferences for laboratory results communication, c) privacy and confidentiality, and d) acceptability of and preferences for text messaging to …

Mean Cd4 Cell Count Changes In Patients Failing A First-Line Antiretroviral Therapy In Resource-Limited Settings, Alexandra Calmy, Eric Balestre, Fabrice Bonnet, Andrew Boulle, Eduardo Sprinz, Robin Wood, Eric Delaporte, Eugène Messou, James Mcintyre, Kamal Marhoum El Filali, Mauro Schechter, N. Kumarasamy, David Bangsberg, Patrick Mcphail, Stefaan Van Der Borght, Carlos Zala, Matthias Egger, Rodolphe Thiébaut, François Dabis, Art-Linc Of Iedea Collaboration (Asia, South America, East, Southern And West Africa)

OHSU-PSU School of Public Health Faculty Publications and Presentations

Background: Changes in CD4 cell counts are poorly documented in individuals with low or moderate-level viremia while on antiretroviral treatment (ART) in resource-limited settings. We assessed the impact of on-going HIV-RNA replication on CD4 cell count slopes in patients treated with a first-line combination ART.

Method: Naïve patients on a first-line ART regimen with at least two measures of HIV-RNA available after ART initiation were included in the study. The relationships between mean CD4 cell count change and HIV-RNA at 6 and 12 months after ART initiation (M6 and M12) were assessed by linear mixed models adjusted for gender, age, …

Instructions For Authors

Journal of Health Disparities Research and Practice

The Journal of Health Disparities Research and Practice publishes research to guide the development of evidence-based solutions, policy and programs in an effort to reduce and ultimately eliminate health disparities. Published three times per year (Spring, Summer, Fall), the journal is an on-line publication that explores the problems and challenges of health disparities among the diverse populations of the United States.

Surveillance Of Infectious Diseases Among American Indians And Alaska Natives, Jeanne Bertolli, Amy Roussel, Jennie Harris, Dan Lentine, Julia Gable, Ron Fichtner, Joann Kauffman, Michael Landen, Ralph T. Bryan

Journal of Health Disparities Research and Practice

We assessed participation in public health surveillance networks among Indian Health Service, tribal, and urban (I/T/U) Indian health facilities for a group of infectious diseases, and barriers to participation. We conducted surveys of I/T/U facilities and key informant interviews with representatives of tribal, urban, and national American Indian/Alaska Native (AI/AN) agencies. For the surveys, frequencies and percentages of responses in each response category were calculated. Qualitative methods were used to analyze interview content. The proportion of facilities participating in case reporting is suboptimal across facility types and diseases. Even when reporting is occurring, there is little feedback to tribal agencies. …

Physicians’ Experiences And Opinions Regarding Strategies To Improve Care For Minority Patients, Jared W. Klein, Lindsay O. Schubiner, Margaret Gadon, Matthew K. Wynia

Journal of Health Disparities Research and Practice

Objective: To assess the views and experiences of a select group of physicians interested in minority health issues regarding promising strategies to improve minority care. Methods: Physicians were asked to respond to a 17-item survey assessing the level of agreement, frequency of implementation of and interest in learning more about 7 promising strategies for alleviating disparities. Results: Most physicians (75-95%) agreed that the 7 proposed strategies could be useful to improve the quality of care provided to minority patients, but only 40-66% of physicians had implemented the strategies sometimes or often in their practices. Between 22 and …

Molecular Epidemiology Of Hiv-Associated Tuberculosis In Dar Es Salaam, Tanzania: Strain Predominance, Clustering, And Polyclonal Disease, Lisa V. Adams, Barry N. Kreiswirth, Robert D. Arbeit, Hanna Soini, Lillian Mtei, Mecky Matee, Muhammad Bakari, Timothy Lahey, Wendy Wieland-Alter

Dartmouth Scholarship

Molecular typing of Mycobacterium tuberculosis can be used to elucidate the epidemiology of tuberculosis, including the rates of clustering, the frequency of polyclonal disease, and the distribution of genotypic families. We performed IS6110 typing and spoligotyping on M. tuberculosis strains isolated from HIV-infected subjects at baseline or during follow-up in the DarDar Trial in Tanzania and on selected community isolates. Clustering occurred in 203 (74%) of 275 subjects: 124 (80%) of 155 HIV-infected subjects with baseline isolates, 56 (69%) of 81 HIV-infected subjects with endpoint isolates, and 23 (59%) of 39 community controls. Overall, 113 (41%) subjects had an …

A Cross-National Analysis Of The Human Papillomavirus, Sexually Transmitted Infections, And Sexual Behavior Among Men, Euna Marie August

USF Tampa Graduate Theses and Dissertations

There is a paucity of research on the risk for sexually transmitted infections (STIs) and sexual behavior among general populations of men. Research with male populations predominantly has focused on those subgroups considered to be at high risk of disease transmission, such as gay and bisexual men, injection drug users, and adolescents/young adults. Considerably fewer studies have examined factors among men, in general, and heterosexual men, specifically. Therefore, I conducted analyses with a cross-national sample of adult, sexually active men in Brazil, Mexico, and the United States to investigate sexual behaviors and risk factors associated with the human papillomavirus (HPV) …

Partnerships For Health - Jeff Health And The Rwanda Village Concept Project – A Model Of Interdisciplinary Health Professions Student Global Education, Ellen Plumb, Md, James D. Plumb Md, Mph, Francis Barchi, Mbe, Phd, Breanne Ward, Ashlyn Sakona, Morgan Greenfield, Elisabeth Collins, Cameron Bass, Md, Kaitlan Elston, Md, Rwanda Squad

JCIPE 2012

Seminar (23 PowerPoint Slides)

A partnership between the Rwanda Village Concept Project (RVCP), a medical student program in Butare, and Jeff HEALTH (Helping East Africans Link to Health), a multidisciplinary student organization at ThomasJeffersonUniversity, has been working in two Rwandan villages for the past five years. Initially, The Rwanda Health and Healing Project consisted of two programs, a Genocide Survivors Village Transformation and creation of a GenocideMemorial Park. These programs lead to a comprehensive community health assessment, which: 1) documented the needs through key informant interviews and focus groups; 2) identified health resources currently available; and 3) reviewed needs in …

The Closure Of New Orleans' Charity Hospital After Hurricane Katrina: A Case Of Disaster Capitalism, Kenneth Brad Ott

LSU New Orleans Theses and Dissertations

Abstract

Amidst the worst disaster to impact a major U.S. city in one hundred years, New Orleans’ main trauma and safety net medical center, the Reverend Avery C. Alexander Charity Hospital, was permanently closed. Charity’s administrative operator, Louisiana State University (LSU), ordered an end to its attempted reopening by its workers and U.S. military personnel in the weeks following the August 29, 2005 storm. Drawing upon rigorous review of literature and an exhaustive analysis of primary and secondary data, this case study found that Charity Hospital was closed as a result of disaster capitalism. LSU, backed by Louisiana state officials, …

A Framework Convention On Global Health: Health For All, Justice For All, Lawrence O. Gostin

Georgetown Law Faculty Publications and Other Works

Health inequalities represent perhaps the most consequential global health challenge and yet they persist despite increased funding and innovative programs. The United Nations is revising the Millennium Development Goals (MDGs) that will shape the world for many years to come. What would a transformative post-MDG framework for global health justice look like? A global coalition of civil society and academics—the Joint Action and Learning Initiative on National and Global Responsibilities for Health (JALI)—has formed an international campaign to advocate for a Framework Convention on Global Health (FCGH). Recently endorsed by the UN Secretary-General, the FCGH would reimagine global governance for …

The Science Of Public Health Practice: Using Pbrns For Delivery System Research In Public Health Settings, Glen P. Mays

Health Management and Policy Presentations

PBRN research tests strategies for improving the delivery of services that promote health and prevent disease and injury on a population-wide basis.