Digital Commons Network^™

Managed Care: As Good As It Gets? (Los Angeles), Lisa Sprague

National Health Policy Forum

This site visit was a return trip to southern California to examine the state of managed care. Between the Forum's last visit (in late 1998) and this one, the marketplace underwent considerable change, including significant movement away from global capitation, the collapse of physician practice management firms, and the development of new insurance products. Site visitors were briefed on managed care trends in the state, and panel discussions focused on issues related to physician group solvency, employer and consumer expectations, managed care regulation, and plan and provider strategies for surviving and prospering in the difficult southern California market. Site visitors …

An Evaluation Of Germ City : Finding A Suitable Design, Suzanne Cherie Lusher

Theses, Dissertations and Capstones

Evaluations are used to determine a program’s merit. “Germ City” utilizes experiential learning of adequate hand washing skills. An elementary school in southwestern West Virginia served to determine if the evaluation design for “Germ City” would prove to be an effective assessment for the hand-washing program. Four hundred and eighty-four participants completed an eight-question pre/post test; one hundred and forty-nine students underwent a hand quadrant evaluation. In addition, a soap and paper towel usage log was recorded. Fifty-four percent of the participants were male, forty-six percent female (n=483) with a mean grade level of 3.6 (n=484). Post test results indicated …

Surveillance For Waterborne-Disease Outbreaks--United States, 1999-2000, Sherline H. Lee, Deborah A. Levy, Gunther F. Craun, Michael J. Beach, Rebecca L. Calderon

Journal Articles: Epidemiology

PROBLEM/CONDITION: Since 1971, CDC, the U.S. Environmental Protection Agency (EPA), and the Council of State and Territorial Epidemiologists (CSTE) have maintained a collaborative surveillance system for the occurrences and causes of waterborne-disease outbreaks (WBDOs).This surveillance system is the primary source of data concerning the scope and effects of waterborne diseases on persons in the United States.

REPORTING PERIOD COVERED: This summary includes data regarding outbreaks occurring during January 1999-December 2000 and previously unreported outbreaks occurring in 1995 and 1997.

DESCRIPTION OF THE SYSTEM: The surveillance system includes data for outbreaks associated with drinking water and recreational water. State, territorial, and …

Characteristic Differences Between Parents/Guardians Who Keep Immunization Records And Those Who Do Not, Rebecca Bonilla Mangual

Theses Digitization Project

No abstract provided.

Associations Between Water-Treatment Methods And Diarrhoea In Hiv-Positive Individuals, J. N. S. Eisenberg, T. J. Wade, A. Hubbard, D. I. Abrams, R. J. Leiser, S. Charles, M. Vu, S. Saha, C. C. Wright, Deborah A. Levy, P. Jensen, J. M. Colford

Journal Articles: Epidemiology

This manuscript extends our previously published work (based on data from one clinic) on the association between three drinking water-treatment modalities (boiling, filtering, and bottling) and diarrhoeal disease in HIV-positive persons by incorporating data from two additional clinics collected in the following year. We conducted a cross-sectional survey of drinking water patterns, medication usage, and episodes of diarrhoea among HIV-positive persons attending clinics associated with the San Francisco Community Consortium. We present combined results from our previously published work in one clinic (n = 226) with data from these two additional clinics (n = 458). In this combined analysis we …

Risk Factors In Hiv-Associated Diarrhoeal Disease: The Role Of Drinking Water, Medication And Immune Status, J. N. S. Eisenberg, T. J. Wade, S. Charles, M. Vu, A. Hubbard, C. C. Wright, Deborah A. Levy, P. Jensen, J. M. Colford

Journal Articles: Epidemiology

In a cross-sectional survey of 226 HIV-infected men, we examined the occurrence of diarrhoea and its relationship to drinking water consumption patterns, risk behaviours, immune status and medication use. Diarrhoea was reported by 47% of the respondents. Neither drinking boiled nor filtered water was significantly associated with diarrhoea (OR = 0.5 [0.2, 1.6], 1.2 [0.6, 2.5] respectively), whereas those that drank bottled water were at risk for diarrhoea (OR = 3.0 [1.1, 7.8]). Overall, 47% always or often used at least one water treatment. Of the 37% who were very concerned about drinking water, 62% had diarrhoea, 70% always or …

Hiv/Aids-Related Stigma And Discrimination: A Conceptual Framework And An Agenda For Action, Richard Parker, Peter Aggleton, Kathy Attawell, Julie Pulerwitz, Lisanne Brown

HIV and AIDS

In 1987, Jonathan Mann, then director of the WHO Global Programme on AIDS, identified three phases of the HIV/AIDS epidemic: the epidemic of HIV, the epidemic of AIDS, and the epidemic of stigma, discrimination, and denial. Despite international efforts to tackle HIV/AIDS since then, stigma and discrimination (S&D) remain among the most poorly understood aspects of the epidemic. This poor understanding is due in part to the complexity and diversity of S&D, but also to limitations in current thinking within the field and the inadequacy of available theoretical and methodological tools. This paper proposes a new conceptual framework to help …

Invisible, Underserved, And Diverse: The Health Of Women In Prison, Janette Y. Taylor, Rachel Williams, M. J. Eliason

International Journal of Global Health

In the United States of America, women are the fastest growing segment of the criminal justice system. They are entering the system with far greater physical and mental health problems than men, but with fewer health services. Additionally, within this expanding population of incarcerated women, are disproportionately represented poor women of color with serious health needs. This article: a) uses an ecosocial model to examine and critique the health and healthcare of women in prison, b) examines social structures that influence incarceration and health status, and c) proposes reconsideration of current prison health services and education.

Pathogenesis Of Human And Bovine Cryptosporidium Parvum In Gnotobiotic Pigs, Sonia J. Pereira, Norma E. Ramirez, Lihua Xiao, Lucy A. Ward

United States Public Health Resources

To compare the pathogenesis of human genotype 1 (HuGl) and bovine genotype 2 (BoG2) Cryptosporidium parvum, neonatal gnotobiotic pigs were given 1-10 HuGl or BoG2 oocysts. The prepatent and patent periods were significantly longer for HuGl than for BoG2 C. parvum (prepatent, 8.6 vs. 5.6 days; patent, 16.6 vs. 10.3 days). BoG2-infected pigs developed signif- icantly more severe disease than did HuGl-infected pigs. BoG2 parasites were seen micro- scopically throughout the intestines during the prepatent and patent periods. HuGl parasites were only detected during the patent period in the ileum and colon but colonized the mucosal surface in significantly …

A Preliminary Linkage Map Of The Tick, Ixodes Scapularis, Amy J. Ullmann, Joseph Piesman, M.C. Dolan, William C. Black, Iv

United States Public Health Resources

A linkage map of the Ixodes scapularis genome was constructed based upon segregation amongst 127 loci. These included 84 random amplified polymorphic DNA (RAPD) markers, 32 Sequence-Tagged RAPD (STAR) markers, 5 cDNAs, and 5 microsatellites in 232 F₁ intercross progeny from a single, field-collected P₁ female. A preliminary linkage map of 616 cM was generated across 14 linkage groups with one marker every 10.8 cM. Assuming a genome size of ∼10⁹ bp, the relationship of physical to genetic distance is ∼300 kb/cM in the I. scapularis genome.

Anopheles Gambiae Genome: Completing The Malaria Triad, Kathryn S. Aultman, Michael Gottlieb, Maria Y. Giovanni, Anthony S. Fauci

United States Public Health Resources

The genome sequence of Anopheles gambiae, the major mosquito vector of the malaria parasite Plasmodium falciparum, as well as analyses of its gene content and organization, are reported by several teams of investigators in this issue. In addition, the sequence of the P. falciparum genome appears in this week’s issue of Nature. The genomes of these two organisms, along with that of the human, provide a triad of critical genetic information relevant to all stages of the malaria transmission cycle and offer unprecedented opportunities to the scientific and public health communities engaged in the fight against malaria, …

Hiv/Aids Prevention Guidance For Reproductive Health Professionals In Developing-Country Settings, Helen Epstein, Daniel Whelan, Janneke Van De Wijgert, Purnima Mane, Suman Mehta

HIV and AIDS

While the integration of information, technologies, and services to respond to HIV/AIDS may seem closely related, there are a variety of issues that continue to create obstacles to integration. Among these are the stigmatizing nature of HIV infection and AIDS and discrimination faced by those who are infected or perceived to be infected; sexual practices and identities that remain socially unacceptable; gender roles and relations that make it difficult for women and men to access information, services, and technologies on HIV prevention; reluctance to recognize the special needs of young people; and barriers to service delivery created by broader economic, …

Cost Of Care And Support Services For Plha: Implications For The Financial Sustainability Of Nongovernmental Organizations, Horizons Program

HIV and AIDS

As HIV/AIDS prevalence increases, providers of care and support services will face greater demand for their services. The ability of nongovernmental organizations (NGOs) to help meet this increased demand will be influenced in part by their ability to control the cost of their services while generating sufficient revenue to meet expenses. The Y.R. Gaitonde Centre for AIDS Research and Education (YRG CARE) in Chennai, India, was one of the earliest providers of integrated care and support services in South India and currently serves clients from the four South Indian states. This brief highlights the key findings of a study that …

Factors Influencing Immunization Status In Primary Care Clinics, David Page, Jan Meires, Amy B. Dailey

Health Sciences Faculty Publications

Background and Objectives: National standards and goals for childhood immunization rates are well established. Yet, despite clear standards and goals, physicians do not achieve the desired rate (90%) for immunization coverage. This study examined factors related to immunization status for 2-year-old children in pediatric and family practice settings.

Methods: Specially trained personnel used computer software to audit 2,552 records from 42 practices in Northeast Florida throughout 1997–1999. Immunization records were judged as either complete or incomplete, and factors related to immunization status were studied. Clinic type and 18 immunization practice standards were reviewed for effect on immunization status.

Results: The …

Participant Blinding And Gastrointestinal Illness In A Randomized, Controlled Trial Of An In-Home Drinking Water Intervention, John M. Colford, Judy R. Rees, Timothy J. Wade, Asheena Khalakdina, Joan F. Hilton, Isaac J. Ergas, Susan Burns, Anne Benker, Catherine Ma, Cliff Bowen, Daniel C. Mills, Duc J. Vugia, Dennis D. Juranek, Deborah A. Levy

Journal Articles: Epidemiology

We conducted a randomized, triple-blinded home drinking water intervention trial to determine if a large study could be undertaken while successfully blinding participants. Households were randomized 50:50 to use externally identical active or sham treatment devices. We measured the effectiveness of blinding of participants by using a published blinding index in which values >0.5 indicate successful blinding. The principal health outcome measured was "highly credible gastrointestinal illness" (HCGI). Participants (n=236) from 77 households were successfully blinded to their treatment assignment. At the end of the study, the blinding index was 0.64 (95% confidence interval 0.51-0.78). There were 103 episodes of …

Changes In Functional Limitations And Survival Among The Elderly In Taiwan: 1993, 1996, And 1999, Zachary Zimmer, Linda G. Martin, Ming-Cheng Chang

Poverty, Gender, and Youth

This paper focuses on changes in the prevalence of functional limitations among nationally representative samples of adults aged 65 and older in Taiwan as measured in 1993, 1996, and 1999. Using data from the Survey of Health and Living Status of the Elderly in Taiwan, we investigate changes in difficulties walking and climbing stairs, two tasks that represent basic lower body movements that are less likely to be influenced by changes in living environments and social roles than are activities of daily living and instrumental activities of daily living. Results are shown for both unadjusted prevalence rates and rates adjusted …

How Community Structures Of Time And Opportunity Shape Adolescent Sexual Behavior In South Africa, Carol E. Kaufman, Shelley Clark, Ntsiki Manzini, Julian May

Poverty, Gender, and Youth

Recently, South Africa has led the world in rates of HIV/AIDS infection. Particularly among young adults, the prevalence of HIV has soared, now reaching 25 percent. The statistics suggest a high level of unprotected sex and risky sexual behavior even in the midst of high levels of knowledge. Research has focused on the dynamics of individuals’ and partners’ sexual decisionmaking. Little is known, however, about the larger context in which those decisions are made. What are the everyday experiences that influence risk-taking? Are young people with little to do more likely to engage in risky behavior? Do community opportunities of …

Universal Sexuality Education In Mongolia: Educating Today To Protect Tomorrow, Delia Barcelona, Laura Laski, Caitlin Gerdts

Poverty, Gender, and Youth

This issue of Quality/Calidad/Qualité demonstrates how Mongolia developed a national plan to a provide a comprehensive sexual and reproductive health curriculum and media for adolescents. Among the lessons learned from the Mongolian experience were the following: 1) questions about unwanted sexual relations and sexual roles were the most pressing among adolescents, especially girls; 2) printed media are efficient and inexpensive; and 3) parental opposition was almost nonexistent in certain settings—often they expressed gratitude for this education.

Mercury Exposure And Malaria Prevalence Among Gold Miners In Pará, Brazil, Ellen K. Silbergeld, Denis Nash, Circey Trevant, G. Thomas Strickland, Jose Maria De Souza, Rui S.U. Da Silva

Publications and Research

No abstract provided.

Detection Of Giardia Duodenalis Antigen In Coprolites Using A Commercially Available Enzyme-Linked Immunosorbent Assay, Marcelo Luiz Carvalho Gonçalves, Adauto Araújo, Rosemere Duarte, Joaquim Pereira Da Silva, Karl Reinhard, Françoise Bouchet, Luis Fernando Ferreira

Karl Reinhard Publications

The objective of this experiment was to assess the utility of a commercially available enzyme-linked immunosorbent assay (ELISA) kit for diagnosis of giardiasis in archaeological human remains. The kit, a monoclonal antibody assay, is used to detect the presence of Giardia-specific antigen 65 (GSA65) in human feces. We utilized the assay in ancient fecal material. The material included desiccated feces found in mummies or in archaeological sites, and sediments from latrines. A total of 83 specimens, previously examined microscopically for parasites, were examined. The ELISA detected 3 positive samples, dated to about 1200 AD, 1600 AD, and 1700 AD. …

Multidisciplinary Coprolite Analysis, Karl Reinhard, Dennis R. Danielson, Mark Daniels, Sérgio Augusto De Miranda Chaves

Karl Reinhard Publications

Coprolite analysis, as reviewed by Reinhard and Bryant (1992), contributes unique and detailed information regarding diet and parasitic disease. We present here an analysis of dietary components of coprolites from Bighorn Cave using macroscopic remains, pollen concentrations, and phytoliths. In addition, we analyzed Bighorn Cave coprolites for evidence of parasitic organisms, especially intestinal worms. Such analyses of coprolites have become important methods for reconstructing past dietary and medicinal practices. Pollen concentration and phytolith quantification techniques have recently been developed, but until this report no known attempt has been made to synthesize pollen, macroscopic, and phytolith data from a single coprolite …

Prevalence And Risk Factors For Vaginal Candida Colonization In Women With Type 1 And Type 2 Diabetes, Ella M. De Leon, Scott J. Jacober, Jack D. Sobel, Betsy Foxman

Wayne State University Associated BioMed Central Scholarship

Abstract

Background

Diabetes mellitus increases the rate of vaginal colonization and infection with Candida species

Methods

We surveyed women with diabetes receiving care at either an urban or suburban diabetes clinic to examine the relationship between vaginal Candida colonization, diabetes type and duration, and HbA_1c level. 101 participants completed the self-administered questionnaire and self-collected a vaginal swab for Candida culture. Candida colonization was similar by age and race.

Results

Type 1 diabetics were three times as likely as type 2 diabetics to be colonized with any Candida species (OR = 3.4; 95% CI: 1.03, 11.41; p = 0.04); even …

Bioterrorism, Public Health, And International Law, David P. Fidler

Articles by Maurer Faculty

No abstract provided.

Introduction To Written Symposium On Public Health And International Law, David P. Fidler

Articles by Maurer Faculty

No abstract provided.

Evaluation Of Directly Observed Therapy In Pulmonary Tuberculosis Patients In Nepal: Treatment Outcome And Patient Compliance, Baishali Bhattacharya

Masters Theses & Specialist Projects

Tuberculosis is the leading cause of infectious disease in Nepal. An estimated 60% of the adult population aged between 15-45 years is infected with tuberculosis, and 45% of the total population is infected. Ten percent of people infected with TB progress to active disease. To combat tuberculosis, Directly Observed Therapy (DOT) was adopted in Nepal in 1996. DOT was administered at four national demonstration sites in 1996 and expanded over time so that 56% of the population to date have been covered by DOT. This study aimed to evaluate DOT in pulmonary TB patients in Nepal in terms of patient …

Using An Importance-Performance Analysis Of Summer Students In The Evaluation Of Student Health Services., Candice Cline Duvernois

Electronic Theses and Dissertations

Hitherto, students have not evaluated the importance and performance of services provided by the student health service (SHS) at East Tennessee State University. An evaluation could provide valuable feedback to providers and administration.

In 2001, there were 944 student visits in the summer sessions. Approximately 256 students were offered a survey containing an Importance-Performance scale of which 151 (59.0%) responded. The I-P scale rates the importance students place on healthcare services and the performance of the SHS in delivering services (i.e., patient satisfaction).

Based on mean scores, students reported high importance, high performance on urgent care, pharmacy and patient education. …

Emergency Preparedness From A Health Perspective: Preparing For Bioterrorism At The Federal, State, And Local Levels, Robin J. Strongin

National Health Policy Forum

Despite the good intentions prior to and in the aftermath of the terrorist attacks of September 11, 2001, the existence of significant gaps in the country's preparedness became increasingly clear in the weeks that followed. This background paper provides an overview of the state of bioterrorism preparedness at all levels of government, identifying both the gaps and the steps being taken to close them. A series of reference materials, including a suggested reading list and Web site addresses, are listed at the end of the paper.

Mission Possible? Maintaining The Safety Net In Urban And Rural Colorado, Karen Matherlee

National Health Policy Forum

This site visit examined urban safety-net concerns in Denver and rural safety-net issues in three communities in the eastern part of Colorado. The Denver segment featured Denver Health, an integrated health system that provides a continuum of services to diverse vulnerable populations. It explored delivery and financing issues for the system itself and in relation to payers, providers, and consumers (particularly through Community Voices) in its catchment area. The eastern Colorado segment focused on delivery and financing issues in Rocky Ford (community health center/migrant health services concerns), Limon (certified rural health center topics), and Hugo (critical-access hospital matters). The visit …

The Outbreak Of West Nile Virus Infection In The New York City Area In 1999, Denis Nash, Farzad Mostashari, Annie Fine, James Miller, Daniel O'Leary, Kristy Murray, Ada Huang, Amy Rosenberg, Abby Greenberg, Margaret Sherman, Susan Wong, Marcelle Layton

Publications and Research

Background In late August 1999, an unusual cluster of cases of meningoencephalitis associated with muscle weakness was reported to the New York City Department of Health. The initial epidemiologic and environmental investigations suggested an arboviral cause.

Methods Active surveillance was implemented to identify patients hospitalized with viral encephalitis and meningitis. Cerebrospinal fluid, serum, and tissue specimens from patients with suspected cases underwent serologic and viral testing for evidence of arboviral infection.

Results Outbreak surveillance identified 59 patients who were hospitalized with West Nile virus infection in the New York City area during August and September of 1999. The median age …

Commencement Program 2001, Loma Linda University

Commencement Programs

CONTENTS

2 | 2001 Events of Commencement

3 | The Academic Procession

4 | The Speakers

10 | The University Honorees

18 | The School Honorees

26 | The Programs

• School of Medicine, 27
• School of Dentistry, 34
• Graduate School, 42
• School of Nursing, 51
• School of Allied Health Professions - Physical Therapy, 56
• School of Allied Health Professions, 63
• School of Public Health, 71