Genetic Risk Factors Underlying White Matter Hyperintensities And Cortical Atrophy, Yash Patel, Jean Shin, Eeva Sliz, Ariana Tang, Aniket Mishra, Rui Xia, Edith Hofer, Hema Sekhar Reddy Rajula, Ruiqi Wang, Frauke Beyer, Katrin Horn, Max Riedl, Jing Yu, Henry Völzke, Robin Bülow, Uwe Völker, Stefan Frenzel, Katharina Wittfeld, Sandra Van Der Auwera, Thomas H Mosley, Vincent Bouteloup, Jean-Charles Lambert, Geneviève Chêne, Carole Dufouil, Christophe Tzourio, Jean-François Mangin, Rebecca F Gottesman, Myriam Fornage, Reinhold Schmidt, Qiong Yang, Veronica Witte, Markus Scholz, Markus Loeffler, Gennady V Roshchupkin, M Arfan Ikram, Hans J Grabe, Sudha Seshadri, Stephanie Debette, Tomas Paus, Zdenka Pausova

Faculty, Staff and Student Publications

White matter hyperintensities index structural abnormalities in the cerebral white matter, including axonal damage. The latter may promote atrophy of the cerebral cortex, a key feature of dementia. Here, we report a study of 51,065 individuals from 10 cohorts demonstrating that higher white matter hyperintensity volume associates with lower cortical thickness. The meta-GWAS of white matter hyperintensities-associated cortical 'atrophy' identifies 20 genome-wide significant loci, and enrichment in genes specific to vascular cell types, astrocytes, and oligodendrocytes. White matter hyperintensities-associated cortical 'atrophy' showed positive genetic correlations with vascular-risk traits and plasma biomarkers of neurodegeneration, and negative genetic correlations with cognitive functioning. …

Successful Application Of Craniosacral Therapy In A Case Of Colic In An 8-Week-Old Baby, Caro O’Neill, Angie Butterfield

Journal of Transformative Touch

This case study reports on the effectiveness of CranioSacral Therapy (CST) for an eight-week-old baby boy experiencing colic. A CST pediatric protocol was utilized during two sessions, a week apart, in May 2023. An improvement in symptoms was recorded after the first treatment. After the second treatment the baby was no longer presenting with symptoms related to infant colic. This case suggests that CST can be an effective support for babies experiencing infant colic.

Word count: 75

Protein Consumption And Risk Of Cvd Among Us Adults: The Multi-Ethnic Study Of Atherosclerosis (Mesa), Ji Yun Tark, Ruosha Li, Bing Yu, Alexis C Wood, Nikhil S Padhye, Marcia C De Oliveira Otto

Faculty, Staff and Students Publications

BACKGROUND: Although some randomized trials have reported beneficial effects of protein intake on cardiometabolic risk factors, evidence from prospective studies have not supported a strong link between protein intake and cardiovascular disease (CVD) risk. It is also unclear whether diversity in protein intake plays a role in CVD risk.

OBJECTIVE: We investigated prospective associations of (1) protein intake, overall and by food source and (2) diversity of protein sources with risk of CVD, coronary heart disease (CHD), and stroke.

METHODS: In a multi-ethnic cohort of 5879 U.S. adults (45-84 years), who were free of CVD at baseline, protein intake was …

Disparities In Cognitive Decline Along The Texas-Mexico Border: Insights From The 2021 Brfss, Bianca D. Valenzuela

Health and Kinesiology Theses

The aging global population has brought increased attention to cognitive health and early detection of cognitive decline. Subjective Cognitive Decline (SCD), defined as self-reported memory or thinking problems, is an early marker of neurodegenerative diseases. Despite growing research, gaps remain in understanding how geographic disparities influence SCD prevalence and contributing factors. The Texas-Mexico border region, predominantly Hispanic and facing unique socioeconomic and health care challenges, offers a unique context to explore these influences. The purpose of this study was to examine the prevalence of SCD and related functional limitations in Texas-Mexico border counties versus non-border counties, using 2021 Behavioral Risk …

Association Of Chronic Malnutrition, And Not Anemia, With Cognitive Development In Ethiopian Schoolchildren: A Cross-Sectional Study, Befikadu Tariku Gutema, Muluken Bekele Sorrie, Sifray Batire, Tadiwos Hailu Zewdie, Bruno Levecke, Amina Abubakar, Stefaan De Henauw, Souheila Abbeddou

Institute for Human Development, East Africa

This study assesses the associations between nutritional statusand cognitive development of schoolchildren. A unit increase inheight-for-age Z-score was associated with 0.12 SD, 0.08 SD and0.12 SD increase in standardized digit span, Raven’s coloredprogressive metrics, and performance index of visual searchtask, respectively. A unit increase in body-mass-index-for-ageZ-score was associated with 0.11 SD increase in standardizeddigit span. Hemoglobin concentration was not associated withany of the cognitive outcomes. Chronic malnutrition was asso-ciated with cognitive development in schoolchildren while thin-ness and hemoglobin concentrations were associated withselected or no cognitive outcomes, respectively.

Identifying Ordinal Categories For The Water Insecurity Experiences Scales, Edward A. Frongillo Jr., Hilary J. Bethancourt, Joshua D. Miller, Sera L. Young, The Household Water Insecurity Experiences Scales (Hwise)-Research Coordination Network (Rcn)

Faculty Publications

The Household Water Insecurity Experiences (HWISE) and Individual Water Insecurity Experiences (IWISE) Scales are globally suitable tools for comparably measuring water insecurity experiences among households and adults, respectively. The potential range for HWISE and IWISE scores is 0–36. When the WISE Scales were first published, scores of 12 and higher were considered indicative of water insecurity, but additional cut-points are needed to provide more nuanced insights. We therefore sought to develop a practical set of cut-points for the WISE Scales using HWISE data from 13 sites across 12 countries (n = 3,293) and nationally representative samples of IWISE data …

Dementia Risk Reduction In The African Context: Multi-National Implementation Of Multimodal Strategies To Promote Healthy Brain Aging In Africa (The Africa-Fingers Project), Chinedu Momoh, Rachel Maina, Lukoye Atwoli, Karen Blackmon, Edna Bosire, Gloria Chemutai, Linda Khakali, Sylvia Mbugua, Zul Merali, Olivera Nesic Taylor,, Anthony Ngugi, Cyprian Mostert, Eunice Muthoni, Roselyter Riang’A, Mansoor Saleh, Shahin Sayed, Jasmit Shah

Brain and Mind Institute

Dementia prevention in Africa is critically underexplored, despite the continent's high prevalence of modifiable risk factors. With a predominantly young and middle-aged population, Africa presents a prime opportunity to implement evidence-based strategies that could significantly reduce future dementia cases and mitigate its economic impact. The multinational Africa-FINGERS program offers an innovative solution, pioneering culturally sensitive, multidomain interventions tailored to the unique challenges of the region. Leveraging insights from landmark global studies such as Worldwide-FINGERS and Alzheimer's Disease Neuroimaging Initiative, the program employs a multideterminant precision prevention framework, grounded in community based systems dynamics. Africa-FINGERS further integrates cutting-edge state-of-the-art multimodal biomarker …

Vol 4 November '24 Cover, Publishing And Table Of Contents, Donna L. Williams

Journal of the Louisiana Public Health Association

No abstract provided.

Vol 4 November '24 Full Issue, Donna L. Williams

Journal of the Louisiana Public Health Association

No abstract provided.

Upside Down World, Donna L. Williams

Journal of the Louisiana Public Health Association

No abstract provided.

Utilizing Prams To Examine Wic And Non-Wic Participants' Smoking Prevalences In Louisiana, Almetra Granger, Tyra Gross, Ty-Runet Bryant, Amy Thierry, Michael D. Celestin Jr.

Journal of the Louisiana Public Health Association

Background: Cigarette and electronic cigarette use before, during, or after pregnancy increases the chances of severe health risks for both the mother and child. Quitting leads to significantly better health outcomes. Women, Infants, and Children (WIC) clinics serve large numbers of pregnant, breastfeeding, and postpartum women, offering an excellent opportunity to address tobacco cessation. But few studies assess tobacco use, particularly electronic cigarette use, among WIC participants. This study examined the relationship between WIC status and maternal tobacco use. Methods: We analyzed WIC (n=315) and non-WIC (n=152) participants smoking data from the 2016-2018 Phase 8 Louisiana Pregnancy Risk Assessment Monitoring …

Sexual Behavior Among Emerging Adults In Africa: A Systematic Review And Meta-Analysis, Stevenson Chea, Vincent A. Kagonya, Osman Abdullahi, Amina Abubakar, Souheila Abbeddou, Kristien Michielsen, Amin Hassan

Institute for Human Development, East Africa

Background: Estimates on sexual behavior (SB) among emerging adults (EmA) is varied in literature, which presents a challenge when designing targeted interventions. We aimed to summarize literature on prevalence and risk factors of SB among EmA in Africa.

Methods: A search for studies published in PubMed, Embase, and Psych Info by March 2023 was done. Studies involving EmA (18–25 years), conducted in Africa, and reporting 1 or more of 7 SBs were reviewed. Pooled prevalence estimates were summarized using forest plots. Heterogeneity in SB was explored. Risk factors were synthesized using a modified socioecological model.

Results: Overall, …

Protein Biomarkers Of Ultra-Processed Food Consumption And Risk Of Coronary Heart Disease, Chronic Kidney Disease, And All-Cause Mortality, Shutong Du, Jingsha Chen, Hyunju Kim, Alice H Lichtenstein, Bing Yu, Lawrence J Appel, Josef Coresh, Casey M Rebholz

Faculty, Staff and Student Publications

Background: There is a need to understand the underlying biological mechanisms through which ultra-processed foods negatively affect health. Proteomics offers a valuable tool with which to examine different aspects of ultra-processed foods and their impact on health.

Objectives: The aim of this study was to identify protein biomarkers of usual ultra-processed food consumption and assess their relation to the incidence of coronary heart disease (CHD), chronic kidney disease (CKD), and all-cause mortality risk.

Methods: A total of 9361 participants from the Atherosclerosis Risk in Communities visit 3 (1993-1995) were included. Dietary intake was assessed using a 66-item food-frequency questionnaire and …

Feasibility, Acceptability, And Initial Efficacy Of A Wheelchair Exercise Training Program In Persons With Multiple Sclerosis: Study Protocol For A Parallel Group Randomized Controlled Trial, Stephanie L Silveira, Robert W Motl, Katherine Froehlich-Grobe, Mitch Kay

Faculty, Staff and Student Publications

Purpose: This study is a randomized controlled trial (RCT) that examines the feasibility, acceptability, and initial efficacy of a home-based, remotely supported and supervised exercise training program that was developed using a three-step community engaged research process for persons with multiple sclerosis (MS) who are wheelchair users.

Materials and methods: The study design is a parallel group RCT (NCT05888727). We aim to enroll 24 wheelchair users with MS who will be randomly assigned using REDCap randomization module into exercise training or attention/contact wellness control conditions. The conditions will be delivered remotely over 16 weeks and supported using online, …

Sex Differences In Hypertension And Its Management Throughout Life, Wan-Jin Yeo, Rahul Abraham, Aditya L Surapaneni, Pascal Schlosser, Shoshana H Ballew, Bige Ozkan, Carina M Flaherty, Bing Yu, Joseph V Bonventre, Chirag R Parikh, Paul L Kimmel, Ramachandran S Vasan, Josef Coresh, Morgan E Grams

Faculty, Staff and Student Publications

Background: The prevalence of hypertension and uncontrolled hypertension may differ by age and sex.

Methods: We included participants in the Atherosclerosis Risk in Communities study at seven study visits over 33 years (visit 1: 15 636 participants; mean age, 54 years; 55% women), estimating sex differences in prevalence of hypertension (systolic blood pressure ≥130 mm Hg; diastolic blood pressure ≥80 mm Hg; or self-reported antihypertension medication use) and uncontrolled hypertension (systolic blood pressure ≥140 mm Hg or diastolic blood pressure ≥90 mm Hg) using unadjusted and comorbidity-adjusted models.

Results: The prevalence of hypertension increased with age from 40% (ages, 43-46 …

Serum Metabolomic Markers Of Artificially Sweetened Beverage Consumption, Hejingzi Jia, Lauren Bernard, Jingsha Chen, Shutong Du, Lyn M Steffen, Kari E Wong, Bing Yu, Valerie K Sullivan, Casey M Rebholz

Faculty, Staff and Student Publications

BACKGROUND: The consumption of artificially sweetened beverages is on the rise. Use of artificial sweeteners has been associated with adverse health outcomes. There is a need to identify novel objective biomarkers of artificially sweetened beverages in order to improve dietary assessment and to provide insight into their metabolic impact.

OBJECTIVES: We aimed to identify serum metabolites that are associated with artificially sweetened beverage consumption.

METHODS: In the Atherosclerosis Risk in Communities (ARIC) study, consumption of artificially sweetened beverages was assessed using a food frequency questionnaire and fasting serum samples were collected during the first study visit (1987-1989). Participants were categorized …

Metabolites Link Intake Of A Healthy Diet To Better Insulin And Glucose Homeostasis In The Microbiome And Insulin Longitudinal Evaluation Study (Miles), Alexis C Wood, Danielle J Lee, Patricia A Sheridan, Elizabeth T Jensen, Gautam Ramesh, Alain G Bertoni, Stephen S Rich, Yii-Der I Chen, David M Herrington, Jerome I Rotter, Mark O Goodarzi

Faculty, Staff and Students Publications

BACKGROUND: Dietary quality has been linked to better glycemic control, but the precise molecular mechanisms giving rise to these associations are not fully understood.

OBJECTIVES: To examine the association of metabolites associated with the intake of a healthy diet with measures of insulin/glucose homeostasis.

METHODS: Using cross-sectional data from 295 United States adults, the associations between 3 diet pattern scores and metabolome-wide metabolites were estimated via linear regression models, which controlled for demographic factors and health behaviors. Subsequently, the associations between the diet-related metabolites with 6 measures of glucose/insulin homeostasis were examined in similar models. A Bonferroni correction was applied …

Factors Associated With Head And Neck Cancer Postoperative Radiotherapy Delays: A Systematic Review And Meta-Analysis, Kelsey A Duckett, Mohamed Faisal Kassir, Shaun A Nguyen, Emily A Brennan, Bhisham S Chera, Katherine R Sterba, Chanita Hughes Halbert, Elizabeth G Hill, Jessica Mccay, Sidharth V Puram, Ryan S Jackson, Vlad C Sandulache, Russel Kahmke, Nosayaba Osazuwa-Peters, Salma Ramadan, Brian Nussenbaum, Anthony J Alberg, Evan M Graboyes

Faculty, Staff and Students Publications

Objective: Initiating postoperative radiotherapy (PORT) within 6 weeks of surgery for head and neck squamous cell carcinoma (HNSCC) is included in the National Comprehensive Cancer Network Clincal Practice Guidelines and is a Commission on Cancer quality metric. Factors associated with delays in starting PORT have not been systematically described nor synthesized.

Data sources: PubMed, Scopus, and CINAHL.

Review methods: We included studies describing demographic characteristics, clinical factors, or social determinants of health associated with PORT delay (>6 weeks) in patients with HNSCC treated in the United States after 2003. Meta-analysis of odds ratios (ORs) was performed on nonoverlapping datasets. …

Asn Kidney Health Guidance On The Management Of Obesity In Persons Living With Kidney Diseases, T Alp Ikizler, Holly J Kramer, Srinivasan Beddhu, Alex R Chang, Allon N Friedman, Meera N Harhay, Elizabeth Yakes Jimenez, Brandon Kistler, Aleksandra Kukla, Kristin Larson, Lindamarie U Lavenburg, Sankar Dass Navaneethan, John Ortiz, Rocio I Pereira, David B Sarwer, Philip R Schauer, Evan M Zeitler

Faculty, Staff and Students Publications

No abstract provided.

Access To Treatment For Chronic Obstructive Pulmonary Disease In The Americas: A Call For Action A Joint Perspective From The Brazilian Thoracic Society, Canadian Thoracic Society, Latin American Thoracic Society, And The American Thoracic Society, Francesca Polverino, Mohit Bhutani, Gustavo Zabert, Frederico Leon Arrabal Fernandes, Karen Czischke, Luiz Fernando Pereira Ferreira, Lian Szabo, Juan P Wisnivesky, Margareth Pretti Dalcolmo, Juan C Celedón

Faculty, Staff and Students Publications

Chronic obstructive pulmonary disease (COPD) is a major public health problem in the Americas (a region of the world comprising North, Central, and South America), although there is substantial variation in disease prevalence, morbidity, and mortality between and within nations. Across the Americas, COPD disproportionately affects vulnerable populations, including minoritized populations and impoverished persons, who are more likely to be exposed to risk factors such as tobacco use, air pollution, infections such as tuberculosis, and biomass smoke, but less likely to have adequate healthcare access. Management of COPD can be challenging across the Americas, with some barriers being specific to …

Inpatient Falls: Epidemiology, Risk Assessment, And Prevention Measures. A Narrative Review, Taylor Locklear, Jeannie Kontos, Callaham A. Brock, Alexander B. Holland, Rachel Hemsath, Anna Deal, Shannon Leonard, Carsten Steinmetz, Saptarshi Biswas

HCA Healthcare Journal of Medicine

Patient falls are a common inpatient dilemma and comprise the largest category of preventable adverse events in hospitalized patients. These events place a clinical burden on the patient, such as increased morbidity and reduced quality of life, in addition to an economic burden on the hospital system. Fall prevention strategies have the opportunity to decrease inpatient health care costs and length of stay. Several risk factors have been identified that contribute to inpatient falls and several strategies have been identified to minimize this risk. These risk factors are typically characterized as intrinsic and extrinsic factors. Intrinsic factors include characteristics such …

Analysis Of Continuous Ambulatory Peritoneal Dialysis Service Readiness At Rsud Kota Bogor In 2023, Ni Nyoman Diah Redyardani, Dumilah Ayuningtyas

Jurnal ARSI : Administrasi Rumah Sakit Indonesia

The availability of health service facilities certainly contributes to one of the success factors in the distribution of health services in Indonesia, including renal replacement therapy (RRT) services. Through Minister of Health Regulation (PMK) No. 8 of 2022, the government ensures that patients with end-stage renal disease (ESRD) receive equal access to RRT. One of the efforts to equalize dialysis services is implementing Continuous Ambulatory Peritoneal Dialysis (CAPD) services. Therefore, RSUD Kota Bogor must prepare for CAPD services in its dialysis installations. This research analyzes the readiness and efforts to provide CAPD services at RSUD Kota Bogor. This study employs …

Hubungan Tingkat Risiko Postur Kerja Dan Faktor Individu Dengan Keluhan Musculoskeletal Disorders Pekerja Mebel Tunjungsekar, Aquila Ghafril Azizah, Mochamad Yusuf, Anita Sulistyorini, Agung Kurniawan

National Journal of Occupational Health and Safety

The high poverty rate in Indonesia can be addressed through the contribution of Micro, Small, and Medium Enterprises (MSMEs), which absorb approximately 57.78% of the workforce in the informal sector. However, this sector faces risks of workplace accidents and occupational diseases that can impact workers' productivity and well-being. Musculoskeletal Disorders (MSDs) account for 42% to 58% of all recorded occupational diseases globally. Preliminary observations identified symptoms of MSDs, such as neck stiffness and back pain, among furniture workers in the informal sector of Tunjungsekar. This study aims to determine the relationship between the risk levels of work posture and individual …

The Relationship Between Snacking And Sugar, Salt, Fat Intake On Nutritional Status Of Adolescents Of Smkn 30 Jakarta, Khoirul Anwar, Syifa Aulia Putri

Indonesian Journal of Public Health Nutrition (IJPHN)

Excessive consumption of sugar, salt, and fat including from snacks can increase the risk of obesity or being overweight. The objective of this study to analyze the relationship between snacking and sugar, salt, and fat intake on nutritional status in adolescents. This design is cross-sectional with a sample of 90 grade X students at SMKN 30 Jakarta. The data collected include physical activity data using the Global Physical Activity Questionnaire (GPAQ), snacking habit data, frequency of sugar, salt, and fat consumption using the SQ-FFQ. The results of the correlation test showed that there was a significant relationship between snacking habits …

Factors Related To The Consumption Of Sugar-Sweetened Beverages (Ssbs) Among High School Students At Sma Negeri 68 Jakarta In 2024, Debora Karyoko, Wahyu Kurnia Yusrin Putra, Teguh Jati Prasetyo

Indonesian Journal of Public Health Nutrition (IJPHN)

Indonesia ranked third in Southeast Asia for Sugar-Sweetened Beverages (SSBs) consumption in 2022, with a consumption rate of 20.23 liters/person/year. According to Riskesdas in 2018, 61.3% of the Indonesian population consumed more than once a day and 47.5% in 2023. This study aims to understand the patterns and levels of SSB consumption among various factors in students of SMA Negeri 68 Jakarta in 2024. This cross-sectional study was conducted from April to May 2024 with 134 respondents using questionnaires and interviews for 24-hour food recall and SQ-FFQ. Univariate analysis showed that 12.69% of respondents had high SSB consumption. Bivariate analysis …

The Relationship Of Dietary Pattern And Physical Activity On Cholesterol Level In Young Adults, Wahyuni Sammeng

Indonesian Journal of Public Health Nutrition (IJPHN)

High blood cholesterol levels are a serious problem because they are one of the risk factors for degenerative diseases such as cardiovascular. Research data shows that in Ambon City, 32.49% of the population has the habit of consuming fatty/cholesterol/fried foods ≥1 time per day. The purpose of this study was to determine the relationship between dietary habit and physical activity with blood cholesterol levels. The type of research used was quantitative, sampling technique used was convenience sampling for 30 people. The independent variables in this study were dietary intake (amount, frequency, and type) measured using a semi-quantitative FFQ and physical …

Different Food Coping Strategies In Urban And Semi-Urban Areas During Coronavirus Disease 2019 (Covid-19) Pandemic, Sandra Fikawati, Ahmad Syafiq, Rizna Notarianti, Syilga Cahya Gemily

Indonesian Journal of Public Health Nutrition (IJPHN)

Consumption-related behavior implemented as an effort to maintain household food security is referred to as a food coping strategy (FCS). This study aims to describe the selection of FCS by families in urban and semi-urban areas in Indonesia during the COVID-19 pandemic. This research is a cross-sectional study with a total sample of 517 people who live in urban (Jakarta) and semi-urban (Depok) areas. The research data was taken from primary research data that had been collected online and purposively through Posyandu cadres who had access to family/community in October-December 2020. Data analysis used the chi-square test and multiple logistic …

Implementation Science And Pediatric Diabetes: A Scoping Review Of The State Of The Literature And Recommendations For Future Research, Julia Price, Jaclynn Hawkins, Daniel J. Amante, Richard James, Debra Haire-Joshu

Department of Medicine Faculty Papers

PURPOSE OF REVIEW: This scoping review aimed to identify implementation science (IS) research in pediatric diabetes, report integration of IS theory and terminology, and offer guidance for future research.

RECENT FINDINGS: Of 23 papers identified, 19 were published since 2017 and 21 focused on type 1 diabetes. Most involved medical evidence-based practices (EBPs; n = 15), whereas fewer focused on psychosocial (n = 7) and diabetes education (n = 2). The majority either identified barriers and facilitators of implementing an EBP (n = 11) or were implementation trials (n = 11). Fewer studies documented gaps in EBP implementation in standard …

Preparedness For Practice Of Health Professionals In Papua New Guinea: A Cross-Sectional Survey Of Nurses And Community Health Workers., Mary Kililo, Julie Dopsie, Sulpain Passingan, Julie Kep, Nina Joseph, Russel Kitau, Mary Roroi, Chris Rossiter, Jenny Sim, Di Brown, Caroline Havery, Ali Moloney, Michele Rumsey

Pacific Journal of Health

Introduction

Papua New Guinea (PNG) experiences widespread health inequity and shortage of health professionals, exacerbated by poverty, isolation, gender-based violence and limited infrastructure, transport and accessible services. Nurses and community health workers (CHW) represent 72% of health workforce. However, health professional education programs are outdated and not aligned with national health priorities. We aimed to explore the adequacy of current curricula for nurses and CHWs by examining graduate competencies and preparedness for practice.

Methods

Cross-sectional study with four cohorts: 1) 130 new nurse graduates, 2) 75 nurses who supervised them, 3) 105 new CHW graduates and 4) 65 CHW supervisors. …

Social Determinants Of Health And How They Affect A Small Rural Community (Case Study) Eastern Shore Of Maryland, Kristopher S. Durham, Lindsay Gietzen

Pacific Journal of Health

The Eastern Shore of Maryland is rural and is characterized by prevalent poverty, housing instability, lack of access to healthcare, chronic diseases, substance abuse, and issues with transportation to access healthcare services. The same problems exist for the population in Maryland and the United States. Understanding the challenges experienced by rural communities in Maryland is critical to addressing the vulnerable population. This study is an explanatory case study that examines the social determinants of health and how those affect small rural communities on the Eastern Shore of Maryland by examining literature published between 2016 and 2024. The literature reviewed resulted …