Digital Commons Network^™

Unmet Need And Unintended Pregnancy: The Bigger Picture, Ian Askew

Reproductive Health

Prevention of unintended pregnancy is often considered the key outcome of reducing unmet need; it is the basic right of women and couples to become pregnant only when intended. This paper explores this relationship by reviewing the definition and measurement of unintended pregnancy, identifying key trends in its distribution within and between populations, and analyzing the relationship between unintended pregnancy, demand for family planning, and family planning program performance. The determinants and consequences of unintended pregnancy are reviewed to further understand the implications of using it as a policy and programming goal. The paper concludes by reviewing the broader policy …

Understanding The Early Stages Of Development Of A Global Health Partnership, Wendy Raquel Gonzalez Navarrete

Theses and Dissertations

Maternal and child undernutrition contributes to more than one-third of child deaths. Global Health Partnerships (GHP) have emerged as a response to undernutrition and other pressing health problems. GHPs promote joint decision-making among donors, multilateral agencies, and country partners. Despite their positive impact on health problems, GHPs have generated unintended negative effects on country partners. This study aimed to understand the factors, strategies, and processes conducive to the establishment of an effective GHP in the context of a cooperative regional effort to reduce undernutrition and improve maternal and child health in eight countries in Latin America, Regional Health Initiative (RHI). …

Review Of Ear Health And Hearing Among Indigenous Peoples, Jane Burns, Neil Thomson

Research outputs pre 2011

This review of ear health and hearing among Indigenous Australians has been prepared by the Australian Indigenous HealthInfoNet as a part of our contributions to ‘closing the gap’ in health between Indigenous people1 and other Australians. The aim is to make relevant, high quality knowledge and information easily accessible to policy makers, health service providers, program managers, clinicians, researchers and the general community. The review is an example of the HealthInfoNet’s translational research, defined as ‘comprehensive applied research that strives to translate the available knowledge and render it operational’

The main purpose of the review, which follows the model of …

Ngala Healthy You, Healthy Baby: A Personalized Online Program To Support Healthy Weight In Pregnancy And Early Life, Margaret R. Miller, Lydia A. Hearn, Anna Fletcher, Lelia R. Green

Research outputs 2013

Perinatal maternal obesity is common and has significant child and maternal health consequences. Online resources have the potential to engage young mothers to adopt healthier lifestyles during pregnancy and postpartum. Intercept interviews with 53 pregnant women at antenatal clinics and focus groups with 67 new mothers at mothers’ groups and playgroups were conducted to determine preferred types and formats of online information and support. The expressed needs of women were matched to behaviour change theory to guide development of the Healthy You Healthy Baby website and Smartphone application. A mix of factual and practical online information, self-assessment, goal-setting and feedback …

Review Of Ear Health And Hearing Among Indigenous Australians, Jane F. Burns, Neil J. Thomson

Research outputs 2013

Indigenous Australians experience some of the highest levels of ear disease and hearing loss in the world, with rates up to ten times more than those for non-Indigenous Australians [4]. Children and adolescents are particularly vulnerable to ear infections. The most common ear disease among Indigenous children is otitis media (OM), which is inflammation/infection of the middle ear typically caused by bacterial and viral pathogens. Indigenous children living in urban, rural and, particularly, remote areas, are more likely than their non-Indigenous counterparts to have OM at younger ages, more often, at a greater level of severity, and with more likelihood …

Tailoring A Physical Activity Promotion Program For A Rural Area, Gavin T. Colquitt, Moya L. Alfonso, Ashley Walker, Vanessa Dunmore

Community Health: Faculty Presentations (1993-2018)

Background/Purpose: VERBTM Summer Scorecard (VSS) has used social marketing to successfully promote physical activity for urban and suburban youth. The purpose of this study was to adapt the program to meet the needs of a minority, rural population.

Method: Qualitative marketing research methods including focus groups were used to gather data from parents (N = 12) and their children (N =12) in April 2012. A structured, open-ended focus group guide was developed specific to parents and youth and based on the social marketing framework. Marketing topics covered included Product, Price, Place and Promotion. Attention was given to testing two previously …

Better Health, But Less Justice: Widening Health Disparities After National Federation Of Independent Business V. Sebelius, Emily W. Parento, Lawrence O. Gostin

Georgetown Law Faculty Publications and Other Works

At the time it was enacted in 2010, the Patient Protection and Affordable Care Act (ACA) was widely applauded by health activists, as it meant that the United States would at last join the overwhelming majority of industrialized countries in providing its population with guaranteed access to affordable health care. Roughly half of the increase in access to health insurance was to come from the expansion of Medicaid eligibility to all U.S. citizens and legal residents with income below 138% of the Federal Poverty Level. However, the Supreme Court’s 2012 ruling in National Federation of Independent Business v. Sebelius ( …

Towards A Framework Convention On Global Health: A Transformative Agenda For Global Health Justice, Lawrence O. Gostin, Eric A. Friedman

Georgetown Law Faculty Publications and Other Works

International law has responded weakly to the inequities in health care, public health, and the broader determinates of health that collectively cause the greatest loss of lives and human potential every year. Approximately one-third of global deaths can be attributed to enduring and unconscionable inequities. Despite significant progress in improving global health over the past several decades, these inequities persist. Current global governance for health is inadequate to the task of resolving these inequities, from lack of accountability and enforcement to inadequate funding and the absence of leadership required to respond to the threats to health that arise from other …

Systematic Review Of Research Into The Psychological Aspects Of Prostate Cancer In Asia: What Do We Know?, Suzanne Kathleen Chambers, Melissa Karen Hyde, David Fu-Keung Ip, Jeffrey Charles Dunn, Robert Alexander Gardiner

Research outputs 2013

Background: To review the peer reviewed literature on the psychological aspects of the prostate cancer experience of men in Asia.

Materials and Methods: Medline and PsycINFO, CINAHL, ProQuest, and Web of Science (1999 – November Week 4, 2012) were searched. Inclusion criteria were: included men with prostate cancer and/or their partners or caregivers who identify as Asian recruited in an Asian country; and assessed health-related quality of life, psychological and social adjustment relating to prostate cancer and published in English after 1st January 1999 and prior to 30th November, 2012.

Study aims: design; quality; level of evidence, and key results …

Children Served By Mainecare, 2012: Survey Findings, Nathaniel J. Anderson Ms, Mph, Kimberley Fox Mpa, Deborah Thayer Mba, Zachariah T. Croll Mph

Medicaid

The purpose of the annual Survey of Children Served by MaineCare is to monitor the quality of services delivered by MaineCare, the State's Medicaid and CHIP program. The 2012 survey examines the experiences of families with children. ages 0-17, who are enrolled in MaineCare using a standardized survey instrument (Consumer Assessment of Healthcare Providers and Systems--CAHPS--4.0H Child Medicaid Health Plan Survey). MaineCare scores very favorably compared with national benchmarks on CAHPS measures of Getting Needed Care, Getting Care Quickly, and How Well the Child's Doctors Community, with ratings at or above the 75th percentile on all the composites and individual …

Using A Community-Based Participatory Research Approach To Address Individual And Community Health In Charleston, Ms. The Initial Step: A Formative Needs Assessment, Catherine Dane Woodyard

Electronic Theses and Dissertations

The purpose of this formative study was to use a Community-Based Participatory Research (CBPR) approach to conduct a comprehensive health needs assessment (CHNA) in Charleston, Mississippi (MS) to determine perceived needs of the community and identify priority health issues. A second purpose was to provide methodological and scholarly contributions to the existing literature regarding CBPR and CHNAs. The target population was residents living in Charleston, MS (N=2,193). Eighty-five residents participated in the study. This was a five-part study including: (1) Key informant interviews (n=11), (2) Focus groups (n=8), (3) Assessment of the built environment, (4) Assessment of the nutrition environment, …

Social Cognitive Theory Vs. Social Comparison Theory: Examining The Relationship Between Social Influence And Weight Loss, Emily Grigg

Masters Theses

This qualitative study investigated the impact of social influence on weight loss, more specifically, the internal and external elements that effect response and success of those who are trying to lose weight. The research focused on three questions: (1) How great of an influence does self-efficacy have in weight loss success? (2) How great of an influence does social comparison have in weight loss success? (3) Which factor has the largest impact on weight loss: self-efficacy, peer efficacy, or positive social support, or negative social support? Data was collected by the researcher conducting semi-structured interviews. These interview were conducted with …

Family-Focused Physical Activity, Diet, And Obesity Interventions In African-American Girls: A Systematic Review, Daheia J. Barr-Anderson, Alexis W. Adams-Wynn, Katherine I. Disantis, Shiriki Kumanyika

Faculty Publications

Obesity interventions that involve family members may be effective with racial/ethnic minority youth. This review assessed the nature and effectiveness of family involvement in obesity interventions among African-American girls aged 5-18 years, a population group with high rates of obesity. Twenty-six databases were searched between January 2011 and March 2012, yielding 27 obesity pilot or full-length prevention or treatment studies with some degree of family involvement and data specific to African-American girls. Interventions varied in type and level of family involvement, cultural adaptation, delivery format, and behavior change intervention strategies; most targeted parent-child dyads. Some similarities in approach based on …

Nevada Children’S Policy Update Bill And Bill Draft Requests - 2013 Nv Legislative Session, The Nevada Institute For Children’S Research And Policy, Children’S Advocacy Alliance

Nevada Institute for Children's Research and Policy Reports

Bill and Bill Draft Requests for 2013 NV Legislative Session for Nevada Children’s Policy Update.

Bloomberg’S Health Legacy: Urban Innovator Or Meddling Nanny?, Lawrence O. Gostin

Georgetown Law Faculty Publications and Other Works

Michael Bloomberg leaves the mayoralty of New York City, with his health legacy is bitterly contested. The public health community views him as an urban innovator—a rare political and business leader willing to fight for a built environment conducive to healthier, safer lifestyles. To his distractors, however, Bloomberg epitomizes a meddling nanny—an elitist dictating to largely poor and working class people about how they ought to lead their lives. His policies have sparked intense public, corporate, and political ire—critical of sweeping mayoral power to socially engineer the city and its inhabitants.

Here, I seek to show how Bloomberg has fundamentally …

Association Between Cruciferous Vegetable Intake And Risk Of Colorectal Cancer Among Men In Shanghai, China, Emily Vogtmann

All ETDs from UAB

Colorectal cancer (CRC) is a major global health concern and the intake of certain foods, such as cruciferous vegetables, has been studied for their potential protective effects against cancer development. The observed association between cruciferous vegetable consumption and CRC has been inconsistent, possibly related to glutathione S-transferase (GST) gene polymorphisms. Therefore, we aimed to (1) evaluate the association between fruits and vegetables, including cruciferous vegetables, on the risk of CRC; (2) determine factors associated with urinary isothiocyanate (ITC), a biomarker of cruciferous vegetable intake; and (3) evaluate the association between cruciferous vegetable consumption and CRC and to estimate the potential …

The Impact Of Weight Status On The Adoption Of Self-Care Behaviors Among Heart Failure Patients, Bern'nadette Knight

All ETDs from UAB

Self-care is a major component of heart failure management. Excess weight is a disease that may negatively affect a patient's ability to effectively practice self-care. The project aimed to assess 1) the relationship between weight status and heart failure self-care behaviors and 2) the modification of the relationship between social support and heart failure self-care by weight status. This cross sectional study utilized baseline data from a cohort of African-American and Caucasian participants diagnosed with heart failure. The heart failure cohort was formed from three larger studies (n=690) designed to assess the relationships among social support, self-care behaviors and hospital …

Uptake Of Antenatal Care Services And Pregnancy Outcome In Kumasi, Ghana, Asundep Ntui

All ETDs from UAB

A prior study reported a 44.6% prevalence of adverse pregnancy outcomes in Kumasi, Ghana. This study investigated factors that may influence antenatal care (ANC) utilization and their association with adverse pregnancy outcomes; defined as low birth weight, stillbirth, preterm delivery or small for gestational age among pregnant women in Kumasi. A quantitative cross sectional study of 643 women, age 19-48 years who presented for delivery at select public hospitals and private traditional birth attendants from July through November 2011 was conducted. Information on socio-demographic characteristics and other factors associated with ANC attendance was collected using a structured questionnaire. Medical and …

Accessibility Of Antenatal Services At Primary Healthcare Facilities In Punjab, Pakistan, Muhammad Ashraf Majrooh, Seema Hasnain, Javaid Akram, Arif Siddiqui, Fatimah Shah, Zahid Memon

Centre of Excellence in Women and Child Health

Introduction: Almost one-fifth of the world\'s population constitutes women of reproductive age who are repeatedly exposed to pregnancy and childbearing. Many are often at high risk of illness and mortality during pregnancy and require maternal healthcare services for early detection of complications. More than 0.5 million women die every year worldwide due to pregnancy-related complications. Almost 0.03 million of them are in Pakistan. Maternal healthcare in Pakistan is poor and results in high rates of morbidity and mortality. This paper evaluates the accessibility of antenatal care (ANC) services in primary healthcare settings in the Punjab province of Pakistan during the …

Harnessing The Power Of The Grassroots To Conduct Public Health Research In Sub-Saharan Africa: A Case Study From Western Kenya In The Adaptation Of Community-Based Participatory Research (Cbpr) Approaches, Allan Kamanda, Lonnie Embleton, David Ayuku, Lukoye Atwoli, Peter Gisore, Samuel Ayaya, Rachel Vreeman, Paula Braitstein

Internal Medicine, East Africa

Background: Community-based participatory research (CBPR) is a collaborative approach to research that involves the equitable participation of those affected by an issue. As the field of global public health grows, the potential of CBPR to build capacity and to engage communities in identification of problems and development and implementation of solutions in sub-Saharan Africa has yet to be fully tapped. The Orphaned and Separated Children’s Assessments Related to their Health and Well-Being (OSCAR) project is a longitudinal cohort of orphaned and non-orphaned children in Kenya. This paper will describe how CBPR approaches and principles can be incorporated and adapted into …

Apparent Change In Obesity-Mortality Associations: Methodological Issues In Survival Analyses With Censored Outcomes, Tapan Shirish Mehta

All ETDs from UAB

Analyses of the National Health and Nutrition Examination Survey (NHANES) have suggested that the mortality rate (MR) associated with obesity has decreased over calendar time. However, there has been conflicting evidence about the apparent change in the obesity-MR over calendar time. This dissertation investigates some of the empirical and methodological issues involved in assessing the longitudinal change in the obesity-mortality associations. In the first manuscript, Obesity and Mortality: Are the Risks Declining? Evidence from Multiple Prospective Studies in the U.S., a multiple longitudinal design is proposed and implemented to evaluate whether the obesity-mortality associations have declined over calendar time after …

Tuberculosis Screening And Treatment Outcomes In Zambia, Jennifer Harris

All ETDs from UAB

Zambia is a country in Southern Africa with dual HIV and tuberculosis (TB) epidemics. The annual TB incidence is 444/100,000 and 64% of TB patients are co-infected with HIV. Accurate screening and diagnosis for TB is challenging since it often presents with non-specific signs and symptoms and the available diagnostics are neither sensitive nor specific. Papers one and two of this dissertation focus on the derivation of TB screening rules to more accurately identify high-risk persons in two Zambian populations: inmates and HIV clinic patients. Among inmates, being HIV positive and having a body mass index < 18.5 most strongly predicted HIV disease. Chest pain was also strongly associated, but this may have been a chance finding. For HIV clinic patients, we developed four rules with increasing complexity of clinical tools used for screening. Sensitivity was very high with all rules; the addition of vital signs and pulmonary exam findings to symptom-based screening rules greatly increased the rules' specificity. Furthermore, a rule incorporating pulmonary exam findings performed similarly to a rule with chest radiography suggesting pulmonary exam may be an inexpensive alternative to x-ray. The final paper looks at TB incidence, mortality and intermediate clinical outcomes in a cohort of HIV clinic patients with and without TB during their first 12 months of HIV care. TB incidence was very high during this time period, despite thorough screening at baseline. Mortality was elevated in both culture-confirmed and clinically-diagnosed TB patients, with much of the elevated risk concentrated in TB patients who had culture-confirmed but clinically-unapparent disease. Looking at intermediate outcomes among patients who started anti-retroviral therapy, the change in CD4 cell count was similar for patients with and without TB. TB patients started off with lower mean body weights and hemoglobin concentrations but also showed greater increases over 12 months, thus `catching up' with the TB-negative patients. If these findings are replicable in other cohorts they could have substantial impact on TB screening and diagnostic procedures in resource limited, high burden countries like Zambia.

The Mediating Role Of Dietary Patterns On The Relation Between Acculturation, Psychosocial Factors, And Cardiovascular Disease Risk Factors In The U.S. - Mexico Border, Ximena Burgos

Open Access Theses & Dissertations

Chronic diseases affect both, developed and developing countries around the world. In the U.S., cardiovascular diseases (CVD) are the leading cause of death for all groups including Hispanics (Heron, 2009). Hispanics are disproportionally affected by CVD and experience risk factors at higher rates than non-Hispanic whites (Swenson, 2002). Although CVD are among the most expensive and widespread health problems, they are among the most preventable. Evidence shows that diet plays a very important role in the development of chronic diseases; current dietary changes are partially responsible for the increasing epidemic of chronic diseases worldwide. It is well established that the …

The Association Of Vitamin D Status With Allergy And Asthma In Children: Findings From The National Health And Nutrition Examination Survey (Nhanes) 2005-2006, Silvia Flores

Open Access Theses & Dissertations

About 23 million people, including almost 10 million children, have asthma in the United States. Asthma prevalence is higher among families with lower incomes living at the US/ Mexico Border and represents the most common serious chronic diseases of childhood. It is the third-ranking cause of hospitalization among children under 15, (De Frances, 2007) as well as the cause of seven million physician visits and nearly 200,000 hospitalizations every year. An average of one out of every ten school-aged children has asthma and, 13 million school days are missed each year due to asthma symptoms (Akinbami, 2006). According to the …

The Role Of A Culturally Appropriate Lifestyle Intervention On Cardiovascular Disease Risk In Hispanic Adults From El Paso, Texas, Julio Ramirez

Open Access Theses & Dissertations

Cardiovascular disease (CVD) has become a worldwide epidemic in the last decade and is the leading cause of death in the U.S. population, including Hispanics. The objective of this study was to conduct secondary data analyses to assess the impact of a lifestyle intervention on clinical and behavioral measures of Hispanic participants. A 16-week culturally appropriate lifestyle intervention was part of the Health Education and Assessment Research Team - H.E.A.R.T. Project, a community-based participatory research that is framed around the socio-ecological approach and employs Community Health Workers (CHW) to address cardiovascular disease risk factors among Hispanics living in El Paso, …

Investigating Developmental Patterns Of Symptom And Impairment Change Among Youth With Adhd, Subthreshold Adhdand Youth Without Adhd, Lorie Love Geryk

Theses and Dissertations

Introduction. Despite a substantial prevalence of subthreshold Attention-Deficit/Hyperactivity Disorder (ADHD) and research indicating that many youth with this disorder have impaired functioning and negative outcomes, few studies have considered patterns of symptom and functioning change for youth with probable ADHD, subthreshold ADHD and youth without ADHD transitioning from childhood to adolescence. Additionally, we are not aware of any studies examining predictors of impairment severity among youth with subthreshold ADHD, and few studies have examined predictors of treatment utilization and patterns of symptom and functioning change based on medication status for youth with subthreshold ADHD compared to youth with ADHD. Methods. …

Bmi At Diagnosis And Its Association With Markers Of Hiv Disease Progression And Cardiovascular Disease Risk., Kelly Deshon Johnson

Theses and Dissertations

Highly active antiretroviral treatment (HAART) has transformed the state of human immunodeficiency virus (HIV) from acute to chronic. As a result, the long-term effect of HAART has caused weight gain among HIV-infected individuals, leading to an increased prevalence of overweight and obesity. Increased Body Mass Index (BMI) has been associated with adverse health outcomes in non-HIV and HIV populations, yet among HIV-infected individuals, a higher BMI at diagnosis offers a slower progression from HIV to AIDS. Pre-HAART, studies reported that obese HIV-infected individuals have higher increases in CD4 count over time. However post-HAART, some report that overweight HIV-infected individuals with …

Promoting Early Childhood Development Through Community Health Worker Interventions: Implementation And Measurement Issues In Rural Pakistan, Zaeem Haq

Theses and Dissertations

Appropriate nutrition and psychosocial stimulation during the first three years of life can have long-lasting effects on a child's health and development. However, not all children in the world receive adequate nutrition and psychosocial stimulation during this period. There has been enormous interest in developing the evidence on the most effective ways of implementing and assessing early childhood development (ECD) promotion interventions in resource poor settings. Despite the interest, the integration of ECD interventions into pre-existing public health programs, and assessment of these interventions in extended family, rural household environment have not been addressed.

The dissertation research presented here was …

Analysis Of Vitamin D Status At Two Academic Medical Centers And A National Reference Laboratory: Result Patterns Vary By Age, Gender, Season, And Patient Location, Jonathan R. Genzen, Jennifer T. Gosselin, Thomas C. Wilson, Emilian Racila, Matthew D. Krasowski

Psychology Faculty Publications

Background: Testing for 25-hydroxyvitamin D [25(OH)D] has increased dramatically in recent years. The present report compares overall utilization and results for 25(OH)D orders at two academic medical centers - one in New York and one in Iowa – in order to characterize the vitamin D status of our inpatient and outpatient populations. Results are also compared to those from a national reference laboratory to determine whether patterns at these two institutions reflect those observed nationally.

Methods: Retrospective data queries of 25(OH)D orders and results were conducted using the laboratory information systems at Weill Cornell Medical College / New York Presbyterian …

Tackling Overweight And Obesity: Does The Public Health Message Match The Science?, Katherine Hafekost, David Lawrence, Francis Mitrou, Therese O'Sullivan, Stephen Zubrick

Research outputs 2013

Background: Despite the increasing understanding of the mechanisms relating to weight loss and maintenance, there are currently no validated public health interventions that are able to achieve sustained long-term weight loss or to stem the increasing prevalence of obesity in the population. We aimed to examine the models of energy balance underpinning current research about weight-loss intervention from the field of public health, and to determine whether they are consistent with the model provided by basic science. EMBASE was searched for papers published in 2011 on weight-loss interventions. We extracted details of the population, nature of the intervention, and key …