Digital Commons Network^™

Reinventing Medicaid: Hoosier Healthwise And Children's Health Insurance In Indiana, Judith D. Moore, Lisa Sprague

National Health Policy Forum

This site visit explored the factors that have made Indiana so successful in enrolling children in its Medicaid and SCHIP plans under the brand name Hoosier Healthwise. Site visitors met with legislators and state officials to gain understanding of the genesis and development of Hoosier Healthwise and its aggressive outreach component. A panel of representatives from partner organizations engaged in enrolling children provided further insight into this process. The site visit participants traveled to observe enrollment and operations in both urban (Marion) and rural (Clay) county offices. They also met with health care executives at hospitals, clinics, and neighborhood health …

Pharmacotherapy Of Smoking Cessation, Kolawole S. Okuyemi, Jasjit S. Ahluwalia, Kari J. Harris

Public and Community Health Sciences Faculty Publications

Tobacco use is the number one cause of preventable diseases in the United States. Smoking accounts for more than 400,000 deaths yearly and 30% of all cancer deaths. Primary care physicians have access to 70% of smokers, approximately 60% of whom are perceived to be in excellent health. Recent advances in the pharmacotherapy of nicotine addiction, including nicotine nasal spray, nicotine inhaler, bupropion hydrochloride, and over-the-counter transdermal nicotine patches, have increased the treatment options physicians can offer to smokers. Physicians, especially thosein primary care specialties, should familiarize themselves with these products to improve efforts to help their patients stop smoking. …

A Mycobacterium Ulcerans Toxin, Mycolactone, Causes Apoptosis In Guinea Pig Ulcers And Tissue Culture Cells, Kathleen M. George, Lisa Pascopella, Diane M. Welty, P. L. C. Small

Public and Community Health Sciences Faculty Publications

Mycobacterium ulcerans is the causative agent of Buruli ulcer, a tropical ulcerative skin disease. One of the most intriguing aspects of this disease is the presence of extensive tissue damage in the absence of an acute inflammatory response. We recently purified and characterized a macrolide toxin, mycolactone, from M. ulcerans. Injection of this molecule into guinea pig skin reproduced cell death and lack of acute inflammatory response similar to that seen following the injection of viable bacteria. We also showed that mycolactone causes a cytopathic effect on mouse fibroblast L929 cells that is characterized by cytoskeletal rearrangements and growth arrest …

Integronlike Structures In Campylobacter Spp. Of Human And Animal Origin, Brigid Lucey, D. Crowley, P. Moloney, B. Cryan, M. Daly, F. O'Halloran, E. J. Threlfall, S. Fanning

Department of Biological Sciences Publications

Resistance to antimicrobial agents used to treat severe Campylobacter spp. gastroenteritis is increasing worldwide. We assessed the antimicrobial resistance patterns of Campylobacter spp. isolates of human and animal origin. More than half (n = 32) were resistant to sulphonamide, a feature known to be associated with the presence of integrons. Analysis of these integrons will further our understanding of Campylobacter spp. epidemiology.

Reshaping Ahcs' Role In Biomedical Research, Karen Matherlee

National Health Policy Forum

This issue brief explores the reconfiguration of academic health centers (AHCs) in response to health marketplace and other pressures. It reviews four roles AHCs play in medical innovation: (a) development of new drugs, devices, diagnostic techniques, and therapeutic procedures; (b) adoption of new technologies, instruments, and drugs; (c) evaluation of new technologies; and (d) assessment of the need for new modalities and monitoring of their initial uses. The paper examines ways in which these roles are enhanced or threatened by evolving economic forces in the public and private sectors.

Response To Critique Of The Claim Of Cannibalism At Cowboy Wash, Patricia M. Lambert, Banks L. Leonard, Brian R. Billman, Richard A. Marlar, Margaret E. Newman, Karl J. Reinhard

Karl Reinhard Publications

The original authors of Billman et af. (2000) are joined by three other analysts from the Cowboy Wash research team to respond to the critique of this article by Dongoske et af. (2000). Dongoske and his coauthors state that Billman et af. (2000) failed to test alternative hypotheses or to consider alternative explanations for the findings at 5MTJOOJO and similar sites. The original authors point out that alternative hypotheses were examined and rejected, leaving a violent episode of cannibalism as the most plausible explanation for the remains found at 5MTJOOJO. Dongoske et af. also question many aspects of the osteological, …

‘Gene Shaving’ As A Method For Identifying Distinct Sets Of Genes With Similar Expression Patterns, Trevor Hastie, Robert Tibshirani, Michael B. Eisen, Ash Alizadeh, Ronald Levy, Louis Staudt, Wing C. Chan, David Botstein, Patrick Brown

United States Public Health Resources

Background: Large gene expression studies, such as those conducted using DNA arrays, often provide millions of different pieces of data. To address the problem of analyzing such data, we describe a statistical method, which we have called ‘gene shaving’. The method identifies subsets of genes with coherent expression patterns and large variation across conditions. Gene shaving differs from hierarchical clustering and other widely used methods for analyzing gene expression studies in that genes may belong to more than one cluster, and the clustering may be supervised by an outcome measure. The technique can be ‘unsupervised’, that is, the genes and …

Interleukin-1 Polymorphisms Associated With Increased Risk Of Gastric Cancer, Emad M. El-Omar, Mary Carrington, Wong-Ho Chow, Kenneth E. L. Mccoll, Jay H. Bream, Howard A. Young, Jesus Herrera, Jolanta Lissowska, Chiu-Chin Yuan, Nathaniel Rothman, George Lanyon, Maureen Martin, Joseph F. Fraumeni Jr., Charles S. Rabkin

United States Public Health Resources

Helicobacter pylori infection is associated with a variety of clinical outcomes including gastric cancer and duodenal ulcer disease¹. The reasons for this variation are not clear, but the gastric physiological response is influenced by the severity and anatomical distribution of gastritis induced by H. pylori. Thus, individuals with gastritis predominantly localized to the antrum retain normal (or even high) acid secretion², whereas individuals with extensive corpus gastritis develop hypochlorhydria and gastric atrophy³, which are presumptive precursors of gastric cancer4. Here we report that interleukin-1 gene cluster polymorphisms suspected of enhancing production of interleukin-1-beta …

Hyperphosphorylation Of The Asialoglycoprotein Receptor In Isolated Rat Hepatocytes Following Ethanol Administration, Benita L. Mcvicker, Dean J. Tuma, Carol A. Casey

United States Public Health Resources

Ethanol administration leads to altered function and impaired receptor-mediated endocytosis of the hepatocyte asialoglycoprotein receptor (ASGP-R). The purpose of the present study was to examine the effects of ethanol on the phosphorylation of the ASGP-R to determine whether this post-translational modification could contribute mechanistically to the observed ethanol-induced alterations. The methodological approach of this work involved the measurement of the phosphorylation state of the receptor obtained from isolated rat hepatocytes, using a combination of experimental designs from the biosynthetic incorporation of phosphate to the determination of steady-state phosphotyrosine levels. We report here that both short-term (1- to 2-week) and chronic …

Genetic Characterization Of H3n2 Influenza Viruses Isolated From Pigs In North America, 1977–1999: Evidence For Wholly Human And Reassortant Virus Genotypes, Alexander I. Karasin, Melissa M. Schutten, Lynn A. Cooper, Catherine B. Smith, Kanta Subbarao, Gary A. Anderson, Suzanne Carman, Christopher W. Olsen

United States Public Health Resources

Since 1998, H3N2 viruses have caused epizootics of respiratory disease in pigs throughout the major swine production regions of the U.S. These outbreaks are remarkable because swine influenza in North America had previously been caused almost exclusively by H1N1 viruses. We sequenced the full-length protein coding regions of all eight RNA segments from four H3N2 viruses that we isolated from pigs in the Midwestern U.S. between March 1998 and March 1999, as well as from H3N2 viruses recovered from a piglet in Canada in January 1997 and from a pig in Colorado in 1977. Phylogenetic analyses demonstrated that the 1977 …

Lessons Learned In Applying The U.S. Epa Proposed Cancer Guidelines To Specific Compounds, Melvin Andersen, M. Elizabeth Meek, Gary Boorman, David Brusick, Samuel Cohen, Yvonne Dragan, Clay Frederick, Jay Goodman, Gordon Hard, Ellen O'Flaherty, Denise Robinson

United States Public Health Resources

An expert panel was convened to evaluate the U.S. Environmental Protection Agency’s “Proposed Guidelines for Carcinogen Risk Assessment” through their application to data sets for chloroform (CHCl₃) and dichloroacetic acid (DCA). The panel also commented on perceived strengths and limitations encountered in applying the guidelines to these specific compounds. This latter aspect of the panel’s activities is the focus of this perspective. The panel was very enthusiastic about the evolution of these proposed guidelines, which represent a major step forward from earlier EPA guidance on cancer-risk assessment. These new guidelines provide the latitude to consider diverse scientific data …

Male Circumcision And Hiv Prevention: Directions For Future Research, Johannes Van Dam, Marie Christine Anastasi

HIV and AIDS

A growing body of scientific publications suggests that male circumcision is associated with reduced risk of HIV infection in sub-Saharan Africa. Thus, male circumcision is being considered as a potential intervention in the prevention of sexually transmitted HIV infection, even though this procedure has profound cultural implications and carries the risk of complications, and its benefits are realized only many years later. This report presents the findings of a meeting of international researchers, organized by the Horizons Project to explore the programmatic and research implications of the association between male circumcision and HIV prevention. Most studies on male circumcision and …

Peer Education And Hiv/Aids: Past Experience, Future Directions, Deanna Kerrigan, Ellen Weiss

HIV and AIDS

Peer education typically involves training and supporting members of a given group to effect change among members of the same group. Peer education is often used to effect changes in knowledge, attitudes, beliefs, and behaviors at the individual level. However, peer education may also create change at the group or societal level by modifying norms and stimulating collective action that contributes to changes in policies and programs. Worldwide, peer education is one of the most widely used strategies to address the HIV/AIDS pandemic. This report presents findings from a project designed to identify components and principles that influence HIV/AIDS peer …

Genetic Variation In Pneumocystis Carinii Isolates From Different Geographic Regions: Implications For Transmission, Charles B. Beard, Jane L. Carter, Scott P. Keely, Laurence Huang, Norman J. Pieniazek, Iaci N. S. Moura, Jacquelin M. Roberts, Allen W. Hightower, Michelle S. Bens, Amanda R. Freeman, Sherline Lee, James R. Stringer, Jeffrey S. Duchin, Carlos Del Rio, David Rimland, Robert P. Baughman, Deborah A. Levy, Vance J. Dietz, Paul Simon, Thomas R. Navin

Journal Articles: Epidemiology

To study transmission patterns of Pneumocystis carinii pneumonia (PCP) in persons with AIDS, we evaluated P. carinii isolates from patients in five U.S. cities for variation at two independent genetic loci, the mitochondrial large subunit rRNA and dihydropteroate synthase. Fourteen unique multilocus genotypes were observed in 191 isolates that were examined at both loci. Mixed infections, accounting for 17.8% of cases, were associated with primary PCP. Genotype frequency distribution patterns varied by patients' place of diagnosis but not by place of birth. Genetic variation at the two loci suggests three probable characteristics of transmission: that most cases of PCP do …

Intimate Partner Violence And Cervical Neoplasia, Ann L. Coker, Maureen Sanderson, Mary Kay Fadden, Lucia Pirisi

CRVAW Faculty Journal Articles

Intimate partner violence (IPV) is associated with a range of adverse physical health outcomes, including chronic and infectious diseases. An emerging literature suggests that partner violence and specifically sexual violence may be associated with an increased risk of cervical neoplasia. To assess the risk of preinvasive and invasive cervical cancer in a cross-sectional study of women screened for IPV by type, frequency and duration, 1152 women ages 18–65 were recruited from family practice clinics in 1997–1998. They were screened for IPV during a brief in-clinic interview, and health history and current status were assessed in a follow-up interview. Of 1152 …

Men As Supportive Partners In Reproductive Health: Moving From Rhetoric To Reality, Saraswati Raju, Ann Leonard

Reproductive Health

This book builds on presentations of the Workshop on Men as Supportive Partners in Reproductive and Sexual Health held in Kathmandu, Nepal, in 1998. By analyzing the experiences of nongovernmental organizations across India, this publication reviews important concerns that should inform the discourse on male partnership. The previous views of reaching men as contraceptive users and removing them as impediments to women’s efforts to control fertility are too limited. The argument is not whether men and women should use family planning, but rather the extent to which men can become supportive of women’s reproductive and sexual rights and actively take …

Sexual And Reproductive Health And Health Sector Reform In Latin America And The Caribbean: Challenges And Opportunities, Ana Langer, Gustavo Nigenda, Sandra G. Garcia, Rosario Valdez, Emanuel Orozco, Jennifer Catino

Reproductive Health

Most countries in Latin America and the Caribbean (LAC) are at varying stages of a reform process to improve the response capacity of health systems by upgrading the effectiveness and sustainability of programs and services. Changes promoted by the reform focus on priority health needs and underprivileged society groups. Some problems, such as sexual and reproductive health (SRH), can be tackled with cost-effective technologies. Reform projects offer a unique opportunity to reconsider policies, programs, and services aimed at facing the issues encompassed in the term SRH. Nonetheless, the formulation of a strategy and the identification of concrete measures represent a …

Identification Of Violence In The Home - Pediatric And Parental Reports, Bonnie D. Kerker, Sarah Mccue Horwitz, John M. Leventhal, Stacey Plichta, Phillip J. Leaf

Community & Environmental Health Faculty Publications

Objectives: To compare the rates of domestic violence reported by mothers with those identified by physicians, to compare the rates of harsh discipline practices reported by mothers with the rates of abuse identified by physicians, and to examine the relationship between reported domestic violence and harsh discipline practices.

Design: Interviews with parents and pediatricians to compare pediatric detection of domestic violence and child abuse with parental reports of domestic violence and harsh discipline practices.

Setting: Community-based pediatric practices in the 13-town greater New Haven, Conn, area.

Participants: Of the 23 practices invited, 19 agreed to participate. Of the 2006 parents …

The Potential Role Of Contraception In Reducing Abortion, John Bongaarts, Charles F. Westoff

Poverty, Gender, and Youth

Since the 1960s the proportion of couples practicing contraception has risen rapidly, particularly in the developing world, and the mix of methods is now dominated by modern methods. Despite these trends, the incidence of unintended pregnancy remains high mainly because the number of children desired has declined. Worldwide there are almost as many unintended as intended pregnancies each year (not counting miscarriages, which are excluded in this analysis) and more than half of these unintended pregnancies end in abortion. This study examines the potential role of further increases in contraceptive prevalence and effectiveness in reducing abortion rates. The model used …

Future Trends In Contraception In The Developing World: Prevalence And Method Mix, John Bongaarts, Elof D.B. Johansson

Poverty, Gender, and Youth

The main objectives of this study are to review existing methodologies for projecting future trends in contraception, evaluate the validity of the assumptions underlying these projections, propose methodological improvements, and assess the prospects for new methods of contraception in the coming decade. The prevalence of contraception in the developing world has increased dramatically over the past several decades from near zero to around 60 percent in 2000. Demand for contraception can be expected to continue to rise rapidly for the next few decades as population size continues to grow and fertility declines further to near the replacement level. As a …

Greater Investments In Children Through Women's Empowerment: A Key To Demographic Change In Pakistan?, Valerie L. Durrant, Zeba Sathar

Poverty, Gender, and Youth

Women’s status has received considerable attention as a significant factor in demographic behavior and outcomes in South Asia however, little research has addressed the links between women’s status and their investments in children. In this paper, we empirically investigate how women’s status on multiple levels is associated with demographic outcomes. Using data from the Pakistan Status of Women and Fertility Survey in rural Punjab, we confirm that empowered women, or those with higher status, are better able to make positive investments in their children, thus increasing their children’s chances of survival during infancy and increasing their likelihood of ever attending …

Adolescents And Reproductive Health In Pakistan: A Literature Review, Ayesha Khan

Reproductive Health

This report reviews research and findings on adolescents and reproductive health in Pakistan. The material is drawn from a range of national surveys and medical research, as well as information gathered by nongovernmental organizations. Although adolescents make up a quarter of the population of Pakistan, they are still a new subject for research. The characterization of adolescents for this review is individuals ages 10–19, whether or not they are married, sexually active, or parents. The discussion of the research material is based on the assumption that adolescence is a developmental phase, a transition from childhood to adulthood. Basic data on …

The Effect Of Stress And Genetic Factors On Alcohol Consumption Among Males In Olancho District, Honduras, Gloria Amanda Madrid

Loma Linda University Electronic Theses, Dissertations & Projects

Alcoholism is a major public health problem globally. More than twenty studies have examined the association between the neurotransmitter dopamine DRD2 TaqI polymorphism and the onset of alcoholism, with half supporting an association. This study was based on the assumption that there is a relationship between the presence of the DRD2, one’s exposure to stress, and alcohol consumption. We examined the gene-stress interactional model in a sample of 309 males of Mayan descendents in the Olancho district of Honduras (age range 18-87). Participants were interviewed by a health care professional and blood samples were obtained for genetic identification. The Michigan …

Predicting Milk And Soft Drink Consumption Among Female Adolescents Using The Theory Of Planned Behavior, Nada Osman Kassem

Loma Linda University Electronic Theses, Dissertations & Projects

A total of 756 female adolescents, aged 13 to 18 years, from five public high schools in Antelope Valley Union High School District located in North Los Angeles County participated in this study between February 1999 and March 1999. The ethnic composition was 53.3% White/Anglo Americans, 19.3% Hispanics or Latinos and 10.2% Black/African Americans. The constructs of the Theory of Planned Behavior (attitude, subjective norm, and perceived behavioral control and their underlying beliefs) were assessed to determine the predictors of low-fat milk and regular soda consumption. A cross-sectional design with group-administered questionnaires was utilized.

Most participants (89.6%, n = 636) …

Risk Factors Associated With Infant Mortality Among Very Low Birthweight Infants Of Teenage Mothers In San Bernardino County, C. Letitia Henry

Loma Linda University Electronic Theses, Dissertations & Projects

Background. Typically, infant mortality decreases as maternal age increases in teenagers. In contrast to these national data, San Bernardino County (SBC) experienced a different phenomenon in 1989-1994 among very low birthweight (VLBW) infants. The infant mortality rate (IMR) of VLBW infants born to mothers under 17 years old (283 per 1000 live births) was significantly lower than the IMR of VLBW infants born to mothers between the ages of 17-19 years old (430 per 1000 live births) (p = .02).

Purpose. The purpose of the study was to explain the discrepancy between IMRs of VLBW infants of younger teenage mothers …

Looking Back: Unneeded X-Rays, Allan Mazur

RISK: Health, Safety & Environment (1990-2002)

From the discovery of x-rays in 1896 to the present, Dr. Mazur explores the history of risk management of radiation exposure from x-rays and nuclear fallout.

Recognition Of Treponematoses In Post Repatriation X Ray And Cd Rom Nebraska Record, Karl J. Reinhard, Bruce Rothschild, Christine Rothschild, Larry Martin

Karl Reinhard Publications

Repatriation has compromised the opportunity to directly examine skeletons and to apply new diagnostic criteria and techniques. Pre-repatriation approaches to non-metric data acquisition, must make a number of assumptions: ( I ) Phenomena must be correctly identitied and segregated; (2) Criteria for severity must be specific to the phenomena studied; and (3) As criteria for disease rewgnition may change with time, it is valuable only as long as the raw data is also recorded. As part of data preservation, x-rays and CD-ROM images were recorded for skeletons trom Nebraska sites undergoing repatriation. This report concentrates on four of them 250K …

The Role Of Mummy Studies In Paleoparasitology, Adauto Araujo, Karl J. Reinhard, Luiz Fernando Ferreira

Karl Reinhard Publications

Paieoparasitology has advance during the past decade to the status of a statistically based science focused on problems of disease ecology and geographic distribution of parasitism. For most of its development, paleoparasitology has focused on the analysis of coprolites and latrine sediments. During the past few years, mummies have been increasingly included in paleoparasitology studies. We evaluate in this paper the interpretive value of mummies relative to other sources of paleoparasitological data.

EI estudio de la paleoparasitologia ha logrado transformarse, en esta ultima decada, en una ciencia basada en la estadistica, enfocada a temas tales como la ecologia de enfermedades …

Archaeoparasitology, Karl Reinhard

Karl Reinhard Publications

The field devoted to the identification of parasite remains in the archaeological record and the reconstruction of past human-parasite interactions. Parasitic disease has always been a major problem. Recent summaries of the prevalence of parasitic diseases in the world today show that there are 4.5 billion infections with all species of parasitic worm, 1 billion infections with giant intestinal roundworm (Ascaris lumbricoides), 750,000,000 infections with whipworms (Trichuris trichiura), 900,000,000 infections with hookworm (Ancylostoma duodenale and Necator americanus), 657,000,000 infections with filarial worms, 200,000,000 with blood flukes (schistosome species), and 489,000,000 infections with malaria. These infections cause between 1,590,000 to 3,130,000 …

Coprolite Analysis: The Analysis Of Ancient Human Feces For Dietary Data, Karl Reinhard

Karl Reinhard Publications

Although archaeological fieldwork is hot and dirty, the most “earthy” side of the discipline is the laboratory analysis of coprolites. Each coprolite contains the remains of one to several actual meals eaten in prehistory, and analysis of many coprolites provides a picture of ancient diet that is unique in accuracy.

The term coprolite originally referred to fossilized feces in paleontological context. In archaeology, the term broadened to refer to any formed fecal mass, including mineralized, desiccated, or frozen feces and even the intestinal contents of mummies. Coprolites contain the remains of animals (parasites) that lived in the humans, the foods …