Digital Commons Network^™

Quantifying Value In Public Health: Using Economic Methods To Analyze System Change, Theresa M. Green

Dissertations

In this time of economic downturn, it is becoming increasingly important for organizations, including those in public health, to “prove their worth,” to show the value in improvement strategies. Health agencies have learned to discuss impact in terms of health outcome and mortality/morbidity measures. However, it is critical that these impacts are also expressed in a way that shows cost-efficiency and economic benefit especially for promising, evidence-based public health interventions. Although several methods of economic evaluation including cost-effective analysis, cost-utility analysis, or cost-benefit analysis and return on investment (ROI) have been used in social sciences and health research, fewer examples …

The Need To Include Animal Protection In Public Health Policies, Aysha Akhtar

Animal Welfare Collection

Many critical public health issues require non-traditional approaches. Although many novel strategies are used, one approach not widely applied involves improving the treatment of animals. Emerging infectious diseases are pressing public health challenges that could benefit from improving the treatment of animals. Other human health issues, that overlap with animal treatment issues, and that warrant further exploration, are medical research and domestic violence. The diverse nature of these health issues and their connection with animal treatment suggest that there may be other similar intersections. Public health would benefit by including the treatment of animals as a topic of study and …

Multi-Criteria Decision Analysis As An Innovative Approach To Managing Zoonoses: Results From A Study On Lyme Disease In Canada, Cécile Aenishaenslin, Valérie Hongoh, Hassane D. Cissé, Anne Gatewood Hoen

Dartmouth Scholarship

ackground: Zoonoses are a growing international threat interacting at the human-animal-environment interface and call for transdisciplinary and multi-sectoral approaches in order to achieve effective disease management. The recent emergence of Lyme disease in Quebec, Canada is a good example of a complex health issue for which the public health sector must find protective interventions. Traditional preventive and control interventions can have important environmental, social and economic impacts and as a result, decision-making requires a systems approach capable of integrating these multiple aspects of interventions. This paper presents the results from a study of a multi-criteria decision analysis (MCDA) approach for …

Structuring Targeted Surveillance For Monitoring Disease Emergence By Mapping Observational Data Onto Ecological Process, Luca Gerardo-Giorda, Gavino Puggioni, Robert J. Rudd, Lance A. Waller, Leslie A. Real

Computer Science and Statistics Faculty Publications

An efficient surveillance system is a crucial factor in identifying, monitoring and tackling outbreaks of infectious diseases. Scarcity of data and limited amounts of economic resources require a targeted effort from public health authorities. In this paper, we propose a mathematical method to identify areas where surveillance is critical and low reporting rates might leave epidemics undetected. Our approach combines the use of reference-based susceptible-exposed-infectious models and observed reporting data;We propose two different specifications, for constant and time-varying surveillance, respectively. Our case study is centred around the spread of the raccoon rabies epidemic in the state of New York, using …

Integration Of Comprehensive Women’S Health Programmes Into Health Systems: Cervical Cancer Prevention, Care And Control In Rwanda, Agnes Binagwaho, Fidele Ngabo, Claire M. Wagner, Cathy Mugeni, Maurice Gatera, Cameron T. Nutt, Sabin Nsanzimana

Dartmouth Scholarship

PROBLEM: Although it is highly preventable and treatable, cervical cancer is the most common and most deadly cancer among women in Rwanda.

APPROACH: By mobilizing a diverse coalition of partnerships, Rwanda became the first country in Africa to develop and implement a national strategic plan for cervical cancer prevention, screening and treatment.

LOCAL SETTING: Rwanda - a small, landlocked nation in East Africa with a population of 10.4 million - is well positioned to tackle a number of "high-burden" noncommunicable diseases. The country's integrated response to infectious diseases has resulted in steep declines in premature mortality over the past decade. …

Maximizing The Delivery Performance Of Point-Of-Care Cd4+ T-Cell Counting Tests In Resource-Limited Settings - A Policy Brief, Nan Kong, J. Paul Robinson, Fenggang Yang

Purdue Policy Research Institute (PPRI) Policy Briefs

Managing HIV/AIDS presents challenges to public health policymakers, frontline workers, and researchers worldwide. A key strategy in the disease management is early diagnosis and rapid treatment initiation. While the technological field of point‐of‐care HIV/AIDS diagnostics has advanced significantly in the past two decades, several critical issues remain that hinder the deployment of point‐of‐care testing devices in resource‐deprived settings. In this policy brief, we discuss these issues, including technological specifics of point‐of‐care CD4⁺ T‐cell counting approaches and requirements of deploying them. We also discuss cultural and religious concerns on the deployment. At the end of the brief, we propose a …

The Public Health Pbrn Program: Building The Science Of Public Health Delivery, Glen P. Mays, Anna Goodman Hoover

Health Management and Policy Presentations

This session describes public health practice-based research networks (PBRNs) and emerging opportunities for collaboration with injury control research centers to advance the science of injury prevention practice.

Public Health Delivery Systems And Population Health, Glen P. Mays

Health Management and Policy Presentations

Despite high overall health expenditures, the U.S. continues to fall behind other high-income countries on many measures of population health. While health care delivery systems are now studied intensively for solutions to U.S. cost and quality problems, the nation's delivery systems for public health programs and policies are only now becoming the subject of rigorous empirical study. This presentation examines recent studies of public health delivery systems and important directions for future inquiry.

System Dynamics Modeling Study Of The Possibility Of Endemic Measles In The State Of Virginia, Ivan W. Gowe

Masters Theses, 2010-2019

After an effective vaccine was widely available, measles incidence fell by 98%. Immunization programs and surveillance systems in the United States (US) are so successful there has been no endemic spread since 2000. The threat from measles lies in its high infectivity, an asymptomatic infectious state that lasts an average of four days and the decreasing popularity of vaccination. The lack of first-hand experience with the infection (due to immunization) has caused some to wonder if the vaccine is necessary. Herd immunity threshold is a measure of the fraction of immune individuals present in a population to keep disease reproduction …

Hiv Reporting In California: By Name Or By Number?, Nicole Kamm

Journal of the National Association of Administrative Law Judiciary

No abstract provided.

A Comparison Of Food Inspection Practices Of The U.S. Air Force And Ohio Local Public Health, Danny R. Pizzino, Karen A.N. Rupp

Master of Public Health Program Student Publications

Objective: As Americans consume more meals outside the home, food safety of restaurants is more critical. The purpose of this study is to examine the effect of food service establishment (FSE) inspection frequency on FSE performance. In this study, the U.S. Air Force (USAF) public health system is compared to Ohio local public health departments (Ohio LPHDs). The USAF inspects FSEs more frequently than Ohio LPHDs do. The goal is to determine if this increased frequency leads to higher food safety in the FSEs.

Methods: We reviewed 1482 reports from three USAF bases and 1909 reports from six Ohio LPHDs …

Experiences Of Kenyan Healthcare Workers Providing Services To Men Who Have Sex With Men: Qualitative Findings From A Sensitivity Training Programme, Elise M. Van Der Elst, Evans Gichuru, Anisa Omar, Jennifer Kanungi, Zoe Duby, Miriam Midoun, Sylvia Shangani, Susan M. Graham, Adrian D. Smith, Eduard J. Sanders, Don Operario

Community & Environmental Health Faculty Publications

Introduction

Men who have sex with men (MSM) in Kenya are at high risk for HIV and may experience prejudiced treatment in health settings due to stigma. An on-line computer-facilitated MSM sensitivity programme was conducted to educate healthcare workers (HCWs) about the health issues and needs of MSM patients.

Methods

Seventy-four HCWs from 49 ART-providing health facilities in the Kenyan Coast were recruited through purposive sampling to undergo a two-day MSM sensitivity training. We conducted eight focus group discussions (FGDs) with programme participants prior to and three months after completing the training programme. Discussions aimed to characterize HCWs’ challenges in …

"Conspicuous Consumption:" Germs And Climate Cures In Denver, 1882-1915, Sydney Rene Gwinn

Graduate Student Theses, Dissertations, & Professional Papers

This thesis argues that the health-seeker’s quest for climatic cures persisted after the germ theory of disease began to alter medical approaches to tuberculosis after its announcement in 1882. Buoyed by anti-modern sentiments and a lack of effective medicinal interventions, physicians continued to recommend that tuberculosis patients travel to Denver to seek recovery in a healthier climate. In turn, Denver’s polity and public health approaches were shaped by the influences of the migration of tuberculosis patients to the city. After 1882, new approaches focused on sanitation and isolation began to take hold among physicians and public health reformers who worked …

Ecology Of Zoonotic Infectious Diseases In Bats: Current Knowledge And Future Directions, D. T. S. Hayman, R. A. Bowen, P. M. Cryan, G. M. Mccracken, T. J. O'Shea, A. J. Peel, A. T. Gilbert, C. T. Webb, J. L. N. Wood

United States Department of Agriculture Wildlife Services: Staff Publications

Bats are hosts to a range of zoonotic and potentially zoonotic pathogens. Human activities that increase exposure to bats will likely increase the opportunity for infections to spill over in the future. Ecological drivers of pathogen spillover and emergence in novel hosts, including humans, involve a complex mixture of processes, and understanding these complexities may aid in predicting spillover. In particular, only once the pathogen and host ecologies are known can the impacts of anthropogenic changes be fully appreciated. Cross-disciplinary approaches are required to understand how host and pathogen ecology interact. Bats differ from other sylvatic disease reservoirs because of …

Guidance From Vaccination Jurisprudence, Michael Ulrich

Faculty Scholarship

The lengthy history of case law covering compulsory vaccination policies state consistently that conscientious exemptions and evaluating their validity can be difficult, administratively cumbersome, and potentially unconstitutional.

Tuskegee Redux: Evolution Of Legal Mandates For Human Experimentation, Robert S. Levine, Jamila C. Williams, Barbara A. Kilbourne, Paul D. Juarez

Sociology Faculty Research

Human health experiments systematically expose people to conditions beyond the boundaries of medical evidence. Such experiments have included legal-medical collaboration, exemplified in the U.S. by the Public Health Service (PHS) Syphilis Study (Tuskegee). That medical experiment was legal, conforming to segregationist protocols and specific legislative authorization which excluded a selected group of African Americans from any medical protection from syphilis. Subsequent corrective action outlawed unethical medical experiments but did not address other forms of collaboration, including PHS submission to laws which may have placed African American women at increased risk from AIDS and breast cancer. Today, anti-lobbying law makes it …

Graph Matching Based Decision Support Tools For Mitigating Spread Of Infectious Diseases Like H1n1, Jomon Aliyas Paul, Kedar Sambhoos

Faculty Articles

Diseases like H1N1 can be prevented from becoming a wide spread epidemic through timely detection and containment measures. Similarity of H1N1 symptoms to any common flu and its alarming rate of spread through animals and humans complicate the deployment of such strategies. We use dynamic implementation of graph matching methods to overcome these challenges. Specifically, we formulate a mixed integer programming model (MIP) that analyzes patient symptom data available at hospitals to generate patient graph match scores. Successful matches are then used to update counters that generate alerts to the Public Health Department when the counters surpass the threshold values. …

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

Master of Public Health Program Student Publications

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

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

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

To What Degree Can Potable Water Foster International Economic Development And Sustainability? What Role Does Health Play?, Bruce Clemens, Thomas J. Douglas

Organization Management Journal

Governments, international organizations, and practitioners have long proclaimed that investments in potable water supply and sanitation and improvements in public health lead to economic development in the developing world. Unfortunately, scholars have not been able to quantify these relationships for a plethora of reasons. This study found significant, positive relationships between investments in integrated projects of potable water supply combined with sanitation and public health and economic development. The study also moderately supported the hypothesis that the relationship between investments in such projects and economic development is stronger in the presence of better health. The article concludes with hopes that …

Achieving High Coverage In Rwanda's National Human Papillomavirus Vaccination Programme, Agnes Binagwaho, Claire Wagner, Maurice Gatera, Corine Karema, Cameron T. Nutt, Fidele Ngabo

Dartmouth Scholarship

Problem: Virtually all women who have cervical cancer are infected with the human papillomavirus (HPV). Of the 275000 women who die from cervical cancer every year, 88% live in developing countries. Two vaccines against the HPV have been approved. However, vaccine implementation in low-income countries tends to lag behind implementation in high-income countries by 15 to 20 years.

Approach: In 2011, Rwanda’s Ministry of Health partnered with Merck to offer the Gardasil HPV vaccine to all girls of appropriate age. The Ministry formed a “public–private community partnership” to ensure effective and equitable delivery.

Local setting: Thanks to a strong national …

Dynamic Pricing Strategy To Optimally Allocate Vaccines, Mauricio Pommier Gasser

Theses

In the United States, the Advisory Committee on Immunization Practices (ACIP) makes recommendations as to which cohorts (identified groups of individuals) ought to have higher priority access to vaccines when their supply is insufficient to immunize all susceptible individuals in the country. Typically, cohorts are determined based on susceptibility to contracting seasonal influenza and on the resulting consequences of infection for different age groups. For seasonal influenza, high-risk cohorts commonly include children, teenagers, pregnant women and people with different chronic diseases. This study proposes the application of revenue management theory to better allocate seasonal influenza vaccines among different risk-based population …

Assessment Of Nutritional Knowledge And Eating Behaviors On The Weight And Obesity Of College Students, Britta Thielemann

General Human Environmental Sciences Undergraduate Honors Theses

Obesity has become a major nationwide health concern. Negative eating habits and lack of proper nutrition information were highlighted as major aspects of weight gain. This study was conducted in order to understand the relationship between nutritional knowledge and eating behaviors and their impact on the weight and obesity of college students. For this study, an instrument was designed that included survey questions regarding perception of healthy and unhealthy foods, personal consumption, and demographic factors. The instrument was administered to 577 college students. The results indicated a positive relationship between the knowledge of nutrition and eating behavior and the weight …

Parasitic Nematodes In Humans : Exploring The Host-Parasite Dynamic Through Historical, Biological, And Public Health Evaluations Of Infection., Erin Christine Welsh 1987-

Electronic Theses and Dissertations

This thesis investigated infection dynamics of parasitic nematodes at both the population and individual levels by exploring evolutionary and historical aspects of infection as well as how host-parasite interactions influence virulence. In particular, this thesis sought to answer questions of how host populations have influenced the spread of infection and how transmission determines infection virulence, with a final goal of understanding how eradication programs for parasites can be developed or improved with this knowledge. The host-parasite dynamic was explored throughout history, with particular focus on the ways host populations have shaped infection distribution in present, historic, and prehistoric times. Then, …

Firearms, Youth Homicide, And Public Health, Robert S. Levine, Irwin Goldzweig, Barbara Kilbourne, Paul Juarez

Sociology Faculty Research

Homicide is seven times as common among U.S. non-Hispanic Black as among non-Hispanic White youth ages 15 to 24 years. In 83% of these youth homicides, the murder weapon is a firearm. Yet, for more than a decade, the national public health position on youth violence has been largely silent about the role of firearms, and tools used by public health professionals to reduce harm from other potential hazards have been unusable where guns are concerned. This deprives already underserved populations from the full benefits public health agencies might be able to deliver. In part, political prohibitions against research about …

Differences In Immunity Offered By The Influenza Vaccination Among Active Duty Us Air Force Personnel From 2007-2011, Billy D. Pruett

Master of Public Health Program Student Publications

OBJECTIVE: To investigate the potential difference in vaccine effectiveness among Active Duty Air Force (ADAF) personnel vaccinated against influenza from 2007-2011. Particularly, to determine if any difference in the protection offered is based on sex, vaccine type, or both.

METHODS: The proposed study incorporated a cross-sectional design using the Department of Defense’s (DoD) comprehensive databases. Laboratory-confirmed influenza and other Influenza-Like Illness (ILI) cases were identified for each of the four influenza seasons of interest, vaccination status and history was then verified, and 2x2 tables were constructed in order to calculate odds ratios.

RESULTS: No consistent difference in vaccine effectiveness in …

Public Health Hb 214, Georgia State University Law Review

Georgia State University Law Review

No abstract provided.

Correlation Of Discharge Diagnostic Codes With Laboratory-Confirmed Methicillin-Resistant Staphylococcus Aureus Bloodstream Infections At A Large Pediatric Hospital, Andrew J. Kreppel

Master of Public Health Program Student Publications

Background: Methicillin-resistant Staphylococcus aureus (MRSA)-specific hospital discharge codes were introduced in October 2008. The purpose of this project is to study the correlation of these codes with laboratory-proven pediatric MRSA bloodstream infections.

Methods: Laboratory and discharge databases were used to identify patientsChildren’s Hospital Medical Center from October 2008 through December 2010 with MRSA bloodstream infections. The laboratory database identified patients with a positive blood culture for MRSA, and the discharge database identified patients with an MRSA bloodstream discharge code (038.12 for MRSA sepsis or 041.12 for MRSA infection with either 790.7 for bacteremia or 771.81 for newborn sepsis or 771.83 …

Heeding The Cry For Help: Addressing Lgbt Bullying As A Public Health Issue Through Law And Policy, Christina Meneses, Nicole Grimm

University of Maryland Law Journal of Race, Religion, Gender and Class

No abstract provided.

Needs Assessment For The Mobile Health Clinic Of The Sukhdev Raj Soin Hospital, Luke Rothermel

Master of Public Health Program Student Publications

India has an established system of medical and public health services to provide care to all citizens through a government‐run network of providers and infrastructure. That system, though, is constrained by socio‐economic limitations, a booming population, and the cultural variations of its population. In addition to the public efforts to provide health care, the private sector has grown to serve a large portion of the population. Many of these private initiatives are found in urban areas where the potential for financial gain are great, but others have spread into semi‐urban areas and villages to serve the more rural populations. The …

Best Practice For Casualty Simulation - Role-Playing Actor, High Fidelity Mannequin Simulation, Or Virtual Reality?, Robert Sarlay

Master of Public Health Program Student Publications

Objective: The purpose of this systemic review of the literature is to determine the best practice with regards to simulating casualties during a disaster response exercise.

Methods: MEDLINE was searched from 1950 till present for the key terms of disaster, simulation, and emergency preparedness. Articles were included which met the following criteria: English language, human subjects, original research using any research design (with or without intervention), and primary focus of disaster preparedness using simulation, virtual reality, or role playing actors.

Results: Of the 386 articles reviewed only 18 met inclusion criteria. The literature is primarily descriptive in nature with regards …