Medicine and Health Sciences Commons^™

Characterizing Primary Care For Patients With Major Depressive Disorder Using Electronic Health Records Of A Us-Based Healthcare Provider, Sharon L. Larson, Andrei Nemoianu, Debra F Lawrence, Melissa A Troup, Michael R Gionfriddo, Bobak Pousti, Haiyan Sun, Faisal Riaz, Eric S Wagner, Lambros Chrones, Maelys Touya

College of Population Health Faculty Papers

Background: Major depressive disorder (MDD) is predominantly managed in primary care. However, primary care providers (PCPs) may not consistently follow evidence-based treatment algorithms, leading to variable patient management that can impact outcomes.

Methods: We retrospectively analyzed adult patients with MDD seen at Geisinger, an integrated health system. Utilizing electronic health record (EHR) data, we classified patients as having MDD based on International Classification of Disease (ICD)-9/10 codes or a Patient Health Questionnaire (PHQ)-9 score ≥5. Outcomes assessed included time to first visit with a PCP or behavioral health specialist following diagnosis, antidepressant medication switching, persistence, healthcare resource utilization (HRU), and …

Risk Factors For Poor Outcomes Among Patients With Extensively Drug-Resistant Tuberculosis (Xdr-Tb): A Scoping Review, Karan Varshney, Beverly Anaele, Matthew Molaei, Rosemary Frasso, Vittorio Maio

College of Population Health Faculty Papers

In recent years, there has been an upsurge in cases of drug-resistant TB, and strains of TB resistant to all forms of treatment have begun to emerge; the highest level of resistance is classified as extensively drug-resistant tuberculosis (XDR-TB). There is an urgent need to prevent poor outcomes (death/default/failed treatment) of XDR-TB, and knowing the risk factors can inform such efforts. The objective of this scoping review was to therefore identify risk factors for poor outcomes among XDR-TB patients. We searched three scientific databases, PubMed, Scopus, and ProQuest, and identified 25 articles that examined relevant risk factors. Across the included …

Evaluation Of Pediatric Rheumatology Telehealth Satisfaction During The Covid-19 Pandemic, Lindsay N Waqar-Cowles, John Chuo, Pamela F Weiss, Sabrina Gmuca, Marianna Lanoue, Jon M Burnham

College of Population Health Faculty Papers

Background: During the Coronavirus disease 2019 pandemic, ambulatory pediatric rheumatology healthcare rapidly transformed to a mainly telehealth model. However, pediatric patient and caregiver satisfaction with broadly deployed telehealth programs remains largely unknown. This study aimed to evaluate patient/caregiver satisfaction with telehealth and identify the factors associated with satisfaction in a generalizable sample of pediatric rheumatology patients.

Methods: Patients with an initial telehealth video visit with a rheumatology provider between April and June 2020 were eligible. All patients/caregivers were sent a post-visit survey to assess a modified version of the Telehealth Usability Questionnaire (TUQ) and demographic and clinical characteristics. TUQ total …

Looking Upstream: Promoting Health Equity In Philadelphia Through Novel Partnership Strategies, Adrea Cope, David B. Nash, Sandra E Brooks, David Platt

College of Population Health Faculty Papers

No abstract provided.

Is Living In A Region With High Groundwater Arsenic Contamination Associated With Adverse Reproductive Health Outcomes? An Analysis Using Nationally Representative Data From India, Jessie Pinchoff, Brent Monseur, Sapna Desai, Katelyn Koons, Ruben Alvero, Michelle J Hindin

Department of Medicine Faculty Papers

Background: Exposure to groundwater arsenic via drinking water is common in certain geographies, such as parts of India, and causes a range of negative health effects, potentially including adverse reproductive health outcomes.

Methods: We conducted an ecological analysis of self-reported rates of stillbirth, recurrent pregnancy loss, and infertility in relation to groundwater arsenic levels in India. We used a gridded, modeled dataset of the probability of groundwater arsenic exceeding 10 μg/L (World Health Organization drinking water limit) to calculate mean probabilities at the district level (n = 599 districts). A spatial integration approach was used to merge these estimates with …

A Mixed Methods Case Study Of Food Shopping In A Community With High Infant Mortality, Sarah Evenosky, Eleanor Lewis, Katherine Isselmann Disantis

College of Population Health Faculty Papers

In the U.S., preterm birth disproportionately impacts certain racial/ethnic groups, with Black women experiencing preterm birth at a rate 50% higher than other groups. Among the numerous factors that likely contribute to these increased rates are neighborhood characteristics, such as food environment. In this mixed-methods case study, we evaluated how pregnant women living in a predominately minority, lower income community with high preterm birth rates navigate and perceive their food environment. Qualitative interviews were performed to assess perceptions of food environment (n = 7) along with geographic and observational assessments of their food environment. Participants traveled an average of 2.10 …

Accrediting Graduate Programs In Healthcare Quality And Safety, Willie H. Oglesby, Allyson G Hall, Annette L Valenta, Kenneth J Harwood, Deidre Mccaughey, Sue Feldman, Anthony C Stanowski, Sandra Chrapah, Teri Chenot, Eric Brichto, David B. Nash

College of Population Health Faculty Papers

The number of master's degree programs in healthcare quality and safety (HQS) has increased significantly over the past decade. Academic accreditation provides assurance that educational programs are of a high quality and meet the needs of students, employers, and the general public. Under the guidance of the Commission on Accreditation of Healthcare Management Education, faculty from 9 universities collaborated in the development of criteria and related content domains to be used in the accreditation of graduate programs in HQS. Thirteen content domains were identified. Four of the content domains, safety and error science, improvement science and quality principles, evidence-based practice, …

Flexibility During The Covid-19 Pandemic Response: Healthcare Facility Assessment Tools For Resilient Evaluation, Andrea Brambilla, Tian-Zhi Sun, Waleed Elshazly, Ahmed Ghazy, Paul Barach, Göran Lindahl, Stefano Capolongo

College of Population Health Faculty Papers

Healthcare facilities are facing huge challenges due to the outbreak of COVID-19. Around the world, national healthcare contingency plans have struggled to cope with the population health impact of COVID-19, with healthcare facilities and critical care systems buckling under the ex-traordinary pressures. COVID-19 has starkly highlighted the lack of reliable operational tools for assessing the level sof flexibility of a hospital building to support strategic and agile decision making. The aim of this study was to modify, improve and test an existing assessment tool for evaluating hospital facilities flexibility and resilience. We followed a five-step process for collecting data by …

Health Of Asylees Compared To Refugees In The United States Using Domestic Medical Examination Data, 2014-2016: A Cross-Sectional Analysis., Gayathri S Kumar, Clelia Pezzi, Colleen Payton, Blain Mamo, Kailey Urban, Kevin Scott, Jessica Montour, Nuny Cabanting, Jenny Aguirre, Rebecca Ford, Stephen E Hughes, Breanna Kawasaki, Lori Kennedy, Emily S Jentes

College of Population Health Faculty Papers

Background: Between 2008 and 2018, persons granted asylum (asylees) increased by 168% in the United States. Asylees are eligible for many of the same domestic benefits as refugees under the US Refugee Admissions Program (USRAP), including health-related benefits such as the domestic medical examination. However, little is known about the health of asylees to guide clinical practice.

Methods: We conducted a retrospective cross-sectional analysis of domestic medical examination data from 9 US sites from 2014 to 2016. We describe and compare demographics and prevalence of several infectious diseases such as latent tuberculosis infection (LTBI), hepatitis B and C virus (HBV, …

Hospital Work Environments Affect The Patient Safety Climate: A Longitudinal Follow-Up Using A Logistic Regression Analysis Model, Kirsten Brubakk, Martin Veel Svendsen, Ellen Tveter Deilkås, Dag Hofoss, Paul Barach, Ole Tjomsland

College of Population Health Faculty Papers

BACKGROUND: Occupational worker wellness and safety climate are key determinants of healthcare organizations' ability to reduce medical harm to patients while supporting their employees. We designed a longitudinal study to evaluate the association between work environment characteristics and the patient safety climate in hospital units.

METHODS: Primary data were collected from Norwegian hospital staff from 970 clinical units in all 21 hospitals of the South-Eastern Norway Health Region using the validated Norwegian Work Environment Survey and the Norwegian version of the Safety Attitudes Questionnaire. Responses from 91,225 surveys were collected over a three year period. We calculated the factor mean …

Association Between Baseline Diastolic Blood Pressure And The Efficacy Of Intensive Vs Standard Blood Pressure-Lowering Therapy, Andrew J Foy, Edward J Filippone, Eric Schaefer, Matt Nudy, Mohammed Ruzieh, Anne-Marie Dyer, Vernon M Chinchilli, Gerald V Naccarelli

Department of Medicine Faculty Papers

Importance: Low diastolic blood pressure (DBP) has been found to be associated with increased adverse cardiovascular events; however, it is unknown whether intensifying blood pressure therapy in patients with an already low DBP to achieve a lower systolic blood pressure (SBP) target is safe or effective.

Objective: To evaluate whether there is an association of baseline DBP and intensification of blood pressure-lowering therapy with the outcomes of all-cause death and cardiovascular events.

Design, setting, and participants: This cohort study analyzed patients who were randomized to intensive or standard BP control in the Action to Control Cardiovascular Risk in Diabetes-Blood Pressure …

The Payvider: An Evolving Model., Zachary N. Goldberg, David B. Nash

College of Population Health Faculty Papers

No abstract provided.

The Efficacy Of Insecticide-Treated Window Screens And Eaves Against Anopheles Mosquitoes: A Scoping Review, Beverly Anaele, Karan Varshney, Francis S O Ugwu, Rosemary Frasso

College of Population Health Faculty Papers

Background: Female mosquitoes serve as vectors for a host of illnesses, including malaria, spread by the Plasmodium parasite. Despite monumental strides to reduce this disease burden through tools such as bed nets, the rate of these gains is slowing. Ongoing disruptions related to the COVID-19 pandemic may also negatively impact gains. The following scoping review was conducted to examine novel means of reversing this trend by exploring the efficacy of insecticide-treated window screens or eaves to reduce Anopheles mosquito bites, mosquito house entry, and density.

Methods: Two reviewers independently searched PubMed, Scopus, and ProQuest databases on 10 July, 2020 for …

Clinical Outcomes In Patients Co-Infected With Covid-19 And Staphylococcus Aureus: A Scoping Review, Jenna Adalbert, Karan Varshney, Rachel Tobin, Rafael Pajaro

College of Population Health Faculty Papers

BACKGROUND: Endemic to the hospital environment, Staphylococcus aureus (S. aureus) is a leading bacterial pathogen that causes deadly infections such as bacteremia and endocarditis. In past viral pandemics, it has been the principal cause of secondary bacterial infections, significantly increasing patient mortality rates. Our world now combats the rapid spread of COVID-19, leading to a pandemic with a death toll greatly surpassing those of many past pandemics. However, the impact of co-infection with S. aureus remains unclear. Therefore, we aimed to perform a high-quality scoping review of the literature to synthesize the existing evidence on the clinical outcomes of COVID-19 …

Digital Intervention Increases Influenza Vaccination Rates For People With Diabetes In A Decentralized Randomized Trial., J L Lee, L Foschini, S Kumar, J Juusola, J Liska, M Mercer, C Tai, R Buzzetti, M Clement, X Cos, L Ji, N Kanumilli, D Kerr, E Montanya, D Müller-Wieland, C G Ostenson, N. Skolnik, V Woo, N Burlet, M Greenberg, S I Samson

Abington Jefferson Health Papers

People with diabetes (PWD) have an increased risk of developing influenza-related complications, including pneumonia, abnormal glycemic events, and hospitalization. Annual influenza vaccination is recommended for PWD, but vaccination rates are suboptimal. The study aimed to increase influenza vaccination rate in people with self-reported diabetes. This study was a prospective, 1:1 randomized controlled trial of a 6-month Digital Diabetes Intervention in U.S. adults with diabetes. The intervention group received monthly messages through an online health platform. The control group received no intervention. Difference in self-reported vaccination rates was tested using multivariable logistic regression controlling for demographics and comorbidities. The study was …

Emergency Medicine And Covid-19: Now And Next Year, Theodore A. Christopher, Adrienne N. Christopher

Department of Emergency Medicine Faculty Papers

The COVID-19 pandemic is responsible for infecting to date more than 93 million people worldwide and causing more than 2 million deaths. That the vast majority of deaths have occurred in the United States (U.S.) can be attributed to nonadherence by Americans to basic public health mitigation strategies that are known to curtail coronavirus spread. Emergency Departments (ED’s) throughout the U.S. experienced a dramatic decrease in patient visits during the first surge of COVID-19, followed by an ED patient visit rebound to approximately 80% of pre-COVID-19 numbers, which have remained relatively stable through the current second COVID-19 surge. The pandemic …

Testing Testimonial., Jason Beiriger, David B. Nash

College of Population Health Faculty Papers

No abstract provided.

Development Of Personas To Communicate Narrative-Based Information About The Hpv Vaccine On Twitter, Philip M Massey, Shawn C Chiang, Meredith Rose, Regan M Murray, Madeline Rockett, Elikem Togo, Ann C Klassen, Jennifer A Manganello, Amy Leader

Department of Medical Oncology Faculty Papers

Introduction: Personas are based on real-life typologies of people that can be used to create characters and messages to communicate important health information through relatable narrative storylines. Persona development is data-driven and can involve multiple phases of formative research and evaluation; however, personas are largely underutilized in digital health research. The purpose of this study was to create and document persona development to deliver narrative-focused health education for parents on Twitter with the goal of increasing uptake of HPV vaccination among adolescents. Methods: Leveraging data from a mixed-method study conducted in the U.S. with a diverse population of parents with …

Gestational Weight Gain In 4 Low- And Middle-Income Countries And Associations With Birth Outcomes: A Secondary Analysis Of The Women First Trial., Melissa S Bauserman, Carla M Bann, K Michael Hambidge, Ana L Garces, Lester Figueroa, Jamie L Westcott, Jackie K Patterson, Elizabeth M Mcclure, Vanessa R Thorsten, Sumera Ali Aziz, Sarah Saleem, Robert L Goldenberg, Richard Derman, Veena Herekar, Manjunath Somannavar, Marion W Koso-Thomas, Adrien L Lokangaka, Antoinette K Tshefu, Nancy F Krebs, Carl L Bose, Shivaprasad Goudar, Sangappa Dhaded, Bhalchandra Kodkany, Omrana Pasha, Abhik Das, Menachem Miodovnik, N K Raju Tonse

Global Health Articles

BACKGROUND: Adequate gestational weight gain (GWG) is essential for healthy fetal growth. However, in low- and middle-income countries, where malnutrition is prevalent, little information is available about GWG and how it might be modified by nutritional status and interventions.

OBJECTIVE: We describe GWG and its associations with fetal growth and birth outcomes. We also examined the extent to which prepregnancy BMI, and preconception and early weight gain modify GWG, and its effects on fetal growth.

METHODS: This was a secondary analysis of the Women First Trial, including 2331 women within the Democratic Republic of Congo (DRC), Guatemala, India, and Pakistan, …

Digital Literacy At An Urban Cancer Center: Implications For Technology Use And Vulnerable Patients, Amy Leader, Lisa M. Capparella, L. Waldman, Ba, Rebecca Cammy, Alison Petok, Rebecca Dean, Ayako Shimada, Liana Yocavitch, Kristin L. Rising, Gregory Garber, Brooke Worster, Adam Dicker

Kimmel Cancer Center Faculty Papers

PURPOSE: eHealth literacy, or the ability to seek, find, understand, and appraise health information from electronic sources, has become increasingly relevant in the era of COVID-19, when so many aspects of patient care became dependent on technology. We aimed to understand eHealth literacy among a diverse sample of patients with cancer and discuss ways for health systems and cancer centers to ensure that all patients have access to high-quality care.

METHODS: A cross-sectional survey of patients with cancer and caregivers was conducted at an NCI-designated cancer center to assess access to the Internet, smartphone ownership, use of mobile apps, willingness …

Value-Based Focused Global Population Health Management, John F. Gibbs, Ashley Newman, Richard G. Stefanacci Do,Mgh,Mba,Agsf,Cmd

College of Population Health Faculty Papers

In 2018, approximately 18 million people worldwide were diagnosed with cancer and are predicted to double by 2040. The global quality chasm in improving health care worldwide requires “systems thinking” as the key to success. Aligning the goal around person-centered care captures the total needs of care of a population and not just disease categories. The integration of the Institute of Medicine’s (IOM) six aims of quality termed “value-based focused” and population health management (PHM) provides all health care leaders grappling with improving the health care of the populations a framework for the communities they serve. In this context, the …

Value-Based Chronic Care Model Approach For Vulnerable Older Patients With Multiple Chronic Conditions, John F. Gibbs, Ellen Guarnieri, Quyen D. Chu, Kenneth Murdoch, Arif Asif

College of Population Health Faculty Papers

“Old age, itself, is not a disease” (Suborne 2007). The rising rate of the global aging population is predicted to create a health care crisis within the next three decades. Vulnerable older adults suffer from multiple chronic conditions (MCCs) in addition to cognitive and physical decline during the process of aging resulting in an inability to optimally achieve self-management. In terms of resource utilization, complex inpatient, and outpatient care results in higher physician visits, polypharmacy, and higher prescription costs. Health literacy has become known as an important social determinant of health affecting the older population. Both reductions in health literacy …

The Evaluation Of Medical Student International Mission Trips: A Rapid Review, Andrew Kamel

Master of Public Health Capstone Presentations

Previous reviews of the literature on medical mission trips have noted that there is a dearth of rigorous data collection and evaluation of the efficacy of medical missions to low- and middle-income countries (LMICs). Medical students are increasingly participating in these trips as global health curriculums become more popular and prevalent, and the literature about these international experiences has not been well-described. This rapid review aims to characterize the evaluation of medical mission trips for medical students to LMICs. This article is a rapid review of the literature using PRIMSA guidelines to search PubMed for studies about the evaluation of …

Prevalence Of Pressure Ulcers In Long-Term Care Facilities: A Focus On Older Adults, Joseph M. Callaghan, Iii

Master of Public Health Capstone Presentations

Pressure Ulcers (PUs) are wounds resulting from skin breakdown. They are common among those who have mobility limitations, and older adults, particularly those residing in nursing homes (NHs) and long-term care facilities (LTCFs). PUs cost U.S. and international healthcare systems millions of dollars per year. For all of these reasons, PUs represent a continuing public health threat.

Our review provides an update on the prevalence of PUs in LTCFs and NHs, especially regarding older adults. We used a single-reviewer, modified PRISMA-P process to conduct a rapid review of the literature. Relevant search terminology were input into PubMed and Scopus^{® …}

Examining The Unseen Trauma Endured By 911 Telecommunicators, Angela Gibilante

Master of Public Health Capstone Presentations

First responders of all types are at risk for the development of mental and behavioral health conditions as a result of the repeated exposure to trauma they face. Much research has explored their lived experiences and work has been done to evaluate interventions to mitigate the stress associated with this type of work. However, the majority of this research fails to include 911 Telecommunicators as first responders even though they are also at risk for experiencing trauma (SAMHSA, 2018; Skeffington et al., 2016; Camaro et al., 2020; Stabile, 2015). The purpose of this study was to examine the experiences and …

Facing Death: Attitudes Toward Physician-Assisted End Of Life Among Physicians Working At A Tertiary-Care-Hospital In Israel, Keren Dopelt, Dganit Cohen, Einat Amar-Krispel, Nadav Davidovitch, Paul Barach

College of Population Health Faculty Papers

The demand for medical assistance in dying remains high and controversial with a large knowledge gap to support optimal patient care. The study aimed to explore physicians’ attitudes regarding euthanasia and examine the factors that related to these attitudes. We surveyed 135 physicians working at a tertiary-care hospital in Israel. The questionnaire was comprised of demographic and background information, DNR procedure information, encounters with terminally ill patients, familiarity with the law regarding end-of-life questions, and Attitudes toward Euthanasia. About 61% agreed that a person has the right to decide whether to expedite their own death, 54% agreed that euthanasia should …

Designer Benzodiazepines: A Review Of Toxicology And Public Health Risks, Pietro Brunetti, Raffaele Giorgetti, Adriano Tagliabracci, Marilyn A. Huestis, Francesco Paolo Busardò

Institute of Emerging Health Professions Faculty Papers

The rising use of designer benzodiazepines (DBZD) is a cat-and-mouse game between organized crime and law enforcement. Non-prohibited benzodiazepines are introduced onto the global drug market and scheduled as rapidly as possible by international authorities. In response, DBZD are continuously modified to avoid legal sanctions and drug seizures and generally to increase the abuse potential of the DBZD. This results in an unpredictable fluctuation between the appearance and disappearance of DBZD in the illicit market. Thirty-one DBZD were considered for review after consulting the international early warning database, but only 3-hydroxyphenazepam, adinazolam, clonazolam, etizolam, deschloroetizolam, diclazepam, flualprazolam, flubromazepam, flubromazolam, meclonazepam, …

Cannabis Use And Car Crashes: A Review., Ulrich W Preuss, Marilyn A. Huestis, Miriam Schneider, Derik Hermann, Beat Lutz, Alkomiet Hasan, Joseph Kambeitz, Jessica W M Wong, Eva Hoch

College of Health Professions Faculty Papers

In this review, state-of-the-art evidence on the relationship between cannabis use, traffic crash risks, and driving safety were analyzed. Systematic reviews, meta-analyses, and other relevant papers published within the last decade were systematically searched and synthesized. Findings show that meta-analyses and culpability studies consistently indicate a slightly but significantly increased risk of crashes after acute cannabis use. These risks vary across included study type, crash severity, and method of substance application and measurement. Some studies show a significant correlation between high THC blood concentrations and car crash risk. Most studies do not support this relationship at lower THC concentrations. However, …

Common Concerns, Barriers To Care, And The Lived Experience Of Individuals With Hepatitis B: A Qualitative Study., Catherine Freeland, Sean Farrell, Priyanka Kumar, Maureen Kamischke, Michaela Jackson, Sierra Bodor, Timothy M Block, Rosemary Frasso Phd, Msc, Cph, Chari Cohen

College of Population Health Faculty Papers

BACKGROUND: An estimated between 257 and 292 million people live with chronic HBV globally. While much is known about the causes, and epidemiology of HBV, little is understood about the quality of life and impact of HBV on those living with the infection.

METHODS: A random sample of HBV-related email queries sent to the Hepatitis B Foundation, a U.S.-based non-profit organization, over a 12-month period in 2018-2019 were retrieved, tabulated, and analyzed qualitatively to highlight information needs and explore the experiences of people living with HBV and their families and loved ones. Codebook development was informed by the literature and …

Seeking Truer Measures Of Success: Moving Toward More Rigorous Evaluations Of Industry-Led Access To Medicines Programs., Cherie Lynn Ramirez, Ashveena Gajeelee, Brianna Desharnais, Jenna Sherman, Dexter Waters

Student Papers, Posters & Projects

No abstract provided.