Medicine and Health Sciences Commons^™

Prevalence And Risk Of Polypharmacy Among The Elderly In An Outpatient Setting: A Retrospective Cohort Study In The Emilia-Romagna Region, Italy, S. Lane Slabaugh, Vittorio Maio, Megan Templin, Safiya Abouzaid

College of Population Health Faculty Papers

Background: Polypharmacy, the simultaneous taking of many medications, has been well documented and is a topic of much concern for those looking to improve the quality of care for the elderly. Elderly patients often develop complicated and multi-factorial health states that require extensive pharmacotherapy, leaving this population at risk for exposure to drug-drug interactions and other adverse events. Previous literature supports an association between an increase in the rate of adverse events as the number of drugs taken by a patient increases.

Objective: We sought to evaluate the prevalence of polypharmacy, and to determine patient characteristics that are predictive of …

Current And Future Directions In Frailty Research., Anita Mohandas, Joanne Reifsnyder, Mimi Jacobs, Tim Fox

College of Population Health Faculty Papers

The concept of frailty has been evolving dramatically for the past 30 years. Through its evolution, a variety of single and multidimensional models have been used to describe frailty. This article reviews the current literature related to the defining dimensions of frailty and identifies the gaps in the literature requiring additional research. A detailed literature review was performed to identify key dimensions and models currently being used to define frailty, classify interventions that have been developed to reverse frailty, and identify potential areas for future research within this field. Despite the large body of research defining the dimensions of frailty, …

Cervical Cancer Screening Outcomes In A Refugee Population, Sarah Pickle, Md, Marc Altshuler, Md, Kevin Scott, Md, Christina Hillson, Md, R. Patrick Mcmanus, Md, Mazvita Nyamukapa, Michael Walker

Department of Family & Community Medicine Presentations and Grand Rounds

The purpose of our study was to determine the prevalence of abnormal Pap smears and high-risk HPV genotypes within our refugee population.

International Evidence On Medical Spending., Robert D. Lieberthal, Phd

College of Population Health Lectures, Presentations, Workshops

Presented for the American Statistical Association Health Policy Statistics Section.9th International Conference on Health Policy Statistics, Cleveland, OH.

14 PowerPoint slides

Presentation associated with this paper: http://jdc.jefferson.edu/healthpolicyfaculty/45/.

International Evidence On Medical Spending., Robert D. Lieberthal, Phd

College of Population Health Lectures, Presentations, Workshops

The 46th Actuarial Research Conference, Poster session I, University of Connecticut, Storrs, CT. August 11, 2011.

Poster conclusions:

• U.S. spending is high.
• Long tailed medical linked insurance may be easier to write in the U.S.
• U.S. healthcare cost curve is not outrageous.
• Average spending
• Low volatility

Poster is associated with this paper: http://jdc.jefferson.edu/healthpolicyfaculty/45/

High Frequency Evidence On Variation In Spending Growth., Robert D. Lieberthal, Phd

College of Population Health Lectures, Presentations, Workshops

Presented for the American Statistical Association Health Policy Statistics Section. 9th International Conference on Health Policy Statistics, Poster session I, Cleveland, OH.

Policy Implications:

• Health insurance regulation should include compensation for taking on riskier groups.
• Health programs should focus on changing needs for risk management versus health management throughout the life cycle.

Funding to support this work came from AHRQ grant R36 HS018835-01.

Strategies For Financing Healthcare Costs Over The Long Term., Robert D. Lieberthal, Phd

College of Population Health Lectures, Presentations, Workshops

Presented for the American Statistical Association Health Policy Statistics Section. 9th International Conference on Health Policy Statistics, Poster session I, Cleveland, OH.

Funding to support this work came from AHRQ grant R36 HS018835-01.

Policy Implications:

-Health insurance companies should use a broad, diversified investment portfolio as their optimal investment strategy -Insurance regulators should be focused on longer term lines of health insurance

Validating The Pridit Method For Determining Hospital Quality With Outcomes Data., Robert D. Lieberthal, Phd, Dominique Comer, Pharmd, Katherine O’Connell, Bs

College of Population Health Lectures, Presentations, Workshops

Presented for The 46th Actuarial Research Conference, University of Connecticut, Storrs, CT.

15 PowerPoint slides

International Evidence On Medical Spending Risk., Robert D. Lieberthal, Phd

College of Population Health Lectures, Presentations, Workshops

Presented for the American Risk and Insurance Association. 2011 ARIA Annual Meeting, San Diego, CA.

20 PowerPoint slides.

Presentation is associated with the paper: http://jdc.jefferson.edu/healthpolicyfaculty/45/

Colorectal Cancer (Crc) Vaccine Study: Aim 2 Internship Experience, Selasie Goka

Summer Training Program in Cancer Immunotherapy

Activities:

1. Conducted literature review

2. CRC vaccine study booklet and survey

3. Recruitment survey questionnaire

4. Prepare web-based decision counseling program

38 PowerPoint Slides.

Appropriate Medication Prescribing In Elderly Patients: How Knowledgeable Are Primary Care Physicians? A Survey Study In Parma, Italy., Vittorio Maio, Pharmd, Ms, Mph, Eric Jutkowitz, Ba, Karina Herrera Ba, Ms, Safiya Abouzaid Pharmd, Giavanna Negri, Pharmd, Stefano Del Canale, Md, Phd

College of Population Health Faculty Papers

What is known and Objective:  Increasing attention is being paid to inappropriate medication prescribing for the elderly. A growing body of studies have detected a prevalence of inappropriate prescribing ranging from 12% to 40% worldwide, including Regione Emilia-Romagna, Italy. To improve quality of prescribing, a multi-phase pilot project in the Local Health Unit (LHU) of Parma, Regione Emilia-Romagna, was established. This phase aimed to assess primary care physicians' knowledge of appropriate prescribing in elderly patients. Methods:  In total, 155 primary care physicians (51% of the total), convened by the LHU of Parma for an educational session, were asked to complete …

Knowledge And Perceived Barriers About Diabetic Retinopathy And Dilated Eye Exam In Patients With Diabetes, Manisha Verma, Md, Mph, Mona Sarfaty, Robert Simmons, Drph, Mph, Albert G. Crawford

College of Population Health Lectures, Presentations, Workshops

Conclusions:

• The results of this study suggest that 68% of the population from this primary care practice got a dilated eye exam within a year. Facilitators were awareness/knowledge about the DR and DFE, eye problems and information from their doctors.
• Almost 20% of the patients did not get an eye exam as recommended. Various barriers included cost, transportation issues, time constraint issues, lack of symptoms of the disease, and fear of the exam.
• There is a significance difference in getting an eye exam by the type of insurance with a smaller percentage of Medicaid recipients (60%) meeting the guidelines compared …

Got Worms?: Planning And Evaluation Of A Culturally Appropriate Health Education Pilot Program For The Control Of Soil-Transmitted Helminth Infections In Rwandan Village Children, Pier Hart

Master of Public Health Capstone Presentations

Infections with parasitic intestinal worms known as soil-transmitted helminthes (STH) are endemic in most poor countries in Africa, Asia and Latin America. In Rwanda, the prevalence of helminth infections among school-age children was found to be nearly 70%. Chronic STH infections are associated with malnutrition and anemia, which cause physical and cognitive developmental problems. These morbidities negatively affect educational attainment and vocational productivity and thereby perpetuate the cycle of poverty in affected communities. Control of STH requires both regular deworming treatments and changes in health behaviors relevant to transmission, including personal hygiene and sanitation practices. In Rwanda, a nationwide program …

The Need For A Sugar-Sweetened Beverage Tax In Philadelphia – Policy Analysis, J M. O'Dell

Master of Public Health Capstone Presentations

The goal of this study was to analyze sugar-sweetened beverage tax policy as one strategy to fight America’s obesity epidemic. Obesity is an enormous problem that plagues individuals worldwide. The prevalence of obesity is high in this country, exceeding 25% in 33 states. In Pennsylvania in 2009, 27.7% of adults were labeled as obese. Additionally, there are many more Philadelphians who are overweight or obese (900,000) than who are at a healthy weight (600,000). Obesity is extremely complex and has several causes. One cause of obesity and the main concern of this study is the consumption of sugar-sweetened beverages. Sugar-sweetened …

Assessing Nutrition Knowledge, Skill And Attitudes In Adolescent Girls, Tatyana Jean

Master of Public Health Capstone Presentations

There is still much to be understood about the nutrition habits of adolescents who are just beginning to break away from familial habits and developing individual identities. The African American community in particular, is known to experience disproportionate amounts of overweight and obesity resulting in chronic diseases such as diabetes and hypertension. This study used quantitative and qualitative measures to assess the nutrition skills, knowledge, and attitudesof African American girls aged 14-17. After data analysis, it was found that African American adolescent girls had high body image and self esteem but poor nutrition skill and knowledge. Body image and weight …

International Evidence On Medical Spending., Robert D. Lieberthal, Phd

College of Population Health Lectures, Presentations, Workshops

Presented for the Casualty Actuarial Society 2011 Seminar on Reinsurance, Philadelphia, PA.

Handouts are also available at: http://www.casact.org/education/reinsure/2011/handouts/C17-Lieberthal.pdf

the audio is available at: http://www.casact.org/education/reinsure/2011/audio/C17.mp3

and it is associated with the paper: http://jdc.jefferson.edu/healthpolicyfaculty/45/

23 PowerPoint slides.

Obesity And Other Predictors Of Absenteeism In Philadelphia School Children., Elizabeth B Rappaport, Constantine Daskalakis, Jocelyn Andrel

Department of Family & Community Medicine Faculty Papers

BACKGROUND: Limited data indicate that obese children are absent from school more than their normal-weight peers. We analyzed administrative data from a large urban school district to investigate the association of obesity and student sociodemographic characteristics with absenteeism.

METHODS: We analyzed 291,040 records, representing 165,056 unique students (grades 1-12). Obesity status was classified according to Centers for Disease Control and Prevention age- and sex-specific percentiles for body mass index (BMI) and analyses were based on negative binomial regression.

RESULTS: Overall rates of overweight and obesity were 17% and 20%, respectively, and the estimated absence rate was 17 absences per 180 …

International Evidence On Medical Spending, Robert D. Lieberthal

College of Population Health Faculty Papers

Abstract
U.S. medical spending is high by measures including the level of spending, level of spending per capita, and level of spending as a share of GDP. U.S. medical spending growth is average by measures including the annual growth rate, annual growth rate per capita, and annual growth in spending as a percent of GDP. The volatility of U.S. medical spending growth is low by measures including the standard deviation, skew, and excess kurtosis.

Foreign healthcare systems, with a much larger government involvement, have not been able to control medical spending growth better than the U.S. with its mixed system. …

Use Of Internet-Based Diabetes Self-Management Education: Emmi Solutions, Esther Pak

Master of Public Health Capstone Presentations

Diabetes is a serious public health problem in the United States and in Philadelphia. A 2007 CDC report stated that 7.8% in the US and 10.4% in Philadelphia had diabetes. While the key to managing one’s diabetes and lowering the risk of its adverse health outcomes is adherence to diabetes management guidelines, the prevalence of these behaviors among adult diabetics in the US remained relatively low. Attendance at a diabetes self-management class was particularly low (55.4%), which is of concern because of the importance of education in a patient’s adherence to diabetes-maintenance behaviors. Emmi Solutions recently developed three Internet-based diabetes …

Price, Access And Education At Philadelphia Farmers' Markets, Anna M. Quinn

Master of Public Health Capstone Presentations

Inadequate intake of fruits and vegetables is linked to chronic disease and obesity. However, consumption rates of fruits and vegetables in the US and specifically in Philadelphia continue to fall short of recommendations for a healthy diet. Access and price are two barriers in the food environment that prevent sufficient fruit and vegetable consumption. Farmers’ markets offer increased access to fruit and vegetables, yet continue to be perceived as being more costly than grocery stores. This study’s primary aim was to determine if the price of fruit and vegetables are more expensive at farmers’ markets than grocery stores in Philadelphia. …

Maternal Health Workforce Shortages In Southeast Pennsylvania, Jacqueline E. Kohl

Master of Public Health Capstone Presentations

Since 1997, 19 maternity wards have closed in Southeastern Pennsylvania, leaving only 23 to serve the women and families in the area. Additionally, there have been reports of maternal health workforce shortages, causing many women difficulty in accessing the care they need. This aims of this qualitative study were to define the problem of maternal health workforce shortages in the region and to identify potential solutions. Ten key stakeholders were identified for participation. A single researcher conducted interviews using a structured interview guide. Results were analyzed for content and major themes by two researchers. The eight sections include: 1. preconception …

Detecting Hospital Quality With Pridit., Robert D. Lieberthal, Phd

College of Population Health Lectures, Presentations, Workshops

Presented for the Temple University, Fox School of Business Department of Risk, Insurance & Healthcare Management. Robert A. Hedges Research Seminar Series, Philadelphia, PA.

25 PowerPoint slides

Associated papers available at: http://onlinelibrary.wiley.com/doi/10.1111/j.1475-6773.2007.00821.x/abstract

and the 2008 Proceedings of the Joint Statistical Meeting.

Beta-Blocker Initiation And Adherence After Hospitalization For Acute Myocardial Infarction., Vittorio Maio, Pharmd, Ms, Msph, Massimiliano Marino, Phd, Mary Robeson, Md, Joshua J Gagne, Pharmd, Ms

College of Population Health Faculty Papers

Aims: We sought to: (1) estimate the proportion of patients who initiated beta-blocker therapy after acute myocardial infarction (AMI) in Regione Emilia-Romagna (RER); (2) examine predictors of post-AMI beta-blocker initiation; and (3) assess adherence to such therapy.

Methods and Results: Using healthcare claims data covering all of RER, we identified a cohort of 24,367 patients with a hospitalization for AMI between 2004 and 2007, who were discharged from the hospital alive and without contraindications to beta-blocker therapy. We estimated the proportion of eligible patients with at least one prescription for a beta-blocker following discharge and performed a multivariable logistic regression …

Patient Empowerment And Multimodal Hand Hygiene Promotion: A Win-Win Strategy., Maryanne Mcguckin, Julie Storr, Yves Longtin, Benedetta Allegranzi, Didier Pittet

College of Population Health Faculty Papers

Patient empowerment is a new concept in health care that has now been extended to the domain of patient safety. Within the framework of the development of the new World Health Organization (WHO) Guidelines on Hand Hygiene in Health Care, the authors conducted a review of the literature from 1997 to 2008 to identify the evidence supporting programs aimed at encouraging patients to take an active role in their care. Patient empowerment is an integral part of the WHO hand hygiene multimodal strategy. Hand hygiene promotion strategies that have demonstrated evidence of successfully empowering patients include one or all of …