Medicine and Health Sciences Commons^™

Aftermath: A Word To Appalachia Following Hurricane Helene, Emily Wilson

Journal of Appalachian Health

On September 27, 2024, Hurricane Helene caused massive and catastrophic flash flooding in the lower Appalachian Region, leveling towns and forever altering much of the landscape. This is an open letter to the people of Appalachia who were affected by the disaster that blindsided our region.

Enhancing Digital Health Equity: A Personalized Approach For Spanish-Speaking Patients, Marissa Witmer, Julianna Lenoir, Mph, Angela Gerolamo, Phd, Crnp, Pmhnp, Akshay Krishnan, David Rigas, Kristin L. Rising, Md, Mshp

Jefferson Center for Connected Care Posters

Background

Limited English Proficiency (LEP) is a barrier among Hispanic communities in accessing digital health tools including patient portals.¹

Patient portals provide patients with access to their electronic medical records. With portals, patients can schedule visits, message providers, check test results, and order medication refills, among other tasks.

Portal use has been shown to help patients better manage chronic diseases, enhance doctor-patient relationships, improve patient understanding and awareness of health status, and increase adherence to therapy.²

Despite interest in using patient portals, Spanish-speaking patients often struggle to use them due to low digital literacy.³

Provision of personalized …

Excess Potassium Promotes Autophagy To Maintain The Immunosuppressive Capacity Of Myeloid-Derived Suppressor Cells Independent Of Arginase 1, Ramesh Thylur Puttalingaiah, Matthew J. Dean, Liqin Zheng, Phaethon Philbrook, Dorota Wyczechowska, Timothy Kayes, Luis Del Valle, Denise Danos, Maria Dulfary Sanchez-Pino

School of Medicine Faculty Publications

Potassium ions (K+) are critical electrolytes that regulate multiple functions in immune cells. Recent studies have shown that the elevated concentration of extracellular potassium in the tumor interstitial fluid limits T cell effector function and suppresses the anti-tumor capacity of tumor-associated macrophages (TAMs). The effect of excess potassium on the biology of myeloid-derived suppressor cells (MDSCs), another important immune cell component of the tumor microenvironment (TME), is unknown. Here, we present data showing that increased concentrations of potassium chloride (KCl), as the source of K+ ions, facilitate autophagy by increasing the expression of the autophagosome marker LC3β. Simultaneously, excess potassium …

Norovirus Acute Gastroenteritis Amongst Us And European Travellers To Areas Of Moderate To High Risk Of Travellers’ Diarrhoea: A Prospective Cohort Study, Martin Alberer, Christine L Moe, Christoph Hatz, Kerstin Kling, Amy E Kirby, Lisa Lindsay, Hans D Nothdurft, Margarita Riera-Montes, Robert Steffen, Thomas Verstraeten, Henry M Wu, Herbert L Dupont

Faculty, Staff and Student Publications

BACKGROUND: Acute gastroenteritis (AGE) is a major medical condition for travellers worldwide, particularly travellers to low- and middle-income countries. Norovirus (NoV) is the most common cause of viral AGE in older children and adults, but data on prevalence and impact amongst travellers is limited.

METHODS: Prospective, multi-site, observational cohort study conducted 2015-2017, amongst adult international travellers from the US and Europe to areas of moderate to high risk of travel-acquired AGE. Participants provided self-collected pre-travel stool samples and self-reported AGE symptoms whilst travelling. Post-travel stool samples were requested from symptomatic subjects and a sample of asymptomatic travellers within 14 days …

The Lived Experiences Of Work Related Violence Against Public Health Professionals During Covid-19 Pandemic, Cynthia Howell

Walden Dissertations and Doctoral Studies

Work-related violence (WRV) against public health professionals is increasingly prevalent worldwide but received much greater attention during the COVID-19 pandemic. This qualitative study addressed a gap in the literature by exploring public health professionals' experiences with WRV threats, what factors contributed to their vulnerability, and the severity of these threats during the COVID-19 pandemic from 2020 to 2023. Rogers' (1975) Protection Motivation Theory was the conceptual framework for phenomenological study. Twelve public health professionals, both male and female, including epidemiologists, nurses, physicians, researchers/scientists, and community health workers, who actively worked during the COVID-19 pandemic and were residents of New York …

Examining The Relationship Between Employment And Health Status Among Adults With Autism Spectrum Disorder (Asd) In The United States, Winifred Beckles

Walden Dissertations and Doctoral Studies

Autism spectrum disorder (ASD), characterized by challenges in social communication and repetitive behaviors, is a developmental disability that impacts over five million adults in the United States. Despite the significant amount of research literature on the association between health and employment in the general population, there remains a gap in research on the relationship between health and employment in adults with autism. Utilizing the Social Ecological Model (SEM) framework, this study examined whether there is a relationship between employment, current living status, non-paid activities, United States Census regions, type of health insurance, and health status when controlling for age, race, …

Black Women’S Perceptions Of Perinatal Healthcare In New York City Community Health Centers, Asiyah Franklin

Walden Dissertations and Doctoral Studies

The purpose of this qualitative study was to explore the experiences of Black women who have received perinatal care in New York City (NYC) community health centers and the perceived impact on their maternal health behaviors and outcomes. Although maternal health care delivery and outcomes among Black women have been explored in research, socially and economically disenfranchised Black women in NYC who rely on community health centers for perinatal care have not been included in this research. This study involved addressing the lack of knowledge of Black women’s experiences with perinatal care in NYC’s community health system and consisted of …

Health Risks Associated With Adopting New-Generation Disposable Products Among Young Adults Who Use E-Cigarettes, Shuyao Ran, James J Yang, Megan E Piper, Hsien-Chang Lin, Anne Buu

Faculty, Staff and Student Publications

New-generation disposable e-cigarettes have become increasingly popular among young adults in the USA since the FDA's partial flavor ban. This study aims to examine longitudinal changes in health risks among young adults who adopted these novel products, as well as the health effects of device types beyond the effects of other important e-cigarette characteristics. This study recruited e-cigarette users via voluntary response sampling from three college campuses in the USA to respond to four-wave online surveys conducted in four consecutive semesters. Among the participants who adopted disposables during the study, their health risks (dependence symptoms, respiratory symptoms, combustible tobacco use) …

Racial Bias In The Treatment Decision Of Breast Cancer In African American And Caucasian Women, Hayaat Mariette Amara

Walden Dissertations and Doctoral Studies

Breast cancer stands as a formidable health challenge in the United States, ranking as the most prevalent and deadly diagnosed cancer and the second leading cause of cancer-related death among women. Of particular concern is the disproportionate impact on African American women, who experience elevated mortality rates compared to other demographic groups. This quantitative study, grounded in critical race theory, investigated whether there is an association between race as well as comorbidity score and first-course treatment plans for breast cancer among women in the State of Georgia, United States, adjusting for the stage of breast cancer, age, and household income. …

Marijuana Legalization And Opioid Use Disorder In Ontario, Canada, From 2015 To 2021, Luke Ome Agada

Walden Dissertations and Doctoral Studies

This study examined the trends in opioid-related hospitalizations and deaths in Ontario, Canada, from 2015, to 2021, with a particular focus on the periods before and after cannabis legalization. The social problem addressed was the ongoing opioid crisis, exacerbated by rising opioid-related health issues. Grounded in the harm reduction theory, this research explored whether cannabis legalization could serve as a substitute to mitigate opioid use disorder. Data were extracted from the Discharge Database, Emergency Department Database, National Ambulatory Care Reporting System, and Hospital Morbidity Database. Analysis using the generalized estimation equation (GEE) method revealed a significant increase in opioid-related hospitalizations, …

Access To Waitlisting And Posttransplant Outcomes In Patients With Failed Kidney Allografts Secondary To Recurrent Glomerulonephritis, Ryan Gately, Germaine Wong, Armando Teixeira-Pinto, Helen Pilmore, Carmel Hawley, Scott Campbell, William Mulley, Wai H. Lim

Research outputs 2022 to 2026

Background. Recurrent glomerulonephritis (GN) is an important cause of allograft loss after transplantation when GN is the primary cause of kidney failure. Retransplantation after allograft loss from recurrent disease requires careful consideration. We aimed to determine the probability of relisting and the risk of allograft loss after retransplantation in recipients with prior allograft loss from recurrent GN. Methods. Using data from the Australia and New Zealand Dialysis and Transplant Registry and multivariable Cox modeling, we compared the probability of waitlisting and allograft loss after second transplantation between those with and without prior allograft loss from recurrent disease. Results. Of 3276 …

Exploring The Association Between Parenting Stress And A Child’S Exposure To Positive Childhood Experiences (Pces), Elizabeth Crouch Ph.D., Elizabeth Radcliff, Monique J. Brown Ph.D., Mph, Peiyin Hung Ph.D

Faculty Publications

High levels of parenting stress, defined as a caregiver or parent feeling stress or aggravation from parenting, has been previously shown to be associated with an increased likelihood of neglect, child maltreatment, and household dysfunction: adverse childhood experiences (ACEs). Despite the potential mitigation of positive childhood experiences (PCEs) on ACEs, prior studies on the increased likelihood of a child experiencing ACEs due to parenting stress have left a critical question unanswered: whether high parenting stress may decrease a child’s likelihood of experiencing PCEs. We analyzed the 2019–2020 National Survey of Children’s Health to examine whether higher levels of parenting stress …

Progress In Physical Activity Research, Policy, And Surveillance In Canada: The Global Observatory For Physical Activity – Gopa!, Ashley Cathro, John C Spence, Christine Cameron, Andrea Ramirez Varela, Diana Morales, Eduardo Ribes Kohn, Michael Pratt, Pedro C Hallal

Faculty, Staff and Student Publications

BACKGROUND: The purpose of this paper is to examine the evolution of physical activity research and the comprehensiveness of national physical activity policies and surveillance systems in Canada.

METHODS: A systematic review was conducted by the Global Observatory for Physical Activity (GoPA! ) on physical activity and health publications between 1950 and 2019. Findings from Canada were extracted and included in the present analysis. The number of articles published, female researcher involvement in authorship, author institution affiliations, and publication themes were examined. Policies were evaluated by determining if there was a standalone physical activity plan and if national guidelines existed. …

Antiplatelet Strategy For Patients With Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention: A Systematic Review And Network Meta-Analysis, Waqas Ullah, Harigopal Sandhyavenu, Amro Taha, Smitha Narayana Gowda, Maryam Mukhtar, Aravind Reddy Polam, Salman Zahid, David L. Fischman, Michael P. Savage, Sunil V. Rao, Mohamad Alkhouli

Division of Cardiology Faculty Papers

BACKGROUND: Optimal duration and choice of antiplatelet therapy in patients with acute coronary syndrome undergoing percutaneous coronary intervention remain controversial.

METHODS AND RESULTS: Digital databases (PubMed, Cochrane, and Embase) were queried to select all randomized controlled trials on a post-percutaneous coronary intervention population with acute coronary syndrome. Dual-antiplatelet therapy (DAPT) with aspirin and clopidogrel for 12 months was compared with 4 major strategies: high-potency, high- to low-potency, low-dose, and short-duration DAPT. A network meta-analysis was performed to compare the safety and efficacy of different antiplatelet strategies. This study was the second updated manuscript under the International Prospective Register of Systematic …

55-Word Stories: Insight Into Healthcare, Nancy E. Krusen

Translational Science in Occupation

Narrative medicine and health humanities focus on arts, ethics, and clinical practice. Many health education programs incorporate creative activities to facilitate learner self-awareness and insight. We include them to address programmatic themes of professional growth and translational science.

Trends In Gaps Of Care For Patients With Congenital Heart Disease: Implications For Social Determinants Of Health And Child Opportunity Index, Abbas H. Zaidi, Adam Alberts, Devyani Chowdhury, Claude Beaty, Benjamin Brewer, Ming Hui Chen, Sarah D. De Ferranti

Department of Surgery Faculty Papers

BACKGROUND: Lifelong continuity of care is essential for patients with congenital heart disease (CHD) to maximize health outcomes; unfortunately, gaps in care (GIC) are common. Trends in GIC and of social determinants of health factors contributing to GIC are poorly understood.

METHODS AND RESULTS: This retrospective cohort study included patients with CHD, aged 0 to 34 years, who underwent surgery between January 2003 and May 2020, followed up at a pediatric subspeciality hospital. Patients were categorized as having simple, moderate, and complex CHD based on 2018 American Heart Association and American College of Cardiology guidelines. Social determinants of health, such …

Preventing The Next Fall: The Power Of A Simple Checklist In Reducing Patient Falls, Ryan P. Bialaszewski, Michael Sander, Maria Hincapie, Rita Garza, Aurora Cavazos

MEDI 9331 Scholarly Activities Clinical Years

Background:
Preventable medical errors and adverse events in US hospitals are far too common and contribute to an estimated $17 billion annually in healthcare expenditures. Falls comprise the majority of these preventable adverse events and are a significant cause of increased healthcare costs, prolonged hospital stays, and patient morbidity and mortality. The average cost per hospital fall is estimated at $62,521 ($35,365 direct costs). Despite numerous preventative measures, the complexity of managing multiple interventions can lead to inconsistent application. Inspired by the success of surgical "time-out" checklists in operating rooms, we hypothesized that a standardized checklist for fall prevention could …

Social Isolation And Loneliness Prevention Among Rural Older Adults Aging-In-Place: A Needs Assessment, Jodi L. Southerland, Shimin Zheng, Kayla Dodson, Erin Mauck, Juanita-Dawne R. Bacsu, Monique J. Brown Ph.D., Mph, Jeremy Holloway, Steffi M. Kim, Ayse Malatyali, Matthew Lee Smith

Faculty Publications

Introduction: The adverse effects of social isolation and loneliness (SI/L) have been documented among older adults in rural communities and contribute to poor health outcomes, premature disability and mortality, and increased burden on the healthcare system. The identification of factors contributing to SI/L among older adults can build the foundation for rural policymakers and leaders to allocate resources and develop tailored strategies more efficiently. The purpose of this article is to describe findings from a needs assessment designed to understand local factors that contribute to SI/L among rural older adults in a county in Northeast Tennessee. Findings from the needs …

Assessing The Climate Readiness Of Physician Education Leaders In Graduate Medical Education, Deborah Simpson, Anne Getzin, Aaron A. Levy, Victoria Gillet

Journal of Patient-Centered Research and Reviews

Climate change affects patient health through an array of exposures, including increasing heatwaves, extreme weather events, poor air quality, and expanding vector-borne illnesses. Physicians are at the forefront of addressing the health consequences of these exposures with patients, and environmental sustainability has become a priority for health care organizations. Accordingly, climate change and health is becoming a critical area for graduate medical education (GME). As GME leaders design and drive education in residency and fellowship programs, understanding those leaders’ baseline knowledge on this topic and its alignment with their organizations’ priorities is an essential step in the development of climate …

Sall4 And Gata4 Induce Cardiac Fibroblast Transition Towards A Partially Multipotent State With Cardiogenic Potential, Hong Gao, Saliha Pathan, Beverly R E A Dixon, Aarthi Pugazenthi, Megumi Mathison, Tamer M A Mohamed, Todd K Rosengart, Jianchang Yang

Faculty, Staff and Students Publications

Cardiac cellular fate transition holds remarkable promise for the treatment of ischemic heart disease. We report that overexpressing two transcription factors, Sall4 and Gata4, which play distinct and overlapping roles in both pluripotent stem cell reprogramming and embryonic heart development, induces a fraction of stem-like cells in rodent cardiac fibroblasts that exhibit unlimited ex vivo expandability with clonogenicity. Transcriptomic and phenotypic analyses reveal that around 32 ± 6.4% of the expanding cells express Nkx2.5, while 13 ± 3.6% express Oct4. Activated signaling pathways like PI3K/Akt, Hippo, Wnt, and multiple epigenetic modification enzymes are also detected. Under suitable conditions, these cells …

The Association Between Oral Microbiome, Oral Inflammation, Periodontal Disease, And Systemic Metabolism In Individuals With/Without Type 1 Diabetes, Mianli Xiao

USF Tampa Graduate Theses and Dissertations

This study explores the associations between oral microbiomes, periodontal disease (PD), and systemic metabolism in individuals with and without Type 1 diabetes (T1D). Data were obtained from 208 participants (99 with T1D, 109 non-diabetic) in the Coronary Artery Calcification in Type 1 Diabetes (CACTI) pilot study and 283 participants from the Oral Microbiome ancillary cohort study. Both studies included the collection of saliva or subgingival plaque samples. Microbial DNA was extracted, and the V4 region of the 16S rRNA gene was sequenced using the Illumina MiSeq platform. Machine learning models, including Random Forest (RF) and Multi-layer Perceptron (MLP), were applied …

Effect Of Covid-19 Vaccination On Covid-19 Mortality By Age In Georgia, Brennan Bogdanovich, Mckenzie E. Maloney, James Pollock, Lane Langston, Brittany Ange, Jack Yu

Journal of the Georgia Public Health Association

Purpose: The COVID-19 epidemic led to significant morbidity and mortality globally, especially among the elderly. Because SARS-CoV-2 is a novel viral pathogen, there was a lack of preventative and treatment options. Availability of effective vaccines has been an important factor in determining the epidemic trajectory. Analyzing the effects of the vaccines in reducing mortality across age groups is important for guiding future public health responses. The objective of this study was to determine the association between age and COVID-19 mortality pre- and post-vaccination periods amongst Georgians.

Methods: This cross-sectional study used COVID-19 case numbers, COVID-19 deaths, age at time of …

Barriers To Help-Seeking Behavior For Maternal Mental Health Disorders: Application Of The Health Belief Model, Tobi F. Oloyede, Joanne Chopak-Foss

Journal of the Georgia Public Health Association

Perinatal mood and anxiety disorders (PMADs) have become a leading cause of maternal mortality due to suicide among women in the first year following pregnancy. Although the profile for new mothers who die by suicide is predominantly white, disparities exist between Black and White women in their seeking help for perinatal and/or post-natal mood disorders. For Black, Indigenous, and People of Color (BIPOC), there are differences in the perceptions of the benefits of seeking help for PMADs. The COVID-19 pandemic exacerbated maternal mental health disorders in the United States particularly for women who live in communities with limited access to …

Examining Assessment Tools To Predict Burnout Among Healthcare Practitioners And Students, Robin Hilliard Albertson, Lindsay Gietzen

Pacific Journal of Health

The U.S. health system is stretched thin by pressures to expand service delivery and improve outcomes while reducing costs. This pressure is intensified by global health crises and other factors, resulting in further reductions in the healthcare workforce due to burnout. The strain leaves healthcare practitioners at risk of experiencing negative consequences of burnout, even death [1]. This study explored the correlations between three validated assessment tools to determine if early signs of burnout in healthcare practitioners and students can be identified succinctly, thus expanding the current body of evidence on the strengths of environments supporting career retention and healthcare …

Beyond The Checklist: Pilot Education, Aviation Resources, And Health Management Skills, Nancy Smith

Pacific Journal of Health

The research study investigates if pilots find aviation health-related materials provided from training or aviation associations to support their own health needs. A mixed methods convergent parallel design was conducted by sampling 27 pilots within general aviation to assess their utilization of aviation health-related materials, health management skills including self-efficacy and prioritization, as well as their views of implementing particular health topics into aviation training. Results of the study indicate that it is unclear if pilots find aviation health materials useful in managing their health, pilots have a relatively high level of self-efficacy and ability to prioritize one’s health and …

Sex Hormones And Risk Of Lung And Colorectal Cancers In Women: A Mendelian Randomization Study, Marion Denos, Yi-Qian Sun, Ben Michael Brumpton, Yafang Li, Demetrius Albanes, Andrea Burnett-Hartman, Peter T Campbell, Sébastien Küry, Christopher I Li, Emily White, Jewel N Samadder, Mark A Jenkins, Xiao-Mei Mai

Faculty, Staff and Students Publications

The roles of sex hormones such as estradiol, testosterone, and sex hormone-binding globulin (SHBG) in the etiology of lung and colorectal cancers in women, among the most common cancers after breast cancer, are unclear. This Mendelian randomization (MR) study evaluated such potential causal associations in women of European ancestry. We used summary statistics data from genome-wide association studies on sex hormones and from the Trøndelag Health Study (HUNT) and large consortia on cancers. There was suggestive evidence of 1-standard deviation increase in total testosterone levels being associated with a lower risk of lung non-adenocarcinoma (hazard ratio 0.60, 95% confidence interval …

The Price Of Prevention: Spain And Italy's Approach To National Prep, Jon Burkart

Claremont-UC Undergraduate Research Conference on the European Union

While recent advancements in antiretroviral therapy (ART) continue to improve the outlook for people living with HIV (PLHIV), new infections remain a concern for health authorities around the world. A clinically proven intervention holds the potential to dramatically reduce new infections: Pre-exposure prophylaxis (PrEP) is a once-daily pill for high-risk populations, including men who have sex with men (MSM), that substantially reduces HIV infection risk. However—much like rates of new infection—public provision of PrEP varies considerably among OECD countries. This case study thus seeks to answer the question: What might explain the disparate timeline of adopting public reimbursement for PrEP …

Factors Affecting The Quality Of Reporting Dispensing Errors Among Pharmacists, Kelley Latrece Lavallais

Walden Dissertations and Doctoral Studies

Medication dispensing errors, which are the inconsistency between the dispensing of medication to the patient against the prescribed medication, continue to be a public health challenge. Many studies have been conducted to examine their causes, including burnout, illegible handwriting, workload, and interruptions. There have also been studies on the types of medication dispensing errors. This study focused on the reporting of errors. The purpose of this quantitative study involving secondary data analysis was to examine the factors affecting the quality of reporting dispensing errors among pharmacists and the seriousness of the adverse events. The social-ecological model served as the theoretical …

Racial Residential Segregation And Covid-19 Health Outcomes: Evidence From The State Of Georgia, Palak Patel, Simon Medcalfe, Catherine P. Slade

Journal of the Georgia Public Health Association

ABSTRACT

Background:

According to the Georgia Department of Public Health (GDPH), the state of Georgia reported 563,658 cumulative COVID-19 cases and 9,845 total deaths in 2020. Decades of research on racial disparities in health outcomes suggest we should not be surprised with the disproportionate number of cases, hospital visits, and deaths of non-white and Black Georgia residents. Racial disparities in health are often defined by a Social Determinants of Health (SDOH) model. One understudied SDOH is racial residential segregation. In this study we explore the relationship between racial residential segregation and COVID-19 health outcomes. Our paper addresses critical challenges for …

Understanding The Role Of Perceived Racial Discrimination On Adolescent Mental Health During The Covid-19 Pandemic, Jill V. Klosky, Delia Lang, Briana Woods-Jaeger, Julie Gazmararian

Journal of the Georgia Public Health Association

Abstract

Background: Adolescent mental health declined during the COVID-19 pandemic. Racial discrimination, which may negatively affect adolescent mental health, has increased. This study sought to understand whether pre-pandemic reports of racial discrimination predicted changes in adolescent depression, anxiety, and self-esteem from before to during the COVID-19 pandemic.

Methods: Two online surveys were administered at two public high schools in semi-rural, north-central Georgia; one in Spring 2020, just before the closing of public schools due to COVID-19; the other to the same students in Fall 2020.

Results: Most participants were White (62%) and the majority (88%), reported the same or better …