Medicine and Health Sciences Commons^™

Access To Medicines For Parkinson's Disease In Kenya: A Qualitative Exploration, Natasha Fothergill-Misbah, Juzar Hooker, Judith Kwasa, Richard Walker

Internal Medicine, East Africa

Background: The accessibility of Parkinson’s disease medicines is limited across sub-Saharan Africa,which can have negative health, social and financial consequences for people with Parkinson’s disease andtheir families. However, there is a stark gap in the literature regarding the impact of poor access to medicineson individuals.

Objectives: The study objective was to understand the accessibility of Parkinson’s disease medicines in Kenyafrom the perspective of people with Parkinson’s disease, their caregivers and neurologists.MethodsMethods: In-depth qualitative interviews were conducted with 55 people with Parkinson’s disease, 23 caregiversand 8 neurologists to understand their experience regarding challenges with accessing Parkinson’s diseasemedicines and the health, social …

Covering The Care: Most Prevalent Health Conditions And Their Associated Costs Among Nh’S Insured Population – Behavioral Health And Cardiovascular Disease Top The List, Bethany Swanson, Erica Plante, Deborah Fournier

Faculty Publications

This data brief presents an analysis of available claims data from New Hampshire’s commercial, Medicaid, and Medicare insured populations. Specifically, the study identifies the top ten most prevalent health conditions, the cost of treatment for those conditions, and the overall medical cost for those with one of the identified conditions. The analysis is based on the most recent calendar year of available claims data (January – December 2022).

Using Gps-Defined Venue-Based Affiliation Networks Among Black Sexually Minoritized Men And Transgender Women To Identify Locations For Hiv Prevention Interventions, Yen-Tyng Chen, Cho-Hee Shrader, Dustin T Duncan, Abby E Rudolph, Seann D Regan, Byoungjun Kim, Jade Pagkas-Bather, Justin Knox, Kayo Fujimoto, John A Schneider

Faculty, Staff and Student Publications

Purpose: HIV biomedical intervention uptake is suboptimal among Black sexually minoritized men (SMM) and transgender women (TW). Venues where people meet and interact shape HIV-related risk and prevention behaviors. We aimed to construct GPS-defined venue-based affiliation networks and identify the unique set of venues that could maximize reach of HIV biomedical interventions among Black SMM and TW.

Methods: We used baseline survey and GPS data from 272 Black SMM and TW in the Neighborhoods and Networks (N2) Cohort Study in Chicago, Illinois (2018-2019). We mapped participants' GPS data to the nearest pre-identified SMM- and TW-friendly venue (n = 222) to …

Trends In Central Nervous System-Active Polypharmacy Among People With Multiple Sclerosis, Hayden Naizer, Joseph Wozny, Trudy Millard Krause, Ethan Huson, Leorah Freeman

Faculty, Staff and Student Publications

BACKGROUND: People with multiple sclerosis (pwMS) are at risk of concurrently using multiple central nervous system (CNS)-active drugs, yet the prevalence of CNS-active polypharmacy remains unmeasured in pwMS.

OBJECTIVE: The objective is to measure the prevalence of CNS-active polypharmacy in pwMS.

METHODS: This serial, cross-sectional study measured CNS-active polypharmacy in people with MS in the United States from 2008 to 2021 using insurance claims data. CNS-active polypharmacy was defined as the concurrent prescription of ⩾3 CNS-active drugs for >30 continuous days. CNS-active drugs included antidepressants, antiepileptics, antipsychotics, benzodiazepines, nonbenzodiazepine benzodiazepine receptor agonist hypnotics, opioids, and skeletal muscle relaxants.

RESULTS: The …

"The Hotel Of 10,000 Stars": The Impact Of Social-Structural Determinants Of Health Among Im/Migrant Shrimpers In The Gulf Of Mexico, Shannon Guillot-Wright, Lacy Davis, Linh Truong, Heide Castañeda, Anabel Rodriguez

Faculty, Staff and Student Publications

Objectives. To identify appropriate interventions to prevent injury, we conducted a qualitative study among commercial shrimp fishermen in the Gulf of Mexico.

Methods. Using qualitative and participatory research methods, including interviews, photovoice, and workplace observations in southeast Texas and the Rio Grande Valley in Texas, we examined the social‒structural dimensions that contribute to physical and psychological injury.

Results. We found that multiple layers of vulnerability and danger exist among shrimpers with interacting themes: (1) recognizing risk, (2) precarious employment, and (3) psychological distress.

Conclusions. Our results add to the growing body of knowledge that emphasizes the negative health impacts of …

Does Every Move Really Count Towards Better Health?, Andrea Ramirez Varela, Pedro C Hallal

Faculty, Staff and Student Publications

No abstract provided.

Sexual Debut In Early Adolescence And Individual, School, And Neighborhood Social Capital, Camila Cribb Fabersunne, Carly Milliren, Mark A Schuster, Marc N Elliott, Susan Tortolero Emery, Paula M Cuccaro, Susan L Davies, Tracy Richmond

Faculty, Staff and Student Publications

Purpose: Sexual debut in early adolescence is associated with poor health outcomes in adulthood. We examined the associations of social capital within families, schools, and neighborhoods with early sexual debut.

Methods: Using data from the Healthy Passages cohort, a longitudinal multilevel study of adolescents, we performed a series of cross-classified multilevel logistic regression models to examine (1) the relative contribution of schools and neighborhoods to the variance and (2) the association of markers of social cohesion/social capital in families, schools, and neighborhoods with sexual debut by 10th grade.

Results: There were 4,001 youth participants nested in 115 schools and 751 …

Recommendations And Implementation Considerations For The Routine Collection Of Sexual Orientation And Gender Identity Data In Research And Practice, Irene Tamí-Maury, Thomas J Millett

Faculty, Staff and Student Publications

No abstract provided.

Plasma Proteins Associated With Plant-Based Diets: Results From The Atherosclerosis Risk In Communities (Aric) Study And Framingham Heart Study (Fhs), Hyunju Kim, Jingsha Chen, Brenton Prescott, Maura E Walker, Morgan E Grams, Bing Yu, Ramachandran S Vasan, James S Floyd, Nona Sotoodehnia, Nicholas L Smith, Dan E Arking, Josef Coresh, Casey M Rebholz

Faculty, Staff and Student Publications

Background & aims: Plant-based diets are associated with a lower risk of chronic diseases. Large-scale proteomics can identify objective biomarkers of plant-based diets, and improve our understanding of the pathways that link plant-based diets to health outcomes. This study investigated the plasma proteome of four different plant-based diets [overall plant-based diet (PDI), provegetarian diet, healthful plant-based diet (hPDI), and unhealthful plant-based diet (uPDI)] in the Atherosclerosis Risk in Communities (ARIC) Study and replicated the findings in the Framingham Heart Study (FHS) Offspring cohort.

Methods: ARIC Study participants at visit 3 (1993-1995) with completed food frequency questionnaire (FFQ) data and proteomics …

Past-Year Hiv Testing, Current Antiretroviral Therapy Use, And Participation In Services For People Who Inject Drugs, Itunu Sokale, Johnny Wilkerson, Paige Wermuth, Folefac Atem, Janet Burnett, Cyprian Wejnert, Salma Khuwaja, Catherine Troisi

Faculty, Staff and Student Publications

Evaluating routine HIV testing and treatment and use of services for people who inject drugs (PWID) is critical to curb the ongoing HIV epidemic. We analyzed data from the 2018 National HIV Behavioral Surveillance of PWID aged 18 years or older, recruited using respondent-driven sampling and offered anonymous HIV testing after survey. We performed bivariate and multivariable analyses with log-linked Poisson regression of the generalized linear models to examine the associations between demographics and PWID service use, past-year HIV testing, and current antiretroviral therapy (ART) use. Among 10,311 HIV-negative PWID, 56% reported past-year HIV testing, and of the 553 HIV-positive …

Analyzing Heterogeneity In Biomarker Discriminative Performance Through Partial Time-Dependent Receiver Operating Characteristic Curve Modeling, Xinyang Jiang, Wen Li, Kang Wang, Ruosha Li, Jing Ning

Faculty, Staff and Student Publications

This study investigates the heterogeneity of a biomarker's discriminative performance for predicting subsequent time-to-event outcomes across different patient subgroups. While the area under the curve (AUC) for the time-dependent receiver operating characteristic curve is commonly used to assess biomarker performance, the partial time-dependent AUC (PAUC) provides insights that are often more pertinent for population screening and diagnostic testing. To achieve this objective, we propose a regression model tailored for PAUC and develop two distinct estimation procedures for discrete and continuous covariates, employing a pseudo-partial likelihood method. Simulation studies are conducted to assess the performance of these procedures across various scenarios. …

E-Cigarette Use Reasons And Associated E-Cigarette Use Dependence Among College Students: A Longitudinal Examination, Tzung-Shiang Ou, Anne Buu, James J Yang, Hsien-Chang Lin

Faculty, Staff and Student Publications

Objective: Previous studies have established an understanding of reasons for e-cigarette use and associated e-cigarette use patterns such as use frequency, yet the critical extension to associated e-cigarette dependence outcome remains under-researched. This study used longitudinal data to examine whether the reasons for e-cigarette use predict a higher/lower level of e-cigarette dependence.

Methods: This study recruited college students who were current e-cigarette users from Fall 2019 to Fall 2020 (four semesters) at three public universities in the Midwest and South of the U.S. Those who participated for at least two semesters were included (N = 366). Data were collected using …

Enhancing Vaginal Delivery In Greece Through Educational And Behavioral Interventions Among Maternity Care Providers Regarding Labor Management: The Engage Stepped-Wedge Randomized Prospective Trial Protocol, Nikolaos Vrachnis, Nikolaos Antonakopoulos, Peter Von Dadelszen, Marianne Vidler, Georgios Maroudias, Jeffrey Bone, Ash Sandhu, Nikolaos Loukas, Laura Magee, Marleen Temmerman

Centre of Excellence in Women and Child Health

Background: There is an emerging need to systematically investigate the causes for the increased cesarean section rates in Greece and undertake interventions so as to substantially reduce its rates. To this end, the ability of the participating Greek obstetricians to follow evidence-based guidelines and respond to other educational and behavioral interventions while managing labor will be explored, along with barriers and enablers. Herein discussed is the protocol of a stepped-wedge designed intervention trial in Greek maternity units with the aforementioned goals in mind, named ENGAGE (ENhancinG vAGinal dElivery in Greece).

Methods: Twenty-two selected maternity units in Greece will participate in …

Outcomes Of Different Steroid Dosing Regimens In Critical Covid-19 Pneumonia At A Kenyan Hospital: A Retrospective Cohort Study, John Odhiambo, Jasmit Shah, Nancy Kunyiha, Felix Riunga, Charles Makasa

Internal Medicine, East Africa

Background: Among therapeutic options for severe and critical COVID- 19 infection, dexamethasone six milligrams once daily for ten days has demonstrated mortality benefit and is guideline recommended at this dose. In practice, variable doses of steroids have been used, especially in critical care settings. Our study aimed to determine the pattern of steroid dosing and outcomes in terms of critical care mortality, occurrence of dysglycaemias, and occurrence of superadded infections in patients with critical COVID-19.

Methods: A retrospective cohort study was carried out on all eligible patients admitted to the Aga Khan University Hospital, Nairobi, with critical COVID-19 between 1st …

Sleep Disturbance As A Precursor To Anxiety, Depression, And Ptsd Among Rural Kenyans: A Cross-Lagged Panel Analysis From A Rural Kenyan Interventional Cohort, Michael L Goodman, Miryoung Lee, Andrew Springer, Vanessa Schick, Elizabeth Vaughan, Christine Markham, Stanley Gitari, Fridah Mukiri

Faculty, Staff and Student Publications

Sleep quality is essential to biopsychosocial functioning, yet there remains limited longitudinal research on sleep and mental or social well-being within low- or middle-income countries. This study utilised longitudinal cohort data from a community-based empowerment programme in Meru County, Kenya to assess cross-lagged correlations between sleep disturbance, social support, symptoms of depression, anxiety, and posttraumatic stress. Participants (n = 373; 92% women; age range 18-86 years) who reported more sleep disturbance at T1 reported significantly more symptoms of depression, anxiety, and PTSD, and significantly less social support at T2 (average 11 weeks later), controlling for all within-time correlations across measures, …

Clinicians’ Perceptions Of Care Partner Involvement In Health Priorities Identification For People Living With Dementia, Joan K Monin, Emily Mroz, Kalisha Bonds Johnson, Rafael Samper-Ternent, Thi Vu, Mary Tinetti

Faculty, Staff and Student Publications

No abstract provided.

Dengue And Climate Change: Assessing Potential Future Areas Of Concern For Transmission In The United States, Matthew Beer

Electronic Theses and Dissertations

Background: Global climate change severely impacts human life, particularly health, as rising temperatures and extreme weather affect physical and mental well-being. Climate change can also alter the risk factors and epidemiology of infectious diseases, notably vector-borne diseases (VBDs), including those transmitted by mosquitoes. The Aedes mosquito, responsible for dengue, poses a significant threat due to its prevalence vector. Dengue prevention lacks effective methods beyond vector control, and the current vaccine has limitations, emphasizing the need for intensified research and prevention strategies to mitigate the expanding dengue burden worldwide. The goal of these studies was to establish a novel risk index …

In Utero Exposure To Antihistamines And Risk Of Hepatocellular Carcinoma In A Multigenerational Cohort, Caitlin C Murphy, Karim Seif El Dahan, Amit G Singal, Piera M Cirillo, Nickilou Y Krigbaum, Barbara A Cohn

Faculty, Staff and Student Publications

BACKGROUND: Growing evidence suggests that liver disease originates in early life. Antihistamines cross the placenta and are frequently prescribed to pregnant women to treat nausea and vomiting, as well as allergy and asthma symptoms. Exposure to antihistamines in utero may impact the developing liver by reprogramming or inducing epigenetic changes in fetal hepatocytes.

METHODS: We examined in utero exposure to antihistamines and the risk of HCC in the Child Health and Development Studies, a multigenerational cohort that enrolled pregnant women in the East Bay, CA, between 1959 and 1966 (n=14,507 mothers and 18,751 liveborn offspring). We reviewed mothers' medical records …

Sequential Inhibition Of Parp And Bet As A Rational Therapeutic Strategy For Glioblastoma, Xin Peng, Xin Huang, Shaolu Zhang, Naixin Zhang, Shengfan Huang, Yingying Wang, Zhenxing Zhong, Shan Zhu, Haiwang Gao, Zixiang Yu, Xiaotong Yan, Zhennan Tao, Yuxiang Dai, Zhe Zhang, Xi Chen, Feng Wang, Francois X Claret, Moshe Elkabets, Ning Ji, Yuxu Zhong, Dexin Kong

Faculty, Staff and Student Publications

PARP inhibitors (PARPi) hold substantial promise in treating glioblastoma (GBM). However, the adverse effects have restricted their broad application. Through unbiased transcriptomic and proteomic sequencing, it is discovered that the BET inhibitor (BETi) Birabresib profoundly alters the processes of DNA replication and cell cycle progression in GBM cells, beyond the previously reported impact of BET inhibition on homologous recombination repair. Through in vitro experiments using established GBM cell lines and patient-derived primary GBM cells, as well as in vivo orthotopic transplantation tumor experiments in zebrafish and nude mice, it is demonstrated that the concurrent administration of PARPi and BETi can …

Prevalence Of Chronic Kidney Disease And Awareness Levels Among Young Adults In Imo And Anambra States, Nigeria, Jacinta Okolie

Walden Dissertations and Doctoral Studies

Chronic kidney disease (CKD) presents a significant public health concern, particularly in developing countries such as Nigeria, where health care resources are limited and awareness remains low. This quantitative study evaluated the prevalence of CKD and awareness levels among young adults in Imo and Anambra States, Nigeria. The relationship between health care access, medication adherence, and CKD diagnosis was also examined. The health belief model and the social ecological model provided the framework for the study. A sample of 800 participants was recruited from in- and outpatient facilities in Imo State and Anambra State, and sociodemographic information, awareness levels, and …

Accelerated Tumor Progression After Covid-19 Infection In Patients With Glioblastoma: A Retrospective Case-Control Study, Timothy A Gregory, Stephanie R Knight, Ashley E Aaroe, Kaitlin N Highsmith, Zachary C Janatpour, Barbara J O'Brien, Nazanin K Majd, Monica E Loghin, Chirag B Patel, Shiao-Pei Weathers, Vinay K Puduvalli, Carlos Kamiya-Matsuoka

Faculty, Staff and Student Publications

Background: We observed rapid tumor progression following COVID-19 infection among patients with glioblastoma and sought to systematically characterize their disease course in a retrospective case-control study.

Methods: Using an institutional database, we retrospectively identified a series of COVID-19-positive glioblastoma cases and matched them by age and sex 1:2 to glioblastoma controls who had a negative COVID-19 test during their disease course. Demographic and clinical data were analyzed. Hyperprogression was defined using modified response evaluation criteria in solid tumors criteria. Time to progression and overall survival were estimated using the Kaplan-Meier method.

Results: Thirty-two glioblastoma cases with positive COVID-19 testing were …

The Effect Of Intermediate Doses Of Roundup® On The Larval Development, Survival, Oviposition And Fitness Of Culex Quinquefasciatus, Abdoulaye Aziz Zerbo

Electronic Theses, Projects, and Dissertations

The southern house mosquito, Culex quinquefasciatus, is a vector to many pathogens in Southern California, including West Nile Virus and St. Louis Encephalitis Virus. Immature stages of mosquitoes may be exposed to Roundup^®, a frequently used herbicide worldwide, due to surface runoffs or overspraying and subsequent drifting. Previous studies have shown some negative impacts of sublethal doses of Roundup^® during the developmental stage of Culex quinquefasciatus, such as physiologic changes and prolonged larval stage or the high mortality of larvae due to exposure to the high doses of glyphosate. This study investigated the effect of …

Emotional Eating In Adolescents With Obesity: Case Series, Paula Dayan

Electronic Theses, Projects, and Dissertations

Childhood obesity remains a significant public health concern, with substantial implications for physical and mental well-being. This thesis aims to explore the intricate relationship between emotional eating and obesity among adolescents, with a focus on identifying emotional triggers and assessing their psychological impact. Utilizing a cross-sectional study design at a university in southern California, data were collected from two adolescents aged 13-18 years. Through surveys and body composition measurements, participants' emotional barriers to weight loss and readiness for change were assessed. The findings underscore the presence of varying degrees of emotional hurdles among adolescents with obesity, including depression, frustration, and …

Effect Of Insufficient Sleep On Activity Limitation: Results From The Brfss 2022 Survey, Jonathan Meyer

Capstone Experience: Master of Public Health

Objective: To determine whether insufficient sleep (less than 7 hours per night) is associated with activity limitation (14 days or more of poor mental or physical health interfering with everyday activities) in Behavioral Risk Factor Surveillance System (BRFSS) survey data from 2022. Methods: BRFSS is a nationally representative cross-sectional survey of non-incarcerated US adults. The exposure of interest was insufficient sleep, and the outcome of interest was activity limitation. Other demographic variables used in a final weighted adjusted analysis include age >65 years, race/ethnicity, gender, marital status, income, and total physical inactivity. Results: The weighted prevalence of insufficient sleep for …

Ensuring Safe Mri Examinations And Earlier Detection Of Recurrent Cancer: A Scoping Review To Identify Breast Tissue Expanders That Are Safe For High-Risk Breast Cancer Survivors, Kristin E. Westmore

Capstone Experience: Master of Public Health

Purpose

This capstone project aims to conduct a scoping review to identify breast tissue expanders that are safe for high-risk breast cancer survivors, ensuring safe magnetic resonance (MR) examinations. The goal is safe MR examinations for early detection of recurrent cancer, post-operative evaluation, monitoring, and reducing preventable morbidity and mortality.

Background

The MR safety of manufacturers' tissue expanders is defined according to the United States Food and Drug Administration (FDA) guidelines and regulations as MR Conditional or MR Unsafe. Before 2023, there was a safety concern about using tissue expanders containing a magnetic port during the first stage of breast …

Exploration Of Canine T. Cruzi Seroprevalence As A Trigger For Enhanced Human Chagas Surveillance, Brittany N. Hocking

Capstone Experience: Master of Public Health

Background: Chagas disease, caused by the parasite Trypanosoma cruzi, is endemic in many Latin American countries and now the southern United States. An increasing number of Chagas cases in the U.S. have occurred because of autochthonous transmission and enzootic cycles involving infected wildlife and domestic animals, like canines.

Objective: This study aimed to explore canine seroprevalence as a trigger for enhanced human Chagas surveillance by describing detected U.S. T. cruzi from human and canine testing data, creating maps to explore geographic areas with potential high yield for T. cruzi surveillance via animal testing, and developing a SWOT analysis for …

Reducing Greenhouse Gases Through Food Waste Reduction: A Literature Review Of Programs And Behavior Change, Schafer Flowerday

Capstone Experience: Master of Public Health

Anthropogenic greenhouse gas (GHG) emissions significantly contribute to climate change. Methane is a potent GHG emitted in landfills as organic material breaks down. Food waste is the single most common item disposed of in Lincoln’s Bluff Road Landfill (LTU, 2022). As such, food waste disposal in the landfill is a preventable issue that could dramatically reduce GHG emissions in Lincoln. This project seeks to determine what barriers and motivations exist for reducing food waste at a consumer level. A literature review was conducted to find what behavior change campaigns and interventions have taken place nationwide to encourage residential food waste …

A Process Evaluation Plan For The Nebraska Fetal Infant Mortality Review (Fimr) Program, Mamello Makhele

Capstone Experience: Master of Public Health

The United States (U.S.) has made substantial progress in reducing fetal and infant mortality, but high rates of infant mortality persist, particularly within minority populations. In Douglas County, Nebraska, racial disparities in infant mortality rates remain a significant issue. In 2019, the infant mortality rate among African American mothers was 14.2 infant deaths per 1,000 live births, compared to 5.7 infant deaths per 1,000 live births among Caucasian mothers.

To reduce fetal and infant mortality in the U.S., the Centers for Disease Control and Prevention along with the Human Resources and Services Administration, fund the Fetal and Infant Mortality Review …

Current Status Of Colorectal Cancer Screening Among Adults With And Without Cognitive Disabilities In The United States, 2022, Elma Vasconcelos

Capstone Experience: Master of Public Health

Objective: Evaluate the prevalence of non-compliance with colorectal cancer screening guidelines among US adults aged 45-75, comparing individuals with cognitive disabilities to those without.

Methods: This study utilized data from the 2022 Behavioral Risk Factor Surveillance System survey, which uses weighted and complex survey sampling methodologies. Participants under 45 were excluded, resulting in a study sample of 220,879. Univariate, bivariate, and multivariable logistic regression analyses were conducted to assess the prevalence odds ratio of colorectal cancer screening among individuals with and without cognitive disabilities.

Results: Those with cognitive disabilities had 1.07 (95% CI: 0.99-1.15) times the odds of not adhering …

Association Between Lifestyle Behaviors And Type 2 Diabetes Among African Immigrants In The United States, Momo Joemah Johnson

Walden Dissertations and Doctoral Studies

Recent evidence demonstrates that African immigrants are healthier than African immigrants born in the United States. After individuals have stayed in the United States for a duration of 4–5 years, the health gap starts to narrow significantly as health conditions worsen. Acculturation and body mass likely play a role; physical inactivity and psychological distress may arbitrate the association. T2DM is an expanding global health problem that is closely linked to the epidemic of obesity. Individuals with T2DM are at risk of other complications that include retinopathy, nephropathy, neuropathy, and microvascular complications. The purpose of the study was to assess the …