Public Health Commons^™

Quality And Access To Care For Cardiovascular Disease Prevalence In Women Veterans: Population Estimate Using Electronic Health Records, Meena Marie Kim-Dopp, Vanessa Gow-Lee, Linda Ferry, Sharon Jamie, Ralph Clark, Suma Singh

Loma Linda University Student Journal

Electronic Health Records are used to measure quality indicators for cardiovascular disease (CVD), but have not been tested for sensitivity and specificity. Computerized Patient Record System (CPRS) used by the Veterans Health Affairs (VHA), has active CVD clinical reminders from Healthcare Effectiveness Data & Information Set (HEDIS) that are compared nationally. San Bernardino County, CA has a 7.8% prevalence of self-reported CVD in both genders. For HEDIS measures, there is only a 4 point CVD composite score gender difference for VHA nationally, but at the Loma Linda VHA there is an 18 point gender difference (2016). Women Veterans (WV) are …

Vietnamese American Women’S Beliefs And Perceptions On Cervical Cancer, Cervical Cancer Screening, And Cancer Prevention Vaccines: A Community-Based Participatory Study, Connie Kim Yen Nguyen-Truong, Kim Quy Vo Nguyen, Thai Hien Nguyen, Tuong Vy Le, Anthony My Truong, Keara Rodela, Rachael Allan

Asian/Pacific Island Nursing Journal

Cervical cancer remains commonly diagnosed in Vietnamese American women. Despite efforts to increase cervical cancer screening among Vietnamese American women, participation rates are persistently lower than the national goal. The objective of this study is to explore beliefs of Vietnamese American women about cervical cancer, cervical cancer screening, and cancer prevention vaccines. A qualitative descriptive investigation captured group perceptions about meaning and beliefs of cervical cancer, screening, and cancer prevention vaccines, and participants’ stories using a community-based participatory research approach.

Forty Vietnamese American women were recruited from the Portland, Oregon metropolitan area into four focus groups. Using a process of …

Journal Conversations: Building The Research Self-Efficacy Of An Aboriginal Early Career Academic, Michelle L. Dickson

The Qualitative Report

This paper shows how I used my research journal mainly as a reflective tool throughout the process of applying for and completing a PhD. Embarking on a PhD can be daunting for anyone and I was challenged by my lack of academic self-efficacy. In the absence of a formal academic mentor my research journal became my confidante, a tool that helped me make progress at times when barriers to research seemed insurmountable. It helped me decrease the cognitive dissonance I was experiencing about issues of subjectivity/objectivity and the positioning of my self in the research. This paper shares research journal …

Six-Year Experience Of Influenza Vaccination As A Condition Of Employment For A Large Regional Health Care System, John R. Brill, Mark Hermanoff, Angela Tonozzi, Mary Jo Capodice, Jennifer Farrar, Zarina Dawoodbhai

Journal of Patient-Centered Research and Reviews

Background: Influenza remains a significant contributor to morbidity and mortality in the United States. Health care workers (HCW) can be both victims and vectors of influenza. Influenza vaccination of HCW is protective for both caregivers and patients, but voluntary programs generally fail to achieve rates recommended by the Centers for Disease Control and Prevention. Despite a complex, multifaceted influenza program initiated in 1996 that included significant education and promotion as well as free on-site vaccination, annual Aurora Health Care caregiver immunization rates remained in the mid-70s until adoption of a “condition of employment” strategy in 2011.

Purpose: Discuss the annual …

Life Expectancy At Birth In Milwaukee County: A Zip Code-Level Analysis, Erica S. Lecounte, Geoffrey R. Swain

Journal of Patient-Centered Research and Reviews

Purpose: Life expectancy at birth is used as a barometer of the health and well-being of a population. Life expectancies vary widely across Wisconsin counties. While much of the analysis of life expectancy in Wisconsin has focused on counties, there may be important differences in life expectancy within counties by zip code.

Methods: To calculate life expectancy, death count data and population estimates were entered into an abridged life table using the Chiang methodology. Data were linked with measures from the American Community Survey to examine the relationship between life expectancy and zip code characteristics.

Results: Life expectancy varies greatly …

Sensitivity Of Current Methods For Diagnosing And Documenting Metabolic Syndrome Within A Large Community-Based Health Care System, Tiffany A. Mullen, Danielle M. Greer, Jennifer T. Fink, Renee E. Walker

Journal of Patient-Centered Research and Reviews

Background: Metabolic syndrome (MetS) is a constellation of metabolic conditions, including abdominal obesity, high blood pressure, high triglyceride level, low high-density-lipoprotein level and high fasting blood glucose level, that increase the risk of developing chronic health conditions. Various combinations of diagnostic criteria have been proposed, including those by the National Cholesterol Education Program Adult Treatment Panel III (ATP III), World Health Organization (WHO) and International Diabetes Foundation (IDF), among others. However, inconsistent use of diagnostic criteria and inadequate scientific evidence supporting use of specific criteria are current problems in health care.

Purpose: Quantify the prevalence of MetS diagnosis within the …

Improving Chronic Pain Management Processes In Primary Care Using Practice Facilitation And Quality Improvement: The Central Appalachia Inter-Professional Pain Education Collaborative, Roberto Cardarelli, Sarah Weatherford, Jennifer Schilling, Dana King, Sue Workman, Wade Rankin, Juanita Hughes, Jonathan Piercy, Amy Conley-Sallaz, Melissa Zook, Kendra Unger, Emma White, Barbara Astuto, Bobbi Stover

Journal of Patient-Centered Research and Reviews

Purpose: With the increasing burden of chronic pain and opioid use, provider shortages in Eastern Kentucky and West Virginia have experienced many challenges related to chronic pain management. This study tested a practice facilitator model in both academic and community clinics that selected and implemented best practice processes to better assist patients with chronic pain and increase the use of interdisciplinary health care services.

Methods: Using a quasi-experimental design, a practice facilitator was assigned to each state’s clinics and trained clinic teams in quality improvement methods to implement chronic pain tool(s) and workflow processes. Charts for 695 patients with chronic …

Identifying And Targeting Age-Related Colorectal Cancer Screening Rate Disparities In Family Medicine Residency Clinics, Jonathan J. Blaza, Jasmine R. Wiley, Matthew Gill, Alonzo Jalan, Will Lehmann, Deborah Simpson, Jeffrey A. Stearns

Journal of Patient-Centered Research and Reviews

Background: Health care systems continuously seek to improve patient care through population-level analysis of clinical quality metrics and patient characteristics to identify disparities in care. Nationally, disparities in colorectal cancer (CRC) screening rates have been identified with lower screening rates reported for patients who are uninsured and/or lower socioeconomic status, African American/black, Asian, and non-English-speaking Hispanic patients. No age-related CRC screening rate disparities with associated interventions have been reported.

Purpose: Determine and address CRC screening disparities in care provided to eligible patients > 50 years old in two primary care residency clinics.

Methods: Retrospective analysis using REAL-G (race, ethnicity, age, preferred …

The Lifestyle Initiative: An Innovative Coaching-Based Quality Improvement Study To Improve The Health Of Aurora Health Care Caregivers And Family Members, Tiffany A. Mullen, Jessica J.F. Kram, Dennis J. Baumgardner

Journal of Patient-Centered Research and Reviews

Background: Self-management support has been shown to improve clinical outcomes. Health coaching, one form of self-management support, empowers patients within the health care system by providing information and through collaboratively developed care plans.

Purpose: Assess the impact of The Lifestyle Initiative, a coaching-based health program utilized by Aurora Health Care caregivers or family members.

Methods: The Lifestyle Initiative is a coaching-based approach for Aurora caregivers or family members enrolled in Aurora’s health insurance network. Individuals were recruited from the care management database, and all participants had an Aurora primary care provider. Participation was limited to those ≥ 18 years of …

Distributing Data And Analysis Software Containers For Better Data Sharing In Clinical Research, William A. Mattingly Phd, Stephen Furmanek, Christopher M. Sinclair, Timothy L. Wiemken Phd

The University of Louisville Journal of Respiratory Infections

Introduction: Data sharing in clinical research is critical for increasing knowledge discovery. Data and software tools should be FAIR: Findable, Accessible, Inter-operable and Re-usable. Many bottlenecks exist in the process of a clinical investigator using shared data including data acquisition and statistical analysis. The objective of this project is to develop a structure for sharing data and providing rapid automated statistical analysis through creation of a pre-packaged, open-source software container.

Methods: We use the open source software container technologies VirtualBox and Vagrant to create a template for sharing clinical data and analysis scripts as a single container. We use …

Streptococcus Pneumoniae Antigen, Missing Opportunities Of A Promising Point Of Care Diagnostic Test, Magdelina Słomka, Ruby Gupta, Baltej Singh, Venkatesh Gondhi, Siddartha Bhandary, Ekezie Francis, Jose Bordon

The University of Louisville Journal of Respiratory Infections

Background: The etiologic diagnosis of community acquired pneumonia (CAP) and community-acquired meningitis (CAM) are still far from optimal accuracy and turnaround time. The most common bacterial pathogen identified in both CAP and CAM is Streptococcus pneumoniae.

Methods: We reviewed the literature on S. pneumoniae antigen to highlight opportunities to optimize its use as a point of care diagnostic test to maximize quality of patient care, antimicrobial stewardship outcomes and cost saving. A PubMed search was performed using key words “S. pneumoniae antigen; rapid diagnostic tests for S. pneumoniae”. We selected articles in English and sorted into randomized …

Most Common Statistical Methodologies In Recent Clinical Studies Of Community-Acquired Pneumonia, Stephen Furmanek, Connor L. English, Thomas Chandler, Timothy L. Wiemken Phd

The University of Louisville Journal of Respiratory Infections

Background: Training new individuals in pneumonia research is imperative to produce a new generation of clinical investigators with the expertise necessary to fill gaps in knowledge. Clinical investigators are often intimidated by their unfamiliarity with statistics. The objective of this study is to define the most common statistical methodologies in recent clinical studies of CAP to inform teaching approaches in the field.

Methods: Articles met inclusion criteria if they were clinical research with an emphasis on incidence, epidemiology, or patient outcomes, searchable via PubMed or Google Scholar, published within the timeframe of January 1st 2012 to August 1st 2017, …

Rationale And Methods Of The Study Protocol: Streptococcus Pneumoniae Serotypes In Adults 18 Years And Older With Radiographically-Confirmed Community-Acquired Pneumonia (Cap), Ronika Alexander, Paula Peyrani, Julio A. Ramirez, Wesley H. Self Md, Mph, Carlos Grijalva, Francis Counselman, Gregory A. Volturo, Heidi Kabler, Luis Ostrosky-Zeichner, Richard Wunderink, Robert L. Sherwin, Senen Pena, Thomas File, Timothy L. Wiemken, Sharon Gray, Michael Pride, Kimbal D. Ford, Qin Jiang, Raul Isturiz

The University of Louisville Journal of Respiratory Infections

This study was an active, prospective surveillance study of adults 18 years and older hospitalized with community-acquired pneumonia (CAP) due to Streptococcus pneumoniae conducted at 21 hospitals in ten cities across the United States. This report describes the surveillance methodology applied between October 7, 2013 and September 30, 2016, including the identification and description of surveillance areas and populations at-risk for CAP hospitalization for estimation of incidence rates for selected study sites.

Pneumonia Pathogenesis And The Lung Microbiome: Back To The Drawing Board, Julio A. Ramirez

The University of Louisville Journal of Respiratory Infections

No abstract provided.

Level Of Recall Bias Regarding Pneumococcal Vaccination History Among Adults Hospitalized With Community-Acquired Pneumonia: Results From The University Of Louisville Pneumonia Study, Sarah Van Heiden, Ruth Carrico, Timothy L. Wiemken, Ronika Alexander, John M. Mclaughlin, Qin Jiang, Paula Peyrani, William A. Mattingly, Stephen P. Furmanek, Connor L. English, Senen Pena, Raul Isturiz, Julio A. Ramirez

The University of Louisville Journal of Respiratory Infections

Background: Recall bias is likely to occur in vaccine effectiveness studies using self-reported vaccination history. The validity of patient-reported vaccination status for adults is not well defined. The objective of this study was to evaluate the validity of self-reported pneumococcal vaccination history among patients hospitalized with community-acquired pneumonia (CAP).

Methods: Prospective ancillary study of a population-based observational study of hospitalized patients with CAP in the city of Louisville. To be included in the analysis, patients had to (i) be reached by phone 30-days after discharge from the hospital and (ii) report that they remembered whether or not they received a …

Preliminary Evaluation Of An Lyta Pcr Assay For Detection Of Streptococcus Pneumoniae In Urine Specimens From Hospitalized Patients With Community-Acquired Pneumonia, Subathra Marimuthu, James T. Summersgill, Kuldeep Ghosh, Leslie A Wolf

The University of Louisville Journal of Respiratory Infections

Community acquired pneumonia (CAP) due to Streptococcus pneumoniae still occurs in at risk populations, despite the availability of effective vaccines. Laboratory confirmation of S. pneumoniae remains challenging in cases of CAP despite advances in blood culture techniques and the availability of nucleic acid amplification tests such as PCR-based methods. Urine specimens are an attractive sample type because they are non-invasive compared to bronchial washes or whole blood specimens for patients with CAP. While urine specimens have been used successfully in antigen detection assays, they have not been extensively evaluated for PCR-based assays. In this preliminary study, we evaluated the potential …

Antimicrobial Stewardship In Hospitalized Patients With Respiratory Infections: Ten-Year Experience From The Robley Rex Louisville Va Medical Center, Leslie A. Beavin, Forest W. Arnold, Paula Peyrani, Anupama Raghuram, David Newman, Ronald Smith, Carmen Sciortino, Stephen P. Furmanek, Ruth M. Carrico, Julio A. Ramirez

The University of Louisville Journal of Respiratory Infections

Rationale: Antibiotic stewardship has been defined as coordinated interventions designed to improve and measure the appropriate use of antibiotic agents. Respiratory infections are the most common infectious reason for hospitalization in the United States. Therefore, one could extrapolate that respiratory infections are then also the most common reason for hospital antibiotic use and possess the highest potential for hospital antibiotic misuse. The primary objective of this article was to evaluate the role of antimicrobial stewardship on improving antibiotic use for respiratory infections in hospitalized patients on intravenous (IV) antibiotics at the Robley Rex Louisville VAMC over a 10-year period.

Methods: …

One-Year Mortality In Patients With Community-Acquired Pneumonia, Paula Peyrani, Julio A. Ramirez

The University of Louisville Journal of Respiratory Infections

Pneumonia remains a common cause of morbidity and mortality in the US. Although, communityacquired pneumonia (CAP) has traditionally been considered an acute process, more recently, data have emerged showing that patients surviving an episode of CAP are at increased risk of death long after hospital discharged. In this descriptive review, we examine the current knowledge of long-term mortality and propose a hypothesis explaining the pathogenesis of long-term mortality in patients with CAP.

Contingency Management For Smoking Cessation In Pregnancy, Jacob Miller, Brady Reynolds, Courtney Crain, Hisham Keblawi, Lynne J. Goebel

Marshall Journal of Medicine

This pilot study examined the feasibility of applying Contingency Management (CM), where the woman receives financial compensation for abstinence from smoking. Eleven subjects were recruited from Marshall’s OB clinic for the program. CO levels were measured daily using online video recording. Quit rates were determined at the end of pregnancy. Birth outcomes were measured at delivery. 21 pregnant smokers from Marshall’s OB clinic were used as the control group. The results demonstrated a trend toward improved rates of smoking abstinence in CM participants as compared with the control group. Our study also showed a trend towards improved birth outcomes in …

A Course On Patient Safety: Pharmacy Student And Community Partner Perceptions, Maryam Noureldin, Chelsea M. Anderson, Patricia L. Darbishire

Purdue Journal of Service-Learning and International Engagement

The authors of this article developed and piloted a three-week intensive elective course for students in their third professional years in the Doctor of Pharmacy program. The goal of this course was to provide students with an opportunity to apply patient safety concepts in a real-world setting using service-learning as the pedagogy and to evaluate student perceptions of the course for potential implementation in the curriculum. Seven pharmacy students were enrolled in the pilot course and divided into three groups. Each group of two to three students was assigned to one of three predetermined community partner sites. Students were instructed …

Building Healthy Futures: Two Students’ Experiences With Global Health In Rural Ecuador, Varsha Kumar, Daniel Shyu

Purdue Journal of Service-Learning and International Engagement

This article highlights two students’ experience on Timmy Global Health’s medical brigade to Quito, Ecuador. Timmy is a nonprofit, Indiana-based organization dedicated to advocacy, service, and fundraising on a domestic and global scale. Every year, Timmy sends a group of sixteen students and medical professionals to Quito, Ecuador, over Purdue’s spring break to treat people in underserved communities who otherwise would not have access to quality health care. On this medical brigade, Timmy students travel to a different location each day for a week, set up clinic, and diagnose, treating nearly 100 patients a day. Those with conditions too complex …

Patient Care: The Forefront Of Pharmacy Practice, Dakota L. Richart

Purdue Journal of Service-Learning and International Engagement

For the past three years, Richart has been a member of APhA–ASP and has actively participated in numerous events. She planned, organized, and executed health fairs, educational presentations, and other direct patient care experiences alongside other members. An interaction as simple as a five-minute discussion with a patient about their blood pressure, antihypertensive medications, and lifestyle modifications can help save their life. Each patient interaction has impacted her by strengthening her communication skills, developing her professionalism, and providing confidence as she applies her knowledge with patients. Whether APhA–ASP’s events focus on a small audience at a local health fair or …

Using Steroids In Patients With Community-Acquired Pneumonia At The University Of Louisville Hospital: Who, What, And When, Rodrigo Cavallazzi, Julio A. Ramirez

The University of Louisville Journal of Respiratory Infections

No abstract provided.

Lung Cytokines And Systemic Inflammation In Patients With Copd, Alessandra Morello Gearhart, Rodrigo Cavallazzi, Paula Peyrani, Timothy L. Wiemken, Stephen P. Furmanek, Andrea Reyes-Vega, Umair Gauhar, Hiram Rivas-Perez, Jesse Roman, Julio A. Ramirez, Rafael Fernandez-Botran

The University of Louisville Journal of Respiratory Infections

Rationale: Chronic obstructive pulmonary disease (COPD) is characterized by lung and systemic inflammation. The role of cytokines in local and systemic inflammation in COPD is not well understood. This study aimed to compare plasma and bronchoalveolar lavage (BAL) fluid cytokine levels in COPD and non-COPD subjects with the intent of better understand their potential roles in driving local and systemic inflammation.

Methods: This cross-sectional study analyzed data from 65 subjects: 31 with COPD confirmed by spirometry and 34 non-COPD controls. All subjects underwent spirometry, plasma sample collection, and bronchoscopy/BAL. Levels of 21 inflammatory cytokines were measured in the plasma (systemic …

Weight-Loss Treatment-Induced Physical Activity Associated With Improved Nutrition Through Changes In Social Cognitive Theory Variables In Women With Obesity, James J. Annesi, Nicole Mareno

Health Behavior Research

Behavioral weight-loss treatments have typically been unsuccessful and a theoretical. Even when treatments were scientifically derived, theory has rarely been used to decompose, and understand the bases of, their effects. This 2-year study evaluated mediation of the prediction of nutritional changes by changes in physical activity, through social cognitive theory variables. Data from women with Class 1–2 obesity, classified as “insufficiently active” (N = 50; Mage = 47.6 years), were extracted from 2 initial trials of a new cognitive-behavioral intervention. That treatment sought to improve self-regulation, mood, and self-efficacy through increased physical activity, to then induce improved eating …

Relationship Of Self-Determination Theory Constructs And Physical Activity And Diet In A Mexican American Population In Nueces County, Texas, Joan E. Cowdery, Jiawei Xing, Brisa N. Sanchez, Kathleen M. Conley, Ken Resnicow, Lewis B. Morgenstern, Devin L. Brown

Health Behavior Research

Due to disparities in stroke risk among U.S. Hispanics, the need for culturally tailored, theory based effective health behavior change interventions persists. The purpose of this study was to examine self-determination theory (SDT) constructs related to cardiovascular disease (CVD) risk factors in a predominantly Mexican American population. The Stroke Health and Risk Education (SHARE) project was a cluster-randomized, faith-based behavioral intervention trial that enrolled Mexican Americans (MAs) and non-Hispanic whites (NHWs) from Catholic Churches in Nueces County, Texas. Data regarding SDT constructs and dietary and physical activity behaviors were collected via computer-assisted interviews using standardized instruments at the baseline assessment. …

The Future Of Health Behavior Research, John B. Lowe

Health Behavior Research

This commentary discusses the author's views of the future of health behavior research.

Knowledge, Attitudes, And Behaviours Of New Zealand Youth In Surf Beach Environments, Stacey M. Willcox-Pidgeon, Bridget Kool, Kevin Moran Ph.D.

International Journal of Aquatic Research and Education

New Zealand youth are over-represented in drowning statistics yet little is known about their understanding of water safety, especially in surf beach context. This study aimed to ascertain current youth surf safety knowledge, specifically rip current awareness, explore self-reported competencies and confidence when surf swimming, and examine youth behaviour when at the beach. A cross-sectional survey was conducted among senior high school students (n = 599) in Auckland, New Zealand. Over half (58%) reported they were unable to swim > 100 m in a pool. Males and students of European-New Zealand and Maori (New Zealand’s indigenous population) heritage were most …

Mobile-Based Sidewalk Inventory App For Smart Communities, Health, And Safety, Madhav Erraguntla, Dursun Delen, Rupesh K. Agrawal, Karthic Madanagopal, Richard Mayer

Suburban Sustainability

As the United States and other nations strive to cope with the obesity epidemic (NCHS, 2015), progressive communities are developing sidewalk infrastructure to promote physical activity and health. The Center for Disease Control (CDC) recommends that community-based interventions like neighborhood walk, bike programs etc. have shown to be effective in promoting physical activity and health. Smart cities are embracing the development of community trails and promoting their use to increase physical activity among youth and adults. System implementation, data collection, and analysis were performed from January 2015 through July 2015. To promote these objectives, communities and cities need accurate information …

Health Profiles Of Newly Arriving Refugees In Kentucky, 2016: Data From The University Of Louisville Global Health Program, Ruth M. Carrico, Timothy L. Wiemken, Rahel Bosson, William A. Mattingly, Rebecca Ford, Sarah Van Heiden, Stanley Kotey, Julio A. Ramirez

Journal of Refugee & Global Health

Objectives: Refugees resettling in the United States bring with them a number of health conditions, the majority chronic. These health conditions may impact their ability to be successful with disease self-management and employment, and acculturate and thrive in their new communities. Knowledge of health conditions present in individual refugee populations can be of benefit to healthcare providers in the community and public health. The objective of this manuscript is to describe the state of health among refugees newly arriving in the US and resettling in Kentucky during 2016.

Methods: Using data from the domestic health screens, immunization clinics, and the …