Public Health Commons^™

Nepal : Healthcare And Sanitation Issues Resulting From Frequent Natural Disasters In Nepal, Jake Lauderdale

Global Public Health

This Public Health Brief calls to attention the issues plaguing Nepal as a result of both frequent natural disasters and poor healthcare infrastructure. The geographic characteristics of Nepal are shown to be a major factor in the damage and aftermath of natural disasters such as earthquakes. Due to its status as a poor and economically weakened country, Nepal must rely heavily on outside aid in order to alleviate the pressure of frequently occurring natural disasters. Despite work being done by several Non-Governmental Organizations, Nepal has a long way to go before they are able to independently manage the outcomes of …

Chad : Hepatitis E, Hanna Pegarsch

Global Public Health

Contaminated drinking water in Chad is the main source for a Hepatitis E outbreak, leading Chad citizens to develop severe illness including jaundice, liver-failure, miscarriage, and death. There are 0.4 physicians for every 10,000 people living in Chad needing healthcare. Of the citizens in Chad, only 42% have access to uncontaminated drinking water. With such a long incubation period for Hepatitis E, the citizens don’t know they are spreading the illness to the rest of their community. Even with the symptoms, the citizens don’t have the access or the capacity for treatment, making Hepatitis E an epidemic in Chad.

Liberia : Maternal Health & Ebola, Chelsey Hernandez

Global Public Health

Throughout the world, many low-income countries suffer from poor nutrition, lack of health resources, and little to no access to other valuable resources. Previous research has demonstrated the poor state of health in Liberia as a result of these various socioeconomic factors. Although Liberia faces many public health issues, the 2014 Ebola epidemic reversed whatever progress was made. Maternal and child health in particular has severely decreased, especially in recent years. This brief focuses on the impact of the 2014 Ebola epidemic had on maternal health.

Conventional Early Infant Diagnosis In Lesotho From Specimen Collection To Results Usage To Manage Patients: Where Are The Bottlenecks?, Appolinaire Tiam, Michelle M Gill, Heather J Hoffman, Anthony Isavwa, Mafusi Mokone, Matokelo Foso, Jeffrey T Safrit, Lynne M Mofenson, Thorkild Tylleskär, Laura Guay

Epidemiology Faculty Publications

INTRODUCTION: Early infant diagnosis is an important step in identifying children infected with HIV during the perinatal period or in utero. Multiple factors contribute to delayed antiretroviral treatment initiation for HIV-infected children, including delays in the early infant HIV diagnosis cascade.

METHODS: We conducted a retrospective study to evaluate early infant diagnosis turnaround times in Lesotho. Trained staff reviewed records of HIV-exposed infants (aged-6-8 weeks) who received an HIV test during 2011. Study sites were drawn from Highlands, Foothills and Lowlands regions of Lesotho. Central laboratory database data were linked to facility and laboratory register information. Turnaround time geometric means …

Mosquitoes Transmit Unique West Nile Virus Populations During Each Feeding Episode, Nathan D. Grubaugh, Joseph R. Fauver, Claudia Rückert, James Weger-Lucarelli, Selene Garcia-Luna, Reyes A. Murrieta, Alex Gendernalik, Darci R. Smith, Doug E. Brackney, Gregory D. Ebel

Journal Articles: Epidemiology

Arthropod-borne viruses (arboviruses), such as Zika virus, chikungunya virus, and West Nile virus (WNV), pose continuous threats to emerge and cause large epidemics. Often, these events are associated with novel virus variants optimized for local transmission that first arise as minorities within a host. Thus, the conditions that regulate the frequency of intrahost variants are important determinants of emergence. Here, we describe the dynamics of WNV genetic diversity during its transmission cycle. By temporally sampling saliva from individual mosquitoes, we demonstrate that virus populations expectorated by mosquitoes are highly diverse and unique to each feeding episode. After transmission to birds, …

Conventional Early Infant Diagnosis In Lesotho From Specimen Collection To Results Usage To Manage Patients: Where Are The Bottlenecks?, Appolinaire Tiam, Michelle M Gill, Heather J Hoffman, Anthony Isavwa, Mafusi Mokone, Matokelo Foso, Jeffrey T Safrit, Lynne M Mofenson, Thorkild Tylleskär, Laura Guay

Epidemiology Faculty Publications

Introduction

Early infant diagnosis is an important step in identifying children infected with HIV during the perinatal period or in utero. Multiple factors contribute to delayed antiretroviral treatment initiation for HIV-infected children, including delays in the early infant HIV diagnosis cascade.

Methods

We conducted a retrospective study to evaluate early infant diagnosis turnaround times in Lesotho. Trained staff reviewed records of HIV-exposed infants (aged-6-8 weeks) who received an HIV test during 2011. Study sites were drawn from Highlands, Foothills and Lowlands regions of Lesotho. Central laboratory database data were linked to facility and laboratory register information. Turnaround time geometric means …

Assessing Very Early Infant Diagnosis Turnaround Times: Findings From A Birth Testing Pilot In Lesotho, Michelle Gill, Heather J. Hoffman, Majoalane Mokone, Vincent Tukei, Matsepeli Nchephe, +Several Additional Authors

Epidemiology Faculty Publications

Very early infant diagnosis (VEID) (testing within two weeks of life), combined with rapid treatment initiation, could reduce early infant mortality. Our study evaluated turnaround time (TAT) to receipt of infants’ HIV test results and ART initiation if HIV-infected, with and without birth testing availability. Data from facility records and national databases were collected for 12 facilities offering VEID, as part of an observational prospective cohort study, and 10 noncohort facilities. HIV-exposed infants born in January–June 2016 and any cohort infant diagnosed as HIV-infected at birth or six weeks were included. The median TAT from blood draw to caregiver result …

Risk Of Gastrointestinal Bleeding Among Dabigatran Users – A Self Controlled Case Series Analysis, Wenze Tang, Hsien-Yen Chang, Meijia Zhou, Sonal Singh

Epidemiology Faculty Publications

This article aims to evaluate the real world risk of gastrointestinal bleeding among users naïve to dabigatran. We adopted a self-controlled case series design. We sampled 1215 eligible adult participants who were continuous insured users between July 1, 2010 and March 31, 2012 with use of dabigatran and at least one gastrointestinal bleeding episode. We used a conditional Poisson regression to estimate incidence rate ratios. The population consisted of 64.69% of male and 60.25% patients equal to or greater than age 65 at start of observation. After adjustment for time-variant confounders, the incidence rate of gastrointestinal bleeding was similar during …

Post-Diagnosis Body Mass Index And Mortality Among Women Diagnosed With Endometrial Cancer: Results From The Women's Health Initiative., Hannah Arem, Ruth M Pfeiffer, Steven C Moore, Melinda L Irwin, Michael J Lamonte, Gloria E Sarto, Rami Nassir, Juhua Luo, Rowan T Chlebowski, Louise A Brinton, Charles E Matthews

Epidemiology Faculty Publications

Higher body mass index (BMI) measured before endometrial cancer diagnosis has been associated with greater risk of developing endometrial cancer and higher mortality, but the association between BMI measured after diagnosis and mortality risk is unclear. We identified 467 women (91 deaths) in the Women's Health Initiative (WHI) with information on BMI measured after diagnosis and used Cox proportional hazards regression to generate hazard ratios (HR) and 95% confidence intervals (CI) for all-cause mortality. Comparing BMI 35+ with/m2, we observed no association with all-cause mortality (HR = 1.02, 95% CI 0.55-1.91). Our study does not support the hypothesis that higher …

Sudan : Malaria, Olivia Jilek

Global Public Health

Sudan faces a great number of public health issues, however one of the most prevalent diseases within the country is Malaria. An estimated nine million cases were reported in 2002, with the total number of deaths at 44,000, in a country that has a population of 37,345,935. The research done on Malaria in Sudan looks at the basic epidemiology of the region, how to identify the disease, and major risks factors present. Other major challenges that Sudan faces are included, as well as suggestions for preventing further illness from the disease.

Visualizing The Diffusion Of Digital Mammography In New York State, Francis P. Boscoe, Xiuling Zhang

Epidemiology & Biostatistics Faculty Scholarship

Digital mammography saw rapid adoption during the first decade of the 2000s. According to data maintained by the Food and Drug Administration, which regulates mammography machines, fewer than 1 percent of the machines in 2001 were digital. By 2014, this figure had risen to 94%. We were interested in identifying the times and locations where the technology was introduced within the state of New York as a way of illustrating the uneven introduction of this technology. While the diffusion of medical innovation has been well-studied, there have not been many instances where maps or geographic information science methods have been …

Statin Use And Risk Of Developing Diabetes: Results From The Diabetes Prevention Program, Diabetes Prevention Program(Dpp) Research Group, Marinella G. Temprosa

GW Biostatistics Center

Objective Several clinical trials of cardiovascular disease prevention with statins have reported increased risk of type 2 diabetes (T2DM) with statin therapy. However, participants in these studies were at relatively low risk for diabetes. Further, diabetes was often based on self-report and was not the primary outcome. It is unknown whether statins similarly modify diabetes risk in higher risk populations.

Research design and methods During the Diabetes Prevention Program Outcomes Study (n=3234), the long-term follow-up to a randomized clinical trial of interventions to prevent T2DM, incident diabetes was assessed by annual 75 g oral glucose tolerance testing and semiannual fasting …

Anti-Müllerian Hormone And Its Relationships With Subclinical Cardiovascular Disease And Renal Disease In A Longitudinal Cohort Study Of Women With Type 1 Diabetes, Catherine Kim, Yuanyuan Pan, Barbara Braffett, Valerie Arends, Michael Steffes, Hunter Wessells, Aruna V. Sarma

GW Biostatistics Center

Background

Reproductive age may be a risk factor for vascular disease. Anti-Müllerian hormone (AMH) is produced by viable ovarian follicles and reflects reproductive age. We examined whether AMH concentrations were associated with markers of subclinical cardiovascular disease (CVD) and kidney disease among women with type 1 diabetes.

Methods

We performed a cross-sectional analysis of the Epidemiology of Diabetes Interventions and Complications Study. Participants included women with type 1 diabetes and ≥1 AMH measurement (n = 390). In multivariable regression models which adjusted for repeated measures, we examined the associations between AMH with CVD risk factors, estimated glomerular filtration rate, …

Biomarkers Of Tubulointerstitial Damage And Function In Type 1 Diabetes, Ian De Boer, Xiaoyu Gao, Ionut Bebu, Andrew Hoofnagle, John Lachin, Diabetes Control And Complications Trial/Epidemiology Of Diabetes Interventions And Complications (Dcct/Edic) Research Group.

Epidemiology Faculty Publications

Objective To evaluate biomarkers of renal tubulointerstitial damage and function in type 1 diabetes with and without diabetic kidney disease.

Research design and methods Cross-sectional case-control study of Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications Study participants. Cases (N=43) had incident persistent estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m2 with urinary albumin excretion >300 mg/24 hour. Controls (N=43) had persistent eGFR >90 mL/min/1.73 m2 and urinary albumin excretion <30 mg/24 hour. Urinary and plasma biomarkers reflecting tubular injury, inflammation, fibrosis, secretion, and synthetic function were measured from stored specimens collected at the first study visit with reduced eGFR (for case participants) or the corresponding study year (for control participants).

Results Mean (SD) age was 51 (9) and 50 (8) years for case and control participants, and mean (SD) duration of diabetes was 30 (6) and 30 (5) years, respectively. Mean (SD) eGFR was 39 …

Detecting Discordance Enrichment Among A Series Of Two-Sample Genome-Wide Expression Data Sets, Yinglei Lai, Fanni Zhang, Tapan Nayak, Reza Modarres, Norman H. Lee, Timothy A. Mccaffrey

Epidemiology Faculty Publications

Background

With the current microarray and RNA-seq technologies, two-sample genome-wide expression data have been widely collected in biological and medical studies. The related differential expression analysis and gene set enrichment analysis have been frequently conducted. Integrative analysis can be conducted when multiple data sets are available. In practice, discordant molecular behaviors among a series of data sets can be of biological and clinical interest.

Methods

In this study, a statistical method is proposed for detecting discordance gene set enrichment. Our method is based on a two-level multivariate normal mixture model. It is statistically efficient with linearly increased parameter space when …

Willingness Of Community-Recruited Men Who Have Sex With Men In Washington, Dc To Use Long-Acting Injectable Hiv Pre-Exposure Prophylaxis., Matthew E Levy, Rudy Patrick, Jonjelyn Gamble, Anthony Rawls, Jenevieve Opoku, Manya Magnus, Michael Kharfen, Alan E Greenberg, Irene Kuo

Epidemiology Faculty Publications

Objectives

Clinical trials are currently investigating the safety and efficacy of long-acting injectable (LAI) agents as HIV pre-exposure prophylaxis (PrEP). Using National HIV Behavioral Surveillance data, we assessed the self-reported willingness of men who have sex with men (MSM) to use LAI PrEP and their preference for LAI versus daily oral PrEP.

Methods

In 2014, venue-based sampling was used to recruit MSM aged ≥18 years in Washington, DC. Participants completed an interviewer-administered survey followed by voluntary HIV testing. This analysis included MSM who self-reported negative/unknown HIV status at study entry. Correlates of being “very likely” to use LAI PrEP and …

Reliability Of Medical Records In Diagnosing Inflammatory Breast Cancer In Egypt, Lynne Le, Catherine Schairer, Ahmed Hablas, Jane L. Meza, Shinobu Watanabe-Galloway, Mohamed Ramadan, Sofia D. Merajver, Ibrahim A. Seifeldin, Amr S. Soliman

Journal Articles: Epidemiology

BACKGROUND: Inflammatory breast cancer (IBC) is a rare, aggressive breast cancer diagnosed clinically by the presence of diffuse erythema, peau d'orange, and edema that arise quickly in the affected breast. This study evaluated the validity of medical records in Gharbiah, Egypt in identifying clinical signs/symptoms of IBC. For 34 IBC cases enrolled in a case-control study at the Gharbiah Cancer Society and Tanta Cancer Center, Egypt (2009-2010), we compared signs/symptoms of IBC noted in medical records to those recorded on a standardized form at the time of IBC diagnosis by clinicians participating in the case-control study. We calculated the sensitivity …

Possible Risk Factors For Multidrug-Resistant Tuberculosis Infection In The Philippines, Molovon Jr Pasagui Azores

Walden Dissertations and Doctoral Studies

Multidrug-resistant Mycobacterium tuberculosis (MDR-TB) is a leading cause of morbidity and mortality in the Philippines. The purpose of this study was to gain knowledge about the relationship between potential risk factors and MDR-TB. Risk factors (the independent variables) for MDR-TB (the dependent variable) include previous TB treatment, infection with HIV, exposure to patients with drug-susceptible TB/MDR-TB, delays in diagnosis and treatment, employment status, smoking, imprisonment, alcohol abuse, and poor compliance with TB treatment regimens. The study was based on the epidemiological approach to causal inference work. A case-control study design was used wherein a quantitative method was applied in data …

Adherence Barriers To Healthcare For African Americans With Hiv/Aids On Antiretroviral Medications, Angela Bumphus Corbin

Walden Dissertations and Doctoral Studies

The purpose of this mixed methods research study was to examine the role of adherence barriers to healthcare and the impact that such barriers have on highly active antiretroviral therapy (HAART) compliance for African Americans living with HIV/AIDS. HAART helps reduce HIV/AIDS morbidity and mortality. Of the 49% of study participants who had been out of medical care for more than 12 months, financial concerns were listed as the most common barrier (22.8%). Not having the support from family and friends (17.5%), being tired of going to doctor appointments (15.8%), health challenges (12.3%), lack of transportation (12.3%), and incarceration (12.3%) …

Differences In Survival Times, By Gender, Among Those Diagnosed With Necrotizing Fasciitis, Ashley Elizabeth Hill

Walden Dissertations and Doctoral Studies

Necrotizing fasciitis infections have high mortality rates especially when treatment is delayed. Despite the abundance of research in many areas of necrotizing fasciitis infection, there are limited and conflicting studies focusing on gender-related outcomes for those diagnosed and died with necrotizing fasciitis infection. The purpose of this study was to determine the association that gender plays on survival time of patients who have been diagnosed with necrotizing fasciitis using a cross-sectional study design. Succeeding the conceptual design of the life course model, the research question tested whether there was a significant difference in survival time between the genders while in …

Retired, Unmarried, Male Baby Boomer Attitudes And Behaviors Toward Disease Prevention, Irene Nyawira Ruminjo

Walden Dissertations and Doctoral Studies

Preventive health care is effective in reducing both infectious diseases and chronic conditions among the elderly. Despite efforts to prevent or decrease the risk of illness, unmarried men are less likely to receive selected preventive services compared to married men. The purpose of this cross-sectional survey was to describe disease prevention attitudes and behaviors of retired, unmarried, male baby boomers residing in Harlingen, Texas. Further, the study examined the effects of socioeconomic status on disease prevention attitudes and behaviors. The health belief theory framed the study. A validated questionnaire collected disease prevention attitudes, behaviors, and sociodemographic characteristics data. Data inquiry …

Sugar Intake And The Five Personality Traits Of Millennials, Flora Gashi

Walden Dissertations and Doctoral Studies

Sugar intake continues to be connected to an increased risk of heart diseases, diabetes, arthritis, and certain forms of cancers, depression, and schizophrenia. The purpose of the study was to examine if sugar intake is related to personality traits in the Millennial population. The health belief model was used as the theoretical framework for conducting the study. The research questions addressed in the current study were in regards to the relationships between Millennials daily sugar intake and openness, conscientiousness, extraversion, agreeableness, and neuroticism. This study was a cross-sectional design in which a panel of randomly selected United States Millennials (N …

Perceived Job Stress And Life Style Behaviors' Effects On The Quality Of Life Of Registered Nurses, Jennifer Rose Limongiello

Walden Dissertations and Doctoral Studies

The purpose of this quantitative study was to examine to what extent work demands as measured by perceived job stress affected the health-related quality of life (HRQOL) as determined by the number of unhealthy days of registered nurses in the United States. This study was also an investigation of the extent to which other variables such as body-mass index (BMI) and certain lifestyle behaviors affected the HRQOL (number of unhealthy days). The independent variables were perceived job stress, weight (BMI), and lifestyle factors such as tobacco and alcohol use, physical inactivity, and the mindful eating score, and the dependent variable …

Association Between Physician Characteristics And Surgical Errors In U.S. Hospitals, Obumneke A. Amadi

Walden Dissertations and Doctoral Studies

The high incidence of medical and surgical errors in U.S. hospitals and clinics affects patients' safety. Not enough is known about the relationship between physician characteristics and medical error rates. The purpose of this quantitative correlational study was to examine the relationship between selected physician characteristics and surgical errors in U.S. hospitals. The ecological model was used to understand personal and systemic factors that might be related to the incidence of surgical errors. Archived data from the National Practitioner Data Bank database of physician surgical errors were analyzed using bivariate and multivariate logistic regression analyses. Independent variables included physicians' home …

Association Between Age-Related Macular Degeneration And Sleep-Disordered Breathing, Jeffrey A. Nau

Walden Dissertations and Doctoral Studies

Age-related macular degeneration (AMD) is a chronic, irreversible disease that robs individuals of vision, quality of life, and independence. It is the leading cause of blindness in industrialized countries. Sleep-disordered breathing (SDB) is a condition characterized by repeated episodes of apnea and/or hypopnea, insomnia, short sleep duration, and/or sleep disturbances (snoring, gasping, etc.). Because SDB has been shown to cause chronic hypoxia resulting in oxidative stress on the retina, it has been proposed that SDB may be associated with AMD. Based on the life course theory of chronic disease, this quantitative, cross-sectional study used data from the 2005-2008 National Health …

Exploring The Role Of Faith In Survival Of Breast Cancer, Franklin D. Lewis, Jr.

Walden Dissertations and Doctoral Studies

In 2013, approximately 232,340 women were diagnosed with breast cancer, and an estimated 39,620 women would die as a result of breast cancer. Stage I breast cancer can often be treated, but Stage IV breast cancer presents more difficulties in treatment, as it spreads to the bones, liver, or other areas of the body. Consequently, women with Stage IV breast cancer have very low 18 month and 5-year survival rates. According to some statistics, 79.5% of the United States population claim to be Christian. Much of this segment of the population uses faith to guide most aspects of their lives, …

Examining The Activities, Effectiveness, And Contribution Of Local Health Departments Using A National Longitudinal Survey Of Public Health Systems, Lava R. Timsina

Theses and Dissertations--Epidemiology and Biostatistics

Health services research and public health services and systems research in the past have contributed to a strong foundation of evidence-based progress in organizing, financing, and delivering medical care and public health strategies across the United States. The purpose of this dissertation was to examine disparities in public health systems and in the delivery of population health services in communities served by these systems using nationally representative data from the National Longitudinal Survey of Local Public Health Systems (1998, 2006, 2012, and 2014).

Data from the 1998 cohort of 497 local health jurisdictions serving at least 100,000 residents, and from …

Mixture Modeling With Applications In Alzheimer's Disease, Frank Appiah

Theses and Dissertations--Epidemiology and Biostatistics

This dissertation involves an application of mixture of regression models to 114 individuals who are cognitively intact (from the Alzheimer's Disease and Neuroimaging Initiative-ADNI, data). The correct number of components in the model were estimated with the Singular BIC (SBIC), marking the first time it has been applied to such a problem. The smallest true model in conjunction with the approximation of SBIC was fixed at 1. The resulting posterior probabilities from the model were used to estimate the probability of a person transitioning and risk plots were obtained that could in principle be used by clinicians to identify patients …

Benefit Of Ultrasound Curriculum Development For Family Medicine Residents, Nithin Natwa, Uzair Munshey, Duncan Vos, Robert Baker

Research Day

Introduction/Purpose: Musculoskeletal problems comprise some of the most common reasons for ambulatory care encounters in the United States, accounting for 8.3% of the 1.2 billion visits per year according to the CDC. Musculoskeletal Ultrasound use has become more common in primary care for diagnosis and therapeutics. In Family Medicine Residency (FMR) Programs there is a deficiency of a structured, competency-based musculoskeletal ultrasound (MSK US) training despite its growing popularity. Currently, there is no formalized requirement for Ultrasound education as in other residency programs in spite of its benefit. Methods: We received a positive response on our needs analysis survey for …

Delivery Of Health Education In Adolescents With Behavioral Health Challenges, Ashley Akkal, Ransome Eke Md, Phd, Sulin Wu, Amy Rechenberg, Michael Madrid, Jose Lopez-Vera, Duncan Vos

Research Day

BACKGROUND Adolescents with behavioral health issues tend to have inadequate access to health education, and are thus less aware of the importance of personal and dental hygiene, exercise, and healthy diet and lifestyle habits. Due to this disparity, this population has been known to harbor a higher prevalence of STI’s, drug and alcohol abuse, physical altercations, juvenile detention, and suicide attempts. PURPOSE The overall objective of this study was to examine the effect of integrating a health science curriculum in this population. METHODS Participants aged 5-17 years old were recruited and assigned to either control or science groups by Family …