Public Health Commons^™

Healthcare Utilization & Health Behaviors Among Older Adults: The Role Of Insurance, Jennifer Rose Geiger

LSU Doctoral Dissertations

As the population of older adults in the U.S. continues its exponential growth, so too will the need for high-quality health and preventive services. Despite the widely acknowledged need for proactive solutions to the coming public health challenges for this rapidly expanding age cohort, healthcare providers and social work practitioners continue to lack the proper education training to serve the needs of older adults. Furthermore, these allied health professionals also frequently engage in ageist behaviors across care settings that also often employ institutionally ageist policies and procedures. As a result, older adults may be particularly at risk of negative health …

Three Years In--Changing Plan Features In The U.S. Health Insurance Marketplace, Caitlin N. Mckillop, Teresa M. Waters, Cameron M. Kaplan, Erin K. Kaplan, Michael P. Thompson, Ilana Graetz

Health Management and Policy Faculty Publications

Background: A central objective of recent U.S. healthcare policy reform, most notably the Affordable Care Act's (ACA) Health Insurance Marketplace, has been to increase access to stable, affordable health insurance. However, changing market dynamics (rising premiums, changes in issuer participation and plan availability) raise significant concerns about the marketplaces' ability to provide a stable source of healthcare for Americans that rely on them. By looking at the effect of instability on changes in the consumer choice set, we can analyze potential incentives to switch plans among price-sensitive enrollees, which can then be used to inform policy going forward.

Methods: Data …

Where Do We Go From Here? The Need For Genetic Referrals In Patients Who Are Deaf Or Hard Of Hearing: Findings From A Regional Survey, Tyson S. Barrett, Amanda Wylie, Beth Vogel, Kunal Sanghavi, Melissa Raspa, Kathryn P. Aveni, Kathryn Tullis, Michele Caggana, Karl R. White, Joann Bodurtha

Journal of Early Hearing Detection and Intervention

Purpose: The purpose of this study was to assess primary health care providers’ knowledge and use of genetic services for children whose hearing screening indicates they may be deaf/hard of hearing (D/HH) and identify areas in which health care providers can be supported to increase family education and referral of families for genetic consultation.

Methodology: A survey was developed on current practices, knowledge, and perceived beliefs regarding genetic education and referrals for deafness. The surveys were distributed to pediatricians, family medicine physicians, nurse practitioners, and physician assistants in DC, DE, MD, NJ, NY, PA, VA, and WV.

Results: Among 266 …

Identification Of Oral Clefts As A Risk Factor For Hearing Loss During Newborn Hearing Screening, Patricia L. Purcell, Kathleen Cy Sie, Todd C. Edwards, Debra Lochner Doyle, Karin Neidt

Journal of Early Hearing Detection and Intervention

Objective: This study assessed whether children with oral clefts are appropriately classified as at-risk for hearing loss at the time of newborn hearing screening and describes their screening and diagnostic results.

Design: Birth certificates were used to identify children with cleft lip and palate or isolated cleft palate born in Washington State from 2008–2013. These were cross-referenced with the state’s Early Hearing Detection, Diagnosis and Intervention (EHDDI) database. Multivariate logistic regression was used to examine associations.

Results: Birth records identified 235 children with cleft lip and palate and 116 with isolated cleft palate. Six children were listed as having both …

Using Mhealth To Increase Treatment Utilization Among Recently Incarcerated Homeless Adults (Link2care): Protocol For A Randomized Controlled Trial, Jennifer M. Reingle Gonzalez, Michael S. Businelle, Darla Kendzor, Michele Staton, Carol S. North, Michael Swartz

Behavioral Science Faculty Publications

Background: There is a significant revolving door of incarceration among homeless adults. Homeless adults who receive professional coordination of individualized care (ie, case management) during the period following their release from jail experience fewer mental health and substance use problems, are more likely to obtain stable housing, and are less likely to be reincarcerated. This is because case managers work to meet the various needs of their clients by helping them to overcome barriers to needed services (eg, food, clothing, housing, job training, substance abuse and mental health treatment, medical care, medication, social support, proof of identification, and legal aid). …

Agreement Between Clinician-Rated Versus Patient-Reported Outcomes In Huntington Disease, Noelle E Carlozzi, Nicholas R Boileau, Joel S Perlmutter, Kelvin L Chou, Julie C Stout, Jane S Paulsen, Michael K Mccormack, David Cella, Martha A Nance, Jin-Shei Lai, Praveen Dayalu

Rowan-Virtua School of Osteopathic Medicine Departmental Research

BACKGROUND: Clinician-rated measures of functioning are often used as primary endpoints in clinical trials and other behavioral research in Huntington disease. As study costs for clinician-rated assessments are not always feasible, there is a question of whether patient self-report of commonly used clinician-rated measures may serve as acceptable alternatives in low risk behavioral trials.

AIM: The purpose of this paper was to determine the level of agreement between self-report and clinician-ratings of commonly used functional assessment measures in Huntington disease.

DESIGN: 486 participants with premanifest or manifest Huntington disease were examined. Total Functional Capacity, Functional Assessment, and Independence Scale assessments …

Incidence, Risk Factors, And Prediction Of Gastrointestinal And Intracranial Bleeding In A Cohort Of Older Veterans Prescribed Oral Anticoagulants, Angela Laurio

Dissertations and Theses

ABSTRACT

Incidence, Risk Factors, and Prediction of Gastrointestinal and

Intracranial Bleeding in a Cohort of Older Veterans Prescribed Oral Anticoagulants

by

Angela L. Laurio

Advisor: Marianne (Mimi) C. Fahs, PhD, MPH

Objectives:

The objectives of this dissertation were to: (1) describe and compare the incidence and odds of gastrointestinal and intracranial bleeding in veterans age 50 to 89 who were prescribed warfarin, direct oral anticoagulants, or no oral anticoagulants; (2) identify risk factors for gastrointestinal and intracranial bleeding among older veterans prescribed oral anticoagulants, and to calculate the relative risk of bleeding over time through time-to-event analysis; and (3) develop …

A Reference Guide: Six Practical Tips For Understanding Data On Female Genital Mutilation/Cutting (Fgm/C), Charlotte Greenbaum, Reshma Naik

Reproductive Health

The Population Reference Bureau (PRB) was a core partner on the Population Council’s Evidence to End FGM/C: Research to Help Girls and Women Thrive—a UKAID-funded research program to help end female genital mutilation/cutting (FGM/C) within one generation. Their role was to build the consortium’s capacity for research utilization and to develop innovative tools and products to improve how researchers communicate their findings about FGM/C to key decisionmakers.
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Improving Pregnancy Outcomes In Low- And Middle-Income Countries, Robert L. Goldenberg, Elizabeth M. Mcclure, Sarah Saleem

Community Health Sciences

This paper reviews the very large discrepancies in pregnancy outcomes between high, low and middle-income countries and then presents the medical causes of maternal mortality, stillbirth and neonatal mortality in low-and middle-income countries. Next, we explore the medical interventions that were associated with the very rapid and very large declines in maternal, fetal and neonatal mortality rates in the last eight decades in high-income countries. The medical interventions likely to achieve similar declines in pregnancy-related mortality in low-income countries are considered. Finally, the quality of providers and the data to be collected necessary to achieve these reductions are discussed. It …

Implementation Of Prevention Of Mother To Child Transmission Of Hiv Program In South Jakarta, Fase Badriah, Minsarnawati Tahangnacca, Raihana Alkaff, Takeru Abe, Laily Hanifah

Kesmas

Even though Prevention of Mother to Child Transmission (PMTCT) program has been running in Indonesia since 2006, the proportion of human immunodeficiency virus (HIV)-infected pregnant women remains high in some districts in Indonesia. The PMTCT program aims to reduce transmission of HIV from mother to child. Thus it requires an examination of the PMTCT program implementation. The study was a qualitative study on PMTCT program implementation in South Jakarta, Indonesia, whereas the proportion of children with HIV positive in the area was quite high. The analysis used domain analysis by looking the implementation of PMTCT as a system consisting of …

The Influence Of Exclusive Breastfeeding To Emotional Development Of Children Aged 48-60 Months, Yuni Kusmiyati, Sumarah Sumarah, Nurul Dwiawati, Hesty Widyasih, Yani Widyastuti, Khadizah Haji Abdul Mumin

Kesmas

Impaired emotional development is a problem faced by children and this can negatively impact on function, development and readiness of their school. Exclusive breastfeeding is able to meet brain development needs that affect child development. This study aimed to determine correlation between exclusive breastfeeding and emotional development of children aged 48-60 months. This study used historical cohort.The subjects of this study were 7-12-month old infants living in area of Borobudur Primary Health Care Primary Health Care, Central Java Province, Indonesia in 2011-2012. Independent variable of exclusive breastfeeding was when infants received only breast milk without any supplementary food or drink …

Larvicidal Effect Of Mixture Of Beauveria Bassiana Crude Metabolite And Chitinase Enzyme Against Aedes Aegypti Larvae, Dyah Widiastuti, Bina Ikawati, Upik Kesumawati Hadi

Kesmas

Aedes aegypti is a major vector of dengue, a deadly disease causing deaths of millions of people in developing countries, both in urban and rural populations. Aedes aegypti control with chemical insecticide is widely used, and affects on a widespread insecticide resistance. Mosquito biological control was needed to replace the use of chemical insecticide. This study aimed to evaluate larvicidal effect of mixture of Beauveria bassiana crude metabolite and chitinase enzyme against Aedes aegypti larvae. An experimental study using completely Randomized Design was conducted in March-April 2016 at Banjarnegara Research and Development Unit for Zoonosis Control. Biolarvacide formula was made …

Perceived Stigma In People Affected By Leprosy In Leprosy Village Of Sinatala, Tangerang District, Banten Province, Indonesia, Erni Astutik, Dwi Gayatri

Kesmas

Leprosy is a disease of neglected tropical diseases (NTDs) which becomes a global problem and causes the perceived stigma in people affected by leprosy. This study aimed to determine most dominant factors affecting perceived stigma in people affected by leprosy in leprosy village of Sitanala, Tangerang District, Banten Province, Indonesia. The data used was secondary data taken from cross-sectional survey of a thesis which determined factors related to perceived stigma of leprosy in leprosy village of Sitanala, Tangerang, Indonesia. Samples were selected by purposive sampling. The results of the study showed that factors related to perceived stigma were level of …

Determinants Of Tourism And Hiv/Aids Incidence In West Java, Cecep Heriana, Rossi Suparman, Sohel Rana, Dera Sukmanawati

Kesmas

Indonesia defined as tourist destination where the international and domestic tourists enjoy the tourist attractions. Prostitution existing in tourism place may increase the prevalence of HIV/AIDS. The incidence and spread of AIDS in many areas in West Java is a problem for tourism industry. These issues become acute in locations where sexual attraction is used as a determinant of tourist portability. The aim of this study was to determine relation between tourism and the incidence of HIV/AIDS in West Java. Non-reactive research design was used to collect secondary data from the Central Bureau of Statistics in 2016 from 26 districts/cities …

Effect Of Personal Protective Equipment During Pesticide Application To Neurological Symptoms In Farmers In Purworejo District, Indonesia, Fajaria Nurcandra, Renti Mahkota, Siddharudha Shivalli

Kesmas

Agriculture is one of major sectors of Indonesia economic source with the high volume of pesticide used. Unfortunately, adverse health effect of neurotoxic pesticide has never been reported in Indonesia. This study aimed to determine effectiveness of personal protective equipment (PPE) during applied pesticides to neurological symptoms in farmers. This study was cross-sectionally conducted from April to May 2016 in Purworejo District. About 125 farmers were selected using purposive sampling, and restriction was applied in male farmers due to the high proportion of male sprayer. Data was collected by observation and interview. Logistic regression showed protective result of PPE used …

Food Hygiene And Sanitation In Six Food Providers At University X, South Sumatra, Yul Isnadi, Tan Malaka, Hatta Dahlan, Novrikasari Novrikasari

Kesmas

Food provider at university is one of places that needs to implement standards of food hygiene and sanitation (FHS). This study aimed to evaluate and analyze practices of FHS based on Regulation of Health Minister No. 1098 of 2003 and best practices in six food providers at University X. This study used mixed method evaluation with sequential explanatory design through two stages. Stage I was in forms of assessment on six food providers, food handlers and laboratory examination on food and beverage samples as well as on eating utensils. Stage II was in form of focus group discussion (FGD) to …

Factors Causing Contraceptive Acceptors Drop Out, Mufdlilah Mufdlilah, Kanthi Aryekti

Kesmas

Family planning program has a very strategic, comprehensive and fundamental meaning in creating a healthy and prosperous Indonesian human being. However, recently the incidence of drop out is quite high for several reasons. This study was conducted to determine the influential factors that cause acceptors to drop out. It is descriptive research. The populations in the study were contraceptive acceptors who dropped out for 3 consecutive months, and not being pregnant. The numbers of sample were 100 people. The data collection employed closed and open questionnaires; data presented in descriptive form. Influential factors of drop out contraceptive acceptors due to …

Variations In Institutional Review Board Processes And Consent Requirements For Trauma Research: An East Multicenter Survey, Jeffry Nahmias, Areg Grigorian, Scott Brakenridge, Randeep S. Jawa, Daniel N. Holena, John Varujan Agapian, Brandon Bruns, Paul J. Chestovich, Bruce Chung, Jonathan Nguyen, Carl I. Schulman, Kristan Staudenmayer, Rachel Dixon, Jason W. Smith, Andrew C. Bernard, Jose L. Pascual

School of Medicine Faculty Research

Oversight of human subject research has evolved considerably since its inception. However, previous studies identified a lack of consistency of institutional review board (IRB) determination for the type of review required and whether informed consent is necessary, especially for prospective observational studies, which pose minimal risk of harm. We hypothesized that there is significant inter-institution variation in IRB requirements for the type of review and necessity of informed consent, especially for prospective observational trials without blood/tissue utilization. We also sought to describe investigators’ and IRB members’ attitudes toward the type of review and need for consent. Eastern Association for the …

Provider Insight On Surmounting Specialty Practice Challenges To Improve Tdap Immunization Rates Among Pregnant Women, Arpita Mehrotra, Allison Kennedy Fisher, Jennifer Mullen, Leslie Rodriguez, Angela J. Jiles, Alison P. Albert, Laura A. Randall, Paula M. Frew

Environmental & Global Health Faculty Research

Background Pertussis, or “whooping cough,” is an acute, contagious pulmonary disease that, despite being vaccine-preventable, has become an increasingly widespread problem in the United States. As a result, the Advisory Committee on Immunization Practices and American College of Obstetricians and Gynecologists updated recommendations stating clinicians should give a Tdap dose during every pregnancy, preferably at 27–36 weeks. Despite this recommendation, reported Tdap vaccine receipt rates during pregnancy vary from 16–61%, and previous studies have shown that clinician recommendation and vaccine administration are strongly associated with vaccine uptake among pregnant women. Methods Our aim was to inform new strategies to increase …

Dynamical Properties Of Postural Control In Obese Community-Dwelling Older Adults, Christopher W. Frames, Rahul Soangra, Thurmon Lockhart, John Lach, Dong Sam Ha, Karen A. Roberto, Abraham Lieberman

Physical Therapy Faculty Articles and Research

Postural control is a key aspect in preventing falls. The aim of this study was to determine if obesity affected balance in community-dwelling older adults and serve as an indicator of fall risk. The participants were randomly assigned to receive a comprehensive geriatric assessment followed by a longitudinal assessment of their fall history. The standing postural balance was measured for 98 participants with a Body Mass Index (BMI) ranging from 18 to 63 kg/m2, using a force plate and an inertial measurement unit affixed at the sternum. Participants’ fall history was recorded over 2 years and participants with at least …

Emerging Themes In Coping With Lifetime Stress And Implication For Stress Management Education, Asrat G. Amnie

Publications and Research

Background: Adults with adverse childhood experiences and exposure to adverse life events experience a diverse array of physical, mental, and social health problems across their lifespan. Adult exposure to emotional trauma, physical injury, or other adverse life events may result in the development of post-traumatic stress and post-traumatic stress disorder. Understanding individuals’ response to stress and their coping strategies is as important as the stimulus or the causes of the stress for effective stress management interventions.

Methods: This is a mixed quantitative and qualitative online survey study which explores the coping strategies to stress in adults with adverse childhood experiences …

Exploring Direct And Indirect Effects Of English Proficiency On Access, Utilization, And Health Status Among Californian Adults With Limited English Proficiency (Lep), Renee E. Pierre-Louis

Seton Hall University Dissertations and Theses (ETDs)

Background and Study Purpose: Findings from previous studies suggest that, in a health care delivery context, individuals with limited English proficiency (LEP) are adversely impacted by lack of patient-provider language concordance. Yet, the concept of LEP has been mostly studied in the context of cultural competence and language has been generally considered a demographic or cultural characteristic. There is a growing body of research concerning LEP and health status; however, it is limited. This study sought to evaluate the effects of LEP on access, utilization, and self-rated health status (SRHS) among LEP respondents to a large health interview survey …

A Cohort Study Of Public Health Insurance Coverage Loss Among Oregon Adolescents, Heather Angier Mph, Carrie Tillotson Mph, Lorraine Wallace Phd, Miguel Marino Phd, Jean O'Malley Mph, Aleksandra Sumic Mph, Lynn Baker Bsee, Christine Nelson Phd, Rn, Nathalie Huguet Phd, Andrew Suchocki Md, Mph, Heather Holderness Mph, Jennifer E. Devoe Md, Dphil

Journal of Health Disparities Research and Practice

ABSTRACT

Introduction: Churning on and off and/or experiencing coverage gaps is common among public health insurance recipients. Although the Affordable Care Act (ACA) provisions to extend parental coverage for adolescents transitioning to young adulthood on private insurance plans were implemented in 2010, no such protection was mandated for adolescents with public health insurance.

Methods: Oregon public health insurance enrollment and electronic health record data from community health centers were used to conduct a retrospective, observational cohort study of Oregon adolescents (17-19 years of age) with public coverage [January 1, 2011-December 31, 2013 (n=51,988)] to assess loss. Time-to-event methods determined the …

Mobile Hiv Units In South Africa: A Systematic Review, Meaghan Doherty

Senior Honors Projects, 2010-2019

Abstract

Objective: To examine existing literature on mobile HIV testing units to determine if they have the potential to increase access to testing, treatment, and HIV education to decrease rates of HIV in South Africa.

Participants: Ten research articles evaluating the HIV intervention method of mobile HIV units in South Africa, including outcome measures.

Analysis: Systematic search of 87 articles from 2000 to 2018 and review of the 10 articles that met inclusion criteria.

Results: Several studies (n=5) showed that mobile testing units are effective at attracting hard to reach populations, such as men and young adults. Studies (n=3) also …

Healthcare Utilization For Behavioral Health Disorders: Policy Implications On Nationwide Readmissions, And Outcomes In The States Of Nebraska And New York, Rajvi J. Wani

Theses & Dissertations

The main goal of this dissertation was to estimate national-level inpatient readmissions and state-level hospital-based emergency department (ED) visits with behavioral health (BH) conditions in the states of Nebraska and New York. The dissertation aims to assess the impact of the policy mandates under the Patient Protection and Affordable Care Act on these state and national estimates. The Nationwide Readmissions Database and the State Emergency Department databases maintained by the Healthcare Cost and Utilization Project were used for this dissertation. US Adult population with high-risk of readmissions in the inpatient departments for alcohol-related disorders (ARD) and of visiting ED for …

Optimism And Compliance: An Examination Of Disempowering Processes Within Online Patient Communities, Wendi F. Coleman

Technical Communication Capstone Course

Patients diagnosed with long-term conditions (LTCs) are now being asked of medical practitioners to take an active role in their own health care as “expert patients.” This trend has accelerated the increase in people with LTCs who are using the internet for both information and social support. A valuable resource to these patients, and of interest to researchers, is a new type of online space: online patient communities (OPCs) created for patients suffering from specific illnesses. In order to better understand potential disempowering processes within OLPs, I follow the research and examine the illness narratives, focusing on their various external …

Underserved And Unaccompanied: Lgbtq Youth, Meeting The Intersecting Needs Of Youth Homelessness And Lgbtq Identities In Worcester, Ma, Molly Kellman

Sustainability and Social Justice

LGBTQ youth are at a much higher risk for experiencing homelessness, victimization, abuse, and disconnection from social and medical services than their non-LGBTQ peers. This research paper uses a mixed-methods approach to identify the specific needs of unaccompanied LGBTQ youth in Worcester, Massachusetts, and how the youth service sector can better meet the needs of this population. Analysis of data from unaccompanied LGBTQ youth and the providers who serve them revealed a disconnect between service providers, and a lack of resources that accommodate the intersections of homelessness and LGBTQ identities. LGBTQ youth in Worcester are more at risk of experiencing …

Efficacy Of Technology-Based And In-Person Health Education For Behavior Change In College-Aged Women, Madeline Bremel

All College Thesis Program, 2016-2019

Purpose: The purpose of this study was to determine whether an in-person or technology based bone health intervention improved bone health knowledge and behaviors in college-aged women. Methods: 30 college-aged women were randomly divided into three groups: personal intervention (n = 10), technological intervention (n = 10), and control (n = 10). Both intervention groups received identical information regarding the importance of bone health and the appropriate behaviors for maintaining strong bones including weight-bearing exercise, calcium consumption, and vitamin D consumption. The technology group received the information via an online video, and the personal group via a one-on-one …

Family Navigator Report, Keri B Vartanian, Jt Thompson, Will Stott

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No abstract provided.

Expression Of Androgen Receptor And Cancer Stem Cell Markers (Cd44 +/Cd24 - And Aldh1 +): Prognostic Implications In Invasive Breast Cancer, Nazia Riaz, Romana Idress, Sadia Habib, Iqbal Azam Syed, El Nasir Lalani

Section of General Surgery

Background: Androgen receptor (AR) has emerged as a significant prognostic marker in early breast cancer (BCa). Association of AR with cancer stem cell (CSC) markers in BCa is unknown. Aim of the present study was to evaluate the immunohistochemical expression of AR, CD44, CD24 and ALDH1 in a cohort of Pakistani patients diagnosed with invasive BCa and to correlate the expression with 5- year disease free survival.
Patients and methods: We evaluated immunohistochemical expression AR, CD44, CD24 and ALDH1 in formalin fixed paraffin embedded archival blocks of 166 cases of primary invasive BCa (stage I-III) and correlated the expression with …