Public Health Commons^™

Pasantía En Red Oss: Más Que Una Clínica, Saad Ehsan

Independent Study Project (ISP) Collection

RED OSS es una organización en Conchalí, Santiago que provee pruebas rápidas de VIH y actualiza otras pruebas para ETS en una manera gratuita desde 1991. Durante mi pasantía, investigué como una organización disminuye las desigualdades de salud. También aprendí sobre el financiamiento de RED OSS, las pruebas rápidas y el nicho de RED OSS en un país con un sistema pública. Utilicé observaciones y entrevistas para estudiar la clínica. Tuve oportunidades para asistir los talleres para prevenir homofobia y ver las consejerías con un voluntario. También actualicé el sitio web para reflejar los servicios que RED OSS ofrece. En …

Usefulness Of An Expanded Health Belief Model With Added Constructs (Self-Efficacy And Ecological System Measures) In Modeling Compliance With Healthy Lifestyle Recommendations In Women With A Recent History Of Gestational Diabetes, Phyllis M. Woodson

Health Services Research Dissertations

Problem Statement: Gestational diabetes (GDM) has been reported to affect as many as 18% of all pregnancies in the U.S. This diagnosis is costly and presents health risks to both baby and mother. The main risk to the mother with a history of GDM is her increased risk for diabetes which has been estimated at 35% to 60% in the following 10 to 20 years; more recent studies report a 7 to 8 times occurrence in the following 3 to 6 years. It is recommended that lifestyle efforts of eating healthfully and exercise can reduce this risk

Methods: Subjects (n=153) …

Tobacco Smoking And Dementia In A Kentucky Cohort: A Competing Risk Analysis, Erin L. Abner, Peter T. Nelson, Gregory A. Jicha, Gregory E. Cooper, David W. Fardo, Frederick A. Schmitt, Richard J. Kryscio

Epidemiology and Environmental Health Faculty Publications

Tobacco smoking was examined as a risk for dementia and neuropathological burden in 531 initially cognitively normal older adults followed longitudinally at the University of Kentucky’s Alzheimer’s Disease Center. The cohort was followed for an average of 11.5 years; 111 (20.9%) participants were diagnosed with dementia, while 242 (45.6%) died without dementia. At baseline, 49 (9.2%) participants reported current smoking (median pack-years = 47.3) and 231 (43.5%) former smoking (median pack-years = 24.5). The hazard ratio (HR) for dementia for former smokers versus never smokers based on the Cox model was 1.64 (95% CI: 1.09, 2.46), while the HR for …

Forgotten Children & Bonds That Heal: The Critical Nature Of Attachment, August Ashbaker

Lesley University Community of Scholars Day

Human attachment is one of the most critical factors in proper neurological and physiological development. Attachment is built through the mutuality of emotional impact, as well as the regular reception of physical touch. Infants and children who have been deprived of these vital necessities through the lacking initiatives of their caregivers—through neglect—display visible signs of its physiological, cognitive, emotional, and behavioral impact. Research has found neglect to be the highest risk factor for permanent damage to brain development in comparison to other forms of complex trauma (i.e. chronic caregiver interpersonal trauma in childhood); it is also the most prevalent …

New Internal Medicine Residency Program At A Community Hospital Improves Mortality Without Increasing The Cost Or Length Of Stay: A Two-Year Follow Up., Javad Savoj, Christine Mikhail, Rajesh Gulati, Napatkamon Ayutyanont, Alina Popa

Medical Education

Opening new residency programs in community hospitals is one strategy to address to address physician shortage. Previous reports have shown better mortality outcomes in university based hospitals. However, less is known about teaching community hospitals. Disrupting well-established workflows in community hospitals is feared to cause an increased cost and possibly a slide in quality of care. Our aim was to assess the impact of starting a new Internal Medicine residency program in a Graduate Medical Education (GME) naive community hospital.

Hematological Profile And Gametocyte Carriage In Malaria Patients From Southern Pakistan, Najia Karim Ghanchi, Mohammad Hassaan Khan, Muhammad Abdullah Arain, Mustafa Bin Ali Zubairi, Ahmed Raheem Buksh, Muhammad A. Khan, Mohammad A. Beg

Department of Pathology and Laboratory Medicine

Background: Malarial infection is a major cause of concern, both worldwide and in Pakistan. Gametocytes are the sexual forms of the parasite that are essential for transmission. They fuse inside the mosquito to develop sporozoites. Gametocytes of the plasmodium parasites, which cause the infection, differentiate into male and female gametocytes. These gametocytes constitute the sexual stage of the malaria parasite and are essential in transmission of the disease from human to vector Anopheles. Gametocytes are affected by factors such as host immunity, drug treatment, reticulocytemia, anemia, low levels of asexual parasitemia and stress to the parasite. The aim of this …

Operationalization Of Bi-Directional Screening For Tuberculosis And Diabetes In Private Sector Healthcare Clinics In Karachi, Pakistan, Mashal S. Basir, Shifa Salman Habib, Syed M A. Zaidi, Saira Khowaja, Hamidah Hussain, Rashida A. Ferrand, Aamir J. Khan

Community Health Sciences

Background: Many countries are facing overlapping epidemics of tuberculosis (TB) and diabetes mellitus (DM). Diabetes increases the overall risk of developing Tuberculosis (TB) and contributes to adverse treatment outcomes. Active screening for both diseases can reduce TB transmission and prevent the development of complications of DM. We investigated bi-directional TB-DM screening in Karachi, Pakistan, a country that ranks fifth among high TB burden countries, and has the seventh highest country burden for DM.
Methods: Between February to November 2014, community-based screeners identified presumptive TB and DM through verbal screening at private health clinics. Individuals with presumptive TB were referred for …

The Opioid Crisis: Exploring The Effects On First Responders And Healthcare Professionals, Rachel Lubischer, Dawne Frain

UNO Student Research and Creative Activity Fair

In 2017, the National Department of Health and Human Services declared the opioid crisis a public health emergency (The White House, 2018). Although Nebraska ranks among the states with the lowest number of drug overdose deaths, rising opioid use creates safety concerns for first responders and healthcare professionals, and leads to strained resources in many jurisdictions. We hope to increase our audience’s knowledge on the opioid crisis, how it effects first responders and healthcare professionals, and pertinent policies and initiatives in Nebraska. Our audience will leave this presentation better equipped to initiate discussions with friends, family, and community members about …

Prevalence, Patterns And Factors Associated With Hypertensive Crises In Mulago Hospital Emergency Department; A Cross-Sectional Study, Martha Sajatovic

Faculty Scholarship

Background: Hypertension is increasing in sub-Saharan Africa (SSA) and it’s the single most important modifiable stroke risk factor, yet it’s control is not routinely emphasized. The prevalence, pattern and factors associated with hypertensive urgencies and emergencies in Uganda is not well established. A cross-sectional study, was conducted between November 2015 and February 2016, using a complete clinical examination and pre-tested standardized questionnaire subjects were enrolled. The prevalence of hypertensive crises and associations of demographic and clinical factors determined using logistic regression. Results: The prevalence of hypertensive crises was 5.1%, (203/4000) of all admissions at the medical section of the accident …

Improving The Quality Of Patient-Provider Interactions And Promoting Equitable, Accessible And Patient-Centered Cancer Care, C. Vaughan-Briggs, Lcsw, A. Petok, Lcsw, Mph, T. Dejesse, Amy Leader, Drph, Mph

Department of Medical Oncology Posters

• Philadelphia is among the top 10 cities in the US with populations over 500,000 with a high Community Need Index score (CNI- severity of Health disparity)
• Data from 2015 County Health Ranking, had Philadelphia last of all 67 counties in the state for social economic factors. (unemployment, income inequality, injury deaths, etc. )
• Cancer is a leading cause of mortality in the US
• The SKCC participated in a year-long, externally supported self study to improve the quality of patientprovider interactions and promote more equitable, accessible and patient- centered cancer care. This program aligned with internal initiatives.
• SKCC at Jefferson is …

Can An Exercise-Based Educational And Motivational Intervention Be Durably Effective In Changing Compliance To Physical Activity And Anthropometric Risk In People With Type 2 Diabetes? A Follow-Up Study, Francesca Gallè, Jesse C. Krakauer, Nir Krakauer, Giuliana Valerio, Giorgio Liguori

Publications and Research

Aims. A nine-month motivational exercise-based intervention was previously offered to subjects with type 2 diabetes (T2D). A year after the end of the intervention, compliance to physical activity (PA) and anthropometric indices of participants were analyzed to evaluate the durability of its effects. Methods. PA levels, expressed as total energy expenditure per week, were assessed with the International Physical Activity Questionnaire (IPAQ). Changes in Body Mass Index (BMI), A Body Shape Index (ABSI), Hip Index (HI) z-scores, the relative mortality risk related to each of these measures, and a combined Anthropometric Risk Index (ARI) were also evaluated. Results. Of a …

A Case-Control Study Of Trace-Element Status And Lung Cancer In Appalachian Kentucky, Jason M. Unrine, Stacey A. Slone, Wayne T. Sanderson, Nancy E. Johnson, Eric B. Durbin, Shristi Shrestha, Ellen J. Hahn, Fran Feltner, Bin Huang, W. Jay Christian, Isabel Mellon, David K. Orren, Susanne M. Arnold

Plant and Soil Sciences Faculty Publications

Appalachian Kentucky (App KY) leads the nation in lung cancer incidence and mortality. Trace elements, such as As, have been associated with lung cancers in other regions of the country and we hypothesized that a population-based study would reveal higher trace element concentrations in App KY individuals with cancer compared to controls. Using toenail and drinking water trace element concentrations, this study investigated a possible association between lung cancer incidence and trace-element exposure in residents of this region. This population-based case-control study had 520 subjects, and 367 subjects provided toenail samples. Additionally, we explored the relationship between toenail and fingernail …

Evaluating Trajectories Of Episodic Memory In Normal Cognition And Mild Cognitive Impairment: Results From Adni, Xiuhua Ding, Richard J. Charnigo, Frederick A. Schmitt, Richard J. Kryscio, Erin L. Abner, Alzheimer’S Disease Neuroimaging Initiative

Statistics Faculty Publications

BACKGROUND: Memory assessment is a key factor for the diagnosis of cognitive impairment. However, memory performance over time may be quite heterogeneous within diagnostic groups.

METHOD: To identify latent trajectories in memory performance and their associated risk factors, we analyzed data from Alzheimer's Disease Neuroimaging Initiative (ADNI) participants who were classified either as cognitively normal or as Mild Cognitive Impairment (MCI) at baseline and were administered the Rey Auditory Verbal Learning test (RAVLT) for up to 9 years. Group-based trajectory modeling on the 30-minute RAVLT delayed recall score was applied separately to the two baseline diagnostic groups.

RESULTS: There were …

Health Care Seeking For Maternal And Newborn Illnesses In Low- And Middle-Income Countries: A Systematic Review Of Observational And Qualitative Studies, Zohra S. Lassi, Philippa Middleton, Zulfiqar Ahmed Bhutta, Caroline Crowther

Woman and Child Health

Background: In low- and middle-income countries, a large number of maternal and newborn deaths occur due to delays in health care seeking. These delays occur at three levels i.e. delay in making decision to seek care, delay in access to care, and delay in receiving care. Factors that cause delays are therefore need to be understand to prevent and avoid these delays to improve health and survival of mothers and babies.
Methods: A systematic review of observational and qualitative studies to identify factors and barriers associated with delays in health care seeking.
Results: A total of 159 observational and qualitative …

Adaptive Statistical Iterative Reconstruction-V For Lung Nodule Analysis, Cherry Au, Zhenteng Li, Md, Eric Gingold, Md, Ethan Halpern, Md, Baskaran Sundaram, Md

Phase 1

Introduction: Low-dose CT in lung cancer screening has demonstrated benefits in select patients. As the traditional filtered back projection (FBP) technique is limited by poor image quality, adaptive statistical iterative reconstruction-V (ASIR-V) algorithm has been developed to achieve higher image quality with processing efficiency.

Objective: To investigate the impact of various CT scan parameters on the semi-automated measurement of lung nodules using a Computer Aided Detection (CAD) program.

Methods: This IRB-exempt phantom experiment was conducted with a CT scanner capable of ASIR-V algorithm. Eight lung nodules sized 5-12 mm, of solid or ground glass type, were placed inside a multipurpose …

Diagnostic Accuracy Of Home Sleep Apnea Testing (Hsat) Based On Recording Duration, Angela Alnemri, Theodora Fynn, Prakash Vasudevan, Ritu Grewa, Karl Doghramji

Phase 1

Introduction: Obstructive Sleep Apnea (OSA) is a chronic sleeping disorder with serious health consequences. Currently, standard diagnosis is through in-lab polysomnography; however, there has been a shift to greater use of Home Sleep Apnea Testing (HSAT) for patients with a high pre-test probability of having OSA.

Objective: To investigate the minimum recording time needed during HSAT to accurately diagnose the presence and severity of OSA.

Methods: A retrospective review was conducted of HSATs done from January-October 2017. Each study was divided into 1-, 2-,3-,4-,5-, 6-, and 7 hour intervals beginning at the recording start time. The respiratory event index (REI) …

Effect Of Tort Reform On Diagnostic Imaging Rates, Israel Ojalva, Ba, Arthur Hong, Md, Mph

Phase 1

Introduction: Defensive medicine, is defined as “order[ing] tests, procedures, or visits, or avoid certain high-risk patients or procedures, primarily (but not solely) because of concern about malpractice liability.” Nearly all physician who fear malpractice litigation have admitted to practicing some degree of defensive medicine. In response, many states have enacted policy reforms to lighten the threat of malpractice on physicians.

Objective: The most common defensive medicine behavior is ordering diagnostic imaging tests when it is potentially unwarranted. Many states have enacted non-economic damage caps from 2000-2010. We explored if these laws had an impact on the rates of diagnostic imaging …

Identifying The Causes Of Cancer Readmissions: A Patient Centered Approach, Katie Holland, Emily Wei, Allison Zibelli

Phase 1

While there are large efforts to decrease readmission rates in the United States, cancer patients represent a population that has been overlooked. Cancer patients are a vulnerable population who make up a large portion of hospital readmissions. Most of the current research on the causes of readmissions in cancer patients focuses on medical chart reviews and insurance claims. Many of these studies fail to incorporate patient input which could further the understanding of the complete burden associated with cancer readmissions. The goal of this study is to understand the personal reasons behind the decision of cancer patients to return to …

Severity Of Disease And Mortality For Hospitalized Patients With Community-Acquired Viral Pneumonia Compared To Patients With Community-Acquired Bacterial Pneumonia, Richard Y. Kim, Thomas Chandler, Stephen P. Furmanek, Timothy Lee Wiemken, Rodrigo Cavallazzi

The University of Louisville Journal of Respiratory Infections

Background: There exists a large body of literature to help identify, diagnose, treat, and manage community-acquired pneumonia (CAP). Despite this, there is little data that directly compares the clinical syndromes and complications of pure bacterial pneumonia to pure viral pneumonia. Our study compares the clinical presentation, morbidity and mortality of viral vs. bacterial etiologies of CAP.

Methods: This was a secondary data analysis of the Community-Acquired Pneumonia Organization (CAPO) international study database. Data was collected concerning patient demographics, physical examination findings, laboratory findings, radiological findings, severity of illness, and clinical outcomes and stratified according to the two study groups, CAVP …

A Multicomponent Quality Improvement Project To Improve Sleep In Hospitalized Patients: A Single Center Pilot Experience, Michelle Konkoly, Alan Kubey, Md

Phase 1

No abstract provided.

Total Body Skin Exam And Number Needed To Screen, Audra Hugo, Michael Bui, Alexander Sherban, Shayan Waseh, Elizabeth Jones, Md

Phase 1

Introduction/Background: Skin cancer screening could impact mortality and morbidity in US adults; however, the effectiveness of widespread screening remains unclear. Further research is necessary to determine what age groups, with what risk factors, might benefit from routine total body skin exams (TBSE) in the US.

Objective: This study sought to determine, on average, the number of patients, per decade, needed to screen via TBSE to identify one person with skin cancer.

Methods: A retrospective review of Jefferson Dermatology outpatient data in Epic was conducted. All patient charts from 1/1/2017 - 1/1/2018 were reviewed if they received a TBSE. The type …

Outcomes Reporting In Regional Anesthesia Patients: A Comparison Of Manual Phone Calls Versus Automated Phone App Messaging, Gavyn Ooi, Mba, Eric Schwenk, Md, Fasa, Jeffrey Mojica, Do, Alexander Grant, Md, Max Shilling, Md, David Barnabei, Md, Jennifer Lessin, Ba, Rn, Ccrc, Marc Torjman, Phd, Kent Berg, Md, Mba

Phase 1

Automation of patient follow-up via mobile phone apps have the potential to save time for physicians, standardize responses from patients, and increase the patient response rate. Studies that assess the effectiveness of mobile phone-based surveys have been favorable, with completion rates of about 60% in the surgical population. The impact of mobile phone-based patient management in anesthesia deserves further study. This study examines the follow-up success rates of (1) manual phone calls (the current standard of care) vs. (2) automated patient outreach (APO) in patients who receive a regional anesthesia block procedure.

As part of normal follow up, anesthesia team …

An Evaluation Of Ultrasound-Guided Regional Block Anesthesia In Outpatient Hand Surgery, Daniel Calem, Armen C. Voskeridjian, Md, Michael Rivlin, Md, Pedro Beredjiklian, Md, Mark L. Wang, Md, Phd

Phase 1

Introduction: The utilization of ultrasound-guided peripheral nerve blocks in orthopedic surgery has increased in popularity as the anesthesia of choice for the management of perioperative pain. Peripheral nerve blockade has been shown to increase overall surgical efficiency, improve patient satisfaction, reduce postoperative narcotic use, and decrease the duration of facility admissions, while increasing overall cost-effectiveness. To date, scant literature exists regarding the safety and efficacy of ultrasound-guided supraclavicular blocks used in common hand surgery procedures, and the rate of neurologic and vascular complications remains unknown.

Objective: The purpose of this study was to examine the effectiveness and complication rate of …

Diet And Addiction: Interview With A Former Food, Pornography, And Alcohol Addict, Tro Kalayjian, Brian Lenzkes

Dignity: A Journal of Analysis of Exploitation and Violence

Drs. Tro Kalayjian (Tapan, New York) and Brian Lenzkes (Santee, California) talk to Matt about his struggles with food, pornography, and alcohol addiction, and how changing his diet contributed to his recovery from his addictions. This report is excerpted from the audio podcast LowCarbMD, Episode 13 (https://itunes.apple.com/us/podcast/low-carb-md-podcast/ ), January 30, 2019). This podcast has filled us with immense hope for those struggling with addiction.

Association Between Asthma And Dental Caries Amongst 12 - 15 Years Old Children: A School-Based Cross-Sectional Study In Karachi, Pakistan, Wajeeha Zahid, Shafquat Rozi, Farhan Raza Khan, Nida Zahid, Muhammad Masood Kadir

Community Health Sciences

Objective: The study aimed to determine an association between dental caries and asthma among 12 to 15 years old children.
Methods: This is a school-based cross-sectional study conducted from January to February 2016. A random sample of 544 children aged 12 - 15 years were enrolled from five private schools of Karachi. Dental caries was assessed using DMFT Index (Decayed, Missing, Filled teeth). The main exposure variable was asthma and information on it was collected through the International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire.
Results: The data was analyzed using Cox Proportional Hazard algorithm. Crude and adjusted …

Functional Gastrointestinal Disorders And Gut-Brain Axis: What Does The Future Hold?, Kashif Mukhtar, Hasham Nawaz, Shahab Abid

Section of Gastroenterology

Despite their high prevalence, lack of understanding of the exact pathophysiology of the functional gastrointestinal disorders has restricted us to symptomatic diagnostic tools and therapies. Complex mechanisms underlying the disturbances in the bidirectional communication between the gastrointestinal tract and the brain have a vital role in the pathogenesis and are key to our understanding of the disease phenomenon. Although we have come a long way in our understanding of these complex disorders with the help of studies on animals especially rodents, there need to be more studies in humans, especially to identify the therapeutic targets. This review study looks at …

The Influence Of Unpredictable, Fragmented Parental Signals On The Developing Brain, Laura M. Glynn, Tallie Z. Baram

Psychology Faculty Articles and Research

Mental illnesses originate early in life, governed by environmental and genetic factors. Because parents are a dominant source of signals to the developing child, parental signals - beginning with maternal signals in utero - are primary contributors to children’s mental health. Existing literature on maternal signals has focused almost exclusively on their quality and valence (e.g. maternal depression, sensitivity). Here we identify a novel dimension of maternal signals: their patterns and especially their predictability/unpredictability, as an important determinant of children’s neurodevelopment. We find that unpredictable maternal mood and behavior presage risk for child and adolescent psychopathology. In experimental models, fragmented/unpredictable …

Health Systems Changes After Decentralisation: Progress, Challenges And Dynamics In Pakistan, Shehla Zaidi, Maryam Bigdeli, Etienne V. Langlois, Atif Riaz, David W. Orr, Nasir Idrees, Jesse B. Bump

Community Health Sciences

Decentralisation is widely practised but its scrutiny tends to focus on structural and authority changes or outcomes. Politics and process of devolution implementation needs to be better understood to evaluate how national governments use the enhanced decision space for bringing improvements in the health system and the underlying challenges faced. We use the example of Pakistan's radical, politically driven provincial devolution to analyse how national structures use decentralisation opportunities for improved health planning, spending and carrying out transformations to the health system. Our narrative draws on secondary data sources from the PRIMASYS study, supplemented with policy roundtable notes from Pakistan. …

Defining Patient-Oriented Research For The Average Person (And Potential Research Partner), Dennis J. Baumgardner

Journal of Patient-Centered Research and Reviews

In this introduction to the first issue of 2019, the editor-in-chief of Journal of Patient-Centered Research and Reviews offers additional context to the findings of Kaur and Pluye (p. 7), who methodically formalized an operational definition of patient-oriented research for the purposes of searching bibliographic databases. A possible succinct, lay definition of patient-oriented research for the average “person on the street” is proposed.

Patient Perceptions Of Planned Organ Removal During Hysterectomy, Zeinab Kassem, Chad M. Coleman, Andrew S. Bossick, Wan-Ting Su, Roopina Sangha, Ganesa Wegienka

Journal of Patient-Centered Research and Reviews

Purpose: Previous reports indicate many women may not have a firm grasp on likely outcomes of different hysterectomy procedures. This study aimed to assess women’s self-reported expectations of how they think their anatomy will change after hysterectomy.

Methods: Women scheduled for hysterectomy at a tertiary care hospital, for non-oncological reasons, reported their planned procedure type and the organs they understood would be removed 2 weeks prior to surgery. Patient reports and electronic medical records were reviewed, and kappa statistics (κ) were calculated to assess agreement for all women and within subgroups.

Results: Most of the 456 study participants (mean age: …