Public Health Commons^™

The Discrete-Event Modeling Of Administrative Claims (Demac) System: Dynamically Modeling The U.S. Healthcare Delivery System With Medicare Claims Data To Improve End-Of-Life Care, Rachael Chacko

Dartmouth College Undergraduate Theses

The shift of the U.S. healthcare delivery system from the treatment of acute conditions to chronic diseases requires a new method of healthcare system analysis to properly assess end- of-life (EOL) quality throughout the country. In this paper, we propose the Discrete-Event Modeling of Administrative Claims (DEMAC) system, which relies on a hetero-functional graph theory and discrete event-driven framework to dynamically model EOL care on multiple levels. The heat map visualizations produced by the DEMAC system enable the elucidation of not only patient-specific EOL care but also broader treatment patterns among providers and hospitals. As a whole, the DEMAC system …

Computational Analysis Of Protein Stability And Allosteric Interaction Networks In Distinct Conformational Forms Of The Sars Cov 2 Spike D614g Mutant: Reconciling Functional Mechanisms Through Allosteric Model Of Spike Regulation, Gennady M. Verkhivker, Steve Agajanian, Deniz Oztas, Grace Gupta

Mathematics, Physics, and Computer Science Faculty Articles and Research

In this study, we used an integrative computational approach to examine molecular mechanisms underlying functional effects of the D614G mutation by exploring atomistic modeling of the SARS-CoV-2 spike proteins as allosteric regulatory machines. We combined coarse-grained simulations, protein stability and dynamic fluctuation communication analysis with network-based community analysis to examine structures of the native and mutant SARS-CoV-2 spike proteins in different functional states. Through distance fluctuations communication analysis, we probed stability and allosteric communication propensities of protein residues in the native and mutant SARS-CoV-2 spike proteins, providing evidence that the D614G mutation can enhance long-range signaling of the allosteric spike …

Knowledge And Anxiety About Covid-19 In The State Of Qatar, And The Middle East And North Africa Region—A Cross Sectional Study, Sathyanarayanan Doraiswamy, Sohaila Cheema, Maisonneuve Patrick, Amit Abraham, Ingmar Weber, Jisun An, Albert B. Lowenfels, Ravinder Mamtani

Research Collection School Of Computing and Information Systems

While the coronavirus disease 2019 (COVID-19) pandemic wreaked havoc across the globe, we have witnessed substantial mis- and disinformation regarding various aspects of the disease. We conducted a cross-sectional study using a self-administered questionnaire for the general public (recruited via social media) and healthcare workers (recruited via email) from the State of Qatar, and the Middle East and North Africa region to understand the knowledge of and anxiety levels around COVID-19 (April–June 2020) during the early stage of the pandemic. The final dataset used for the analysis comprised of 1658 questionnaires (53.0% of 3129 received questionnaires; 1337 [80.6%] from the …

Construct Validity And Invariance Assessment Of The Social Impacts Of Occupational Heat Stress Scale (Siohss) Among Ghanaian Mining Workers, Victor F. Nunfam, Ebenezer Afrifa-Yamoah, Kwadwo Adusei-Asante, Eddie J. Van Etten, Kwasi Frimpong, Isaac Adjei-Mensah, Jacques Oosthuizen

Research outputs 2014 to 2021

Heat exposure studies over the last decade have shown little attention in assessing and reporting the psychometric properties of the various scales used to measure impacts of occupational heat stress on workers. A descriptive cross-sectional survey including 320 small- and large-scale mining workers was employed to assess the construct validity of the social impacts of occupational heat stress scale (SIOHSS) in the Western Region of Ghana in 2017. A confirmatory factor analysis (CFA) and invariance analysis were carried out using AMOS version 25 and statistical product and service solutions (SPSS) version 26 to examine the model fit and establish consistency …

The Essence Of Telemedicine For Bridging The Gap In Health Services, Budi Wiweko, Sarah Chairani Zakirah, Atha Luthfi

Kesmas

This study aimed to review the essence of telemedicine in this modern era of technology and innovation, especially in developing countries. It also investigated the regulation aspect as the main component for healthcare services. There were five main categories of telemedicine: revenue stream and technology literacy, health facilities, human resources, data authorization and security, and health protocol. Furthermore, when combined with wearable devices, it enhanced healthcare delivery opportunities. There were two major components of global electronic health, namely telehealth and health informatics, based one-commerce and e-learning systems. The World Health Organization (WHO) has been able to describe the roles of …

The Determinants Of Stunting For Children Aged 24-59 Months In Kulon Progo District 2019, Chatrine Aprilia Hendraswari, Yuliasti Eka Purnamaningrum, Tri Maryani, Yani Widyastuti, Sakinah Harith

Kesmas

This study pertains to stunting in children in Indonesian with z-scores of less than -2 Standard Deviation (SD) and less than -3 SD. The preliminary study results showed the highest prevalence of stunting to be 22.6%, at the Temon II Primary Health Care in Kulon Progo District. The study aimed to assess the determinants of stunting children aged 24–59 months. This study was conducted from September 2018–May 2019. The design of this study was analytical observational with study design case-control. The sample was 60 children aged 24–59 months. The method utilized proportional sampling, whereas the data analysis applied chi-square and …

A Path Analysis Model For Explaining The Factors Influencing Wearing A Mask Among Commuting Workers Using Commuter Line Bogor-Jakarta, David Kusmawan, Shofi Andari, Ira Gustina, Indri Hapsari Susilowati, Mufti Wirawan

Kesmas

Jakarta is one of the most air-polluted cities in the world, which can increase the health risk of commuting workers exposed to pollutants. This study aimed to determine the factors that directly and indirectly affect healthy behavior (wearing a mask) for commuters using the Bogor-Jakarta Commuter Line. Furthermore, a total of 155 respondents participated and the data collected were analyzed using descriptive and path analysis. The commuters aware of the hazard potential related to air pollution during commuting were 137 people (88.4%). While 104 people (67.1%) were aware of the good perception of pollution and 125 uses masks during commuting …

Empowering Health Cadres To Support Drug-Resistant Tuberculosis (Dr-Tb) Patient To Enroll In Treatment, Esty Febriani, Adik Wibowo, Neeraj Kak, Hala Jassim Al Mossawi

Kesmas

Tuberculosis (TB) remains a big challenge globally, while the involvement of health cadres’ constitutes one of the key strategies for the TB program in Indonesia. These roles were further expanded to providing support to DR-TB patients. This study was a qualitative study, conducted in 2015 to explore the various factors which influence the performance of health cadres’ in supporting DR-TB patients to enroll in treatment. A total of 39 informants consisting of 24 health cadres, three nurses, four DR-TB patients, and three family members, two peer support, a head of primary health care, and two TB staffs from the District …

National Health Insurance Scheme: Internal And External Barriers In The Use Of Reproductive Health Services Among Women, Evi Martha, Herna Lestari, Resvi Siti Zulfa, Yoslien Sopamena

Kesmas

Lack of familiarity among the community, medical workers, and administrative staff regarding reproductive health services covered by Badan Penyelenggara Jaminan Sosial (BPJS) or the National Health Insurance (NHI) in Indonesia remained a problem. Therefore, this resulted in sub-optimal use of the medical services, as shown by surveys from the Women's Health Foundation for three consecutive years (2015-2017). This qualitative study was conducted with a Rapid Assessment Procedure design in three cities within Indonesia: Padang Pariaman, Manado, and Kupang. Data were collected through IDIs (n = 47informants) and 6 FGDs (7 persons/group). Participants also consisted of NHI RHS users (mothers and …

Prevalence And Determinants Of Pre-Lacteal Feeding: Insights From The 2017 Indonesia Demographic And Health Survey, Siti Nurokhmah, Siti Masitoh, Kusuma Estu Werdani

Kesmas

Pre-lacteal feeding is widely known as a distraction to exclusive breastfeeding, and the malpractice continues to be prevalent in Indonesia. Therefore, this study aimed to explore the potential determinants of pre-lacteal feeding among mothers of infants below 24 months. A sample of 6,455 mother-infant pairs from the 2017 Indonesia Demographic and Health Survey (IDHS) was used. Also, multivariate logistic regression was employed to identify factors associated with pre-lacteal feeding practice. In Indonesia, 44% of infants were introduced to solid/liquid feeds in their first three days of life. Infant formula was the most common pre-lacteal feed given, followed by any other …

Inter-Related Factors Influencing Sexual Quality Of Life Among Women Living With Hiv In Banten Province, Indonesia: A Mixed Methods Study, Dyah Juliastuti, Judith Dean, Yati Afiyanti, Lisa Fitzgerald

Kesmas

Socio-cultural concerns often restrict women's sexual rights and well-being living with HIV (WLHIV) in developing countries. These convergent parallel mixed methods study combined quantitative and qualitative approaches to explore factors influencing WLHIV sexual quality of life in Banten Province, Indonesia. A 2017 cross-sectional survey of 207 reproductive-aged WLHIV was analyzed using univariate and multivariate logistic regression statistics. Furthermore, in-depth interviews with a sub-sample of survey participants (n = 30) were thematically analyzed. Most of the women (60%) involved reported loss of sexual pleasure and depressed sexual life. Meanwhile, 48% affirmed low sexual quality of life which was associated with unemployment …

Attitudes Concerning Sexual Behavior Towards Risky Sexual Behavior Of Sexual Transmitted Infections Among Male Adolescents In Indonesia, Helda Helda, Nurul Muchlisa

Kesmas

There has been an increase of sexually transmitted infections (STIs) such as HIV/AIDS worldwide, especially in Indonesia. Several studies on adolescent behavior, especially the male as the main predictor, reported increased in STIs’ cases due to risky sexual behavior. This study aimed to show the relationship between attitudes, sexual behavior, and the risks of STIs among male adolescents in Indonesia based on the Indonesia Demographic and Health Survey (IDHS) data in 2017. This cross-sectional study involved 10,547 male adolescents using the total sampling method according to the inclusion and exclusion criteria. Data were analyzed using a complex sample logistic regression …

The Effect Of Smoking On Carbon Monoxide Respiration Among Active Smokers In Palembang City, Indonesia, Rico Januar Sitorus, Imelda Gernauli Purba, Merry Natalia, Kraichat Tantrakarnapa

Kesmas

Smoking leads to disease and disability as well as harm nearly every organ of the body. Furthermore, smoking of tobacco is known to cause pulmonary dysfunction and lead to complications, pain, or even death. This study aimed to measure the risk factors for the respiration of carbon monoxide among smokers. A cross-sectional design was implemented by involving 156 smokers in Karyajaya Subdistrict, Palembang City. The dependent variable was carbon monoxide levels (ppm), while the independent variables were smoking frequency, duration, and the last period of smoking. The carbon monoxide levels (ppm) measured with a PiCO + Smokerlyzer® device from Bedfont …

The Significance Of Super Depo Sutorejo: Waste Management Project In Surabaya Municipality, Indonesia, Yohanes Kambaru Windi, Dyah Wijayanti, Eko Rustamaji Wiyatno, Loetfia Dwi Rahariyani

Kesmas

The Super Depo Sutorejo Surabaya (SDSS) Project was created to separate household waste into fractions, but its separation effect is unknown. This study assessed the significance of the project in sorting general waste into biodegradable, non-biodegradable, and assorted. The t-test compared the means of general and biodegradable waste (normally distributed). The non-biodegradable and assorted waste were not significantly distributed; therefore, the Wilcoxon Signed Ranks Test was used to compare their medians against general waste. The multivariate analysis compared the significance level of each waste fraction. Each statistical analysis showed that the SDSS significantly sorts the general waste. The p-values were …

Spatially Refined Time-Varying Reproduction Numbers Of Covid-19 By Health District In Georgia, Usa, March–December 2020, Chigozie A. Ogwara, Arshpreet Kaur Mallhi, Xinyi Hua, Kamalich Muniz-Rodriguez, Jessica S. Schwind, Xiaolu Zhou, Jeffery A. Jones, Joanne Chopak-Foss, Gerardo Chowell, Isaac Chun-Hai Fung

Biostatistics, Epidemiology & Environmental Health Sciences: Faculty Publications

This study quantifies the transmission potential of SARS-CoV-2 across public health districts in Georgia, USA, and tests if per capita cumulative case count varies across counties. To estimate the time-varying reproduction number, Rt of SARS-CoV-2 in Georgia and its 18 public health districts, we apply the R package ‘EpiEstim’ to the time series of historical daily incidence of confirmed cases, 2 March–15 December 2020. The epidemic curve is shifted backward by nine days to account for the incubation period and delay to testing. Linear regression is performed between log10-transformed per capita cumulative case count and log10-transformed population size. We observe …

Reporting Of Eating Disorder Deaths, Katherine Mobley, Amy Hord

Symposium of Student Scholars

Those affected by eating disorders experience disturbances in eating behaviors which are often related to underlying psychiatric disorders such as anxiety, depression, or obsessive-compulsive disorder (Parekh, 2017, Drieberg et al., 1998 p.53). The duplicitous nature of the disorder makes it difficult to diagnose, and the tole it takes on an individual’s physical health makes its mortality rate the second highest among psychiatric disorders (Guinhut et al., 2021 p.130). Even if the correct education and resources are accessible to certain individuals, negative stigmatization about the disorder can make sufferers unlikely to seek help (Becker et al., 2010). Findings from analysis of …

Differences In ​The Proportion Of Children Meeting Behavior Guidelines ​Between Summer ​And School By Socioeconomic Status And Race, Ethan T. Hunt, Lauren Von Klinggraeff, Alexis Jones, Sarah Burkart, Roddrick Dugger, Bridget Armstrong Ph.D., Michael Beets Ph.D., Gabrielle Turner-Mcgrievy Ph.D., Rd, Marco Geraci, Robert Glenn Weaver Med, Phd

Faculty Publications

Objective

Children who fail to meet activity, sleep, and screen-time guidelines are at increased risk for obesity. Further, children who are Black are more likely to have obesity when compared to children who are White, and children from low-income households are at increased risk for obesity when compared to children from higher-income households. The objective of this study was to evaluate the proportion of days meeting obesogenic behavior guidelines during the school year compared to summer vacation by race and free/reduced priced lunch (FRPL) eligibility.

Methods

Mixed-effects linear and logistic regressions estimated the proportion of days participants met activity, sleep, …

Differences In Effectiveness And Use Of Laparoscopic Surgery In Locally Advanced Colon Cancer Patients, M. Schootman, Matthew Mutch, T. Loux, Jan M. Eberth Ph.D., N. O. Davidson

Faculty Publications

Patients with locally advanced colon cancer have worse outcomes. Guidelines of various organizations are conflicting about the use of laparoscopic colectomy (LC) in locally advanced colon cancer. We determined whether patient outcomes of LC and open colectomy (OC) for locally advanced (T4) colon cancer are comparable in all colon cancer patients, T4a versus T4b patients, obese versus non-obese patients, and tumors located in the ascending, descending, and transverse colon. We used data from the 2013–2015 American College of Surgeons’ National Surgical Quality Improvement Program. Patients were diagnosed with nonmetastatic pT4 colon cancer, with or without obstruction, and underwent LC (n …

Time Series Forecasting Of Covid-19 Deaths In Massachusetts, Andrew Disher

Honors Program Theses and Projects

The aim of this study was to use data provided by the Department of Public Health in the state of Massachusetts on its online dashboard to produce a time series model to accurately forecast the number of new confirmed deaths that have resulted from the spread of CoViD-19. Multiple different time series models were created, which can be classified as either an Auto-Regressive Integrated Moving Average (ARIMA) model or a Regression Model with ARIMA Errors. Two ARIMA models were created to provide a baseline forecasting performance for comparison with the Regression Model with ARIMA Errors, which used the number of …

Extreme Weather And Its Impacts On Human Civilizations: An In-Depth Investigation Of Causes And Effects, Jason Zabel

Senior Honors Theses

Extreme weather has impacted humanity since creation and is an important topic that deserves examination. In this thesis, the main event that is presented and analyzed is the extreme haze that clouded much of China’s skies in 2013. Further, the impacts this major event had on people, including changes in population movement, death/injury rate, and changes in atmospheric chemistry due to the high concentration of particulates are discussed. Subsequent examples that will be explored include Hurricane Katrina and the eruption of Mt. St. Helens. The main contention of this thesis is that the effects extreme weather has on human civilization …

An Analysis Of The Applications Of Technology To Health Care Within The Caribbean And Latin America, Chineme Ezema

School of Professional Studies

This project aims to investigate and document the evolution of health technology applications and uses within the regions of Latin America and the Caribbean. Originally inspired by the Cayman Islands’ thus far successful handling of the Coronavirus pandemic, I was eager to explore how the applications of technology to the field of healthcare have existed within the region currently and over time. With this foundation, I then explored the regions’ trajectory in terms of technological growth and what the future may hold for these countries and communities.

Title Ix: Perceptions And Utilization On U.S. College Campuses, Emma Narkewicz

School of Professional Studies

The research study investigated student perceptions and utilization of Title IX services on U.S. university and college campuses, testing the hypothesis that if students hold negative perceptions of Title IX offices, then they will not report campus sexual violence they experience to Title IX offices. There are currently high rates of sexual violence on college campuses but very low rates of reporting. Current or former U.S. college students aged 18-30 (N = 47) completed a mixed methods anonymous survey composed of Likert scale and open response questions. Participants were asked about prior interactions with Title IX offices and their perceptions …

Happening In Plain Sight: An Evaluation Of Sexual Harassment In Municipal Government Through A Case Study Of Newark, New Jersey, Hoween R. A. Flexer, Caitlin R. Louie

School of Professional Studies

In the city of Newark, New Jersey, Sebrevious Scott, a participant in the New Jersey Reentry program was hired as part-time office assistant in the city's re-entry office. After being transferred to the city’s Parks and Grounds Departments, she started being sexually harassed, inappropriately touched and propositioned by her supervisor, Richard Kirkland. Scott made repeated attempts to report these actions through the appropriate channels. She was met with dismissal, resistance, and later retaliation. While working in this hostile environment she was also pursuing a full-time employment opportunity with the city upon the completion of the reentry program. Unfortunately, this never …

Mathematical Models Of Covid-19, Kate Faria

Honors Program Theses and Projects

For more than a year, the COVID-19 pandemic has been a major public health issue, affecting the lives of most people around the world. With both people’s health and the economy at great risks, governments rushed to control the spread of the virus. Containment measures were heavily enforced worldwide until a vaccine was developed and distributed. Although researchers today know more about the characteristics of the virus, a lot of work still needs to be done in order to completely remove the disease from the population. However, this is true for most of the infectious diseases in existence, including Influenza, …

Randomised Trials At The Level Of The Individual, Jay J H. Park, Nathan Ford, Denis Xavier, Per Ashorn, Rebecca F. Grais, Zulfiqar Ahmed Bhutta, Herman Goossens, Kristian Thorlund, Maria Eugenia Socias, Edward J. Mills

Centre of Excellence in Women and Child Health

In global health research, short-term, small-scale clinical trials with fixed, two-arm trial designs that generally do not allow for major changes throughout the trial are the most common study design. Building on the introductory paper of this Series, this paper discusses data-driven approaches to clinical trial research across several adaptive trial designs, as well as the master protocol framework that can help to harmonise clinical trial research efforts in global health research. We provide a general framework for more efficient trial research, and we discuss the importance of considering different study designs in the planning stage with statistical simulations. We …

Examining The Benefits Of A Sustained Balance And Fall Prevention Programming For Independent Older Adults Living In A Community Setting, Noah Davis

Legacy Theses & Dissertations (2009 - 2024)

Falls have been an identified public health and social problem since the 1980’s and now recognized as a global health problem in many of the developed nations. The National Council on Aging and the Centers for Disease Control and Prevention acknowledge many evidence-based fall prevention programs. However, there are identified concerns to the programs; for example, a lack of sustained programming for older adults in the community setting. The literature review on fall prevention interventions identifies that few programs are sustained after two years, primarily due to a lack of funding and a lack of interest by older adults. However, …

Heavy Metals In Ends Liquids: A Comparative Analysis Of Products From The United States, England, Canada, And Australia, Ashleigh Coggins-Block

Forensic Science Theses

The International Tobacco Control (ITC) Policy Evaluation Project 4-Country Survey, which this thesis is a part of, aims to compare policies and electronic nicotine delivery system (ENDS) products between the United States, England, Canada, and Australia. Since they can pose many serious health risks, this thesis investigated the presence of and source of heavy metals, including lead, nickel, chromium, and cadmium, in ENDS e-liquids. The source of these metals in ENDS e-liquids has been disputed between cultivated tobacco used to derive nicotine and the metal parts of ENDS devices. ENDS purchased in 2017 from each of the four countries of …

Technology And Sustainability: The New Business Playing Field, Havovi Joshi

Asian Management Insights

Two topics that have consistently cropped up in conversations among business leaders during the pandemic are technology, in the context of the pervasiveness and quickening pace of digital transformation, and sustainability, especially how we should be doing business without harming the environment and society. The collective belief is that both topics will continue to rise on the world’s agenda, reshaping entire industries while creating new ones. They have changed the way of doing business. So what does the new playbook look like?

Evaluating Urban Parks Accessibility And Equity: A Case Study Of Hartford, Ct And New Haven, Ct, Natalie Roach, Mara Tu

Honors Scholar Theses

Public parks provide cities with environmental benefits, positive health effects, recreational opportunities, community building, educational spaces, and public amenities. However, certain populations have been systematically denied their fair share of these benefits because of unjust practices in the creation and maintenance of urban parks. With a lens of environmental justice, the goal of this research was to assess park quality and accessibility of two Connecticut cities, Hartford and New Haven, by gathering publicly available information as well as using GIS tools.

The Trust for Public Land (TPL) has an existing ParkScore rating system that evaluates the quality of a city’s …

Association Between Dietary Inflammatory Index, Dietary Patterns, Plant-Based Dietary Index And The Risk Of Obesity, Yoko B. Wang, Nitin Shivappa, James R. Hébert Scd, Amanda J. Page, Yohannes Adama Melaku

Faculty Publications

Evidence on the association between various dietary constructs and obesity risk is limited. This study aims to investigate the longitudinal relationship between different diet indices and dietary patterns with the risk of obesity. Non-obese participants (n = 787) in the North West Adelaide Health Study were followed from 2010 to 2015. The dietary inflammatory index (DII®), plant-based dietary index (PDI) and factor-derived dietary pattern scores were computed based on food frequency questionnaire data. We found the incidence of obesity was 7.62% at the 5-year follow up. In the adjusted model, results from multivariable log-binomial logistic regression showed that a prudent …