Public Health Commons^™

Quantifying Syringe Exchange Program Operational Space In The District Of Columbia., Sean T. Allen, Monica Ruiz, Jeff Jones

Prevention and Community Health Faculty Publications

Syringe exchange programs (SEPs) are effective structural interventions for HIV prevention among persons who inject drugs. In 2000, a buffer zone policy (the 1000 Foot Rule) was implemented in Washington, DC, that prohibited SEP operations within 1000 feet of schools. We examined changes in the amount of legal SEP operational space over time. We used data pertaining to school operations and their approximate physical property boundaries to quantify the impact of the 1000 Foot Rule on legal SEP operational space from its implementation in 2000-2013. Adherence to the 1000 Foot Rule reduced SEP operational space by more than 50 % …

Effect Of An Improved Biomass Stove On Acute Lower Respiratory Infections In Young Children In Rural Nepal: A Cluster-Randomised, Step-Wedge Trial, James M. Tielsch, Joanne Katz, Subarna K. Khatry, Laxman Shrestha, Patrick N. Breysse, Scott L. Zeger, +5 Additional Authors

Global Health Faculty Publications

Background

Acute lower respiratory infections (ALRI) are an important cause of death in young children in low income countries. High concentrations of fine particulate matter (PM2.5) indoors caused by open burning of biomass are associated with risk of ALRI. However, improved biomass stoves reduce emissions and might reduce the incidence of lower respiratory illness. A cluster-randomised, step-wedge, community-based trial was conducted to estimate the eff ect that a change from open burning of biomass to improved biomass stoves could have on rates of ALRI in children younger than 36 months in a rural area of southern Nepal.

Methods

Households were …

Validity Of Home-Based Sonographic Diagnosis Of Obstetric Risk Factors By Auxiliary Nurse Midwives In Rural Nepal, Naoko Kozuki, Luke C. Mullany, Subarna K. Khatry, Ram Ghimire, Sharma Paudel, James M. Tielsch, +5 Additional Authors

Global Health Faculty Publications

Background

Approximately 2·3 million fetal, neonatal, or maternal deaths occur annually during the intrapartum period or on the day of birth. Several risk factors for intrapartum-related complications require ultrasonography for accurate diagnosis, but sonographic services are scarce in low-resource settings. In this study, we aimed to assess the feasibility of community-based ultrasonography conducted by auxiliary nurse midwives to identify basic obstetric risk factors, in rural Sarlahi District, Nepal. We aimed to assess the validity at which these health workers can detect noncephalic position, multiple gestation, and placenta previa and to explore whether sonographic diagnosis could improve outcomes for women with …

Phylogenetic Organization Of Bacterial Activity., Ember M Morrissey, Rebecca L Mau, Egbert Schwartz, J Gregory Caporaso, Paul Dijkstra, Natasja Van Gestel, Benjamin J Koch, Cindy M. Liu, Michaela Hayer, Theresa A Mchugh, Jane C Marks, Lance B. Price, Bruce A Hungate

Environmental and Occupational Health Faculty Publications

Phylogeny is an ecologically meaningful way to classify plants and animals, as closely related taxa frequently have similar ecological characteristics, functional traits and effects on ecosystem processes. For bacteria, however, phylogeny has been argued to be an unreliable indicator of an organism's ecology owing to evolutionary processes more common to microbes such as gene loss and lateral gene transfer, as well as convergent evolution. Here we use advanced stable isotope probing with (13)C and (18)O to show that evolutionary history has ecological significance for in situ bacterial activity. Phylogenetic organization in the activity of bacteria sets the stage for characterizing …

Cord Blood Methylmercury And Fetal Growth Outcomes In Baltimore Newborns: Potential Confounding And Effect Modification By Omega-3 Fatty Acids, Selenium, And Sex, Ellen M Wells, Julie B Herbstman, Yu Hong Lin, Jeffery Jarrett, Carl P Verdon, Cynthia Ward, Kathleen L Caldwell, Joseph R Hibbeln, Frank R Witter, Rolf U Halden, Lynn R. Goldman

Environmental and Occupational Health Faculty Publications

BACKGROUND: Methylmercury (MeHg) may affect fetal growth; however, prior research often lacked assessment of mercury speciation, confounders, and interactions.

OBJECTIVE: Our objective was to assess the relationship between MeHg and fetal growth as well as the potential for confounding or interaction of this relationship from speciated mercury, fatty acids, selenium, and sex.

METHODS: This cross-sectional study includes 271 singletons born in Baltimore, Maryland, 2004-2005. Umbilical cord blood was analyzed for speciated mercury, serum omega-3 highly unsaturated fatty acids (n-3 HUFAs), and selenium. Multivariable linear regression models controlled for gestational age, birth weight, maternal age, parity, prepregnancy body mass index, smoking, …

(Video) Income-Related Inequalities In Utilization Of Health Services Among Private Health Insurance Beneficiaries In Brazil, Heitor Werneck

GW Research Days 2016 - 2020

Brazil’s 1988 health reform created the Unified Health System (SUS). SUS is a universal health system that emulates British National Health Service, featuring an open-ended benefit package and a major goal of health equity. An unforeseen consequence of the reform was that former beneficiaries of the social health insurance sought to sustain their privileged access to health services through private health insurance. Despite achievements in expanding healthcare access and improved health outcomes, recurring opinion polls suggest that Brazilians are skeptical about SUS’ capacity to delivery timely and quality health services, making private insurance a priority to most households. The literature …

(Video) Maternal Depression And Child Externalizing Behaviors, Julia Gruspier, Shannon Shisler, Rina C. Eiden

GW Research Days 2016 - 2020

About 10.97% of women with children aged 1 to 4 years old are identified with depression. Children of mothers with depression are more likely to exhibit externalizing behavior problems, and these problems have been reported to appear more frequently in male children. We examined the association between maternal depression and externalizing behavior in toddlers, and whether child sex moderated these effects, as previous studies have shown child behavior to be linked to both child sex and maternal depression. The sample included 186 mother/child dyads (95 male children) who were recruited in the first trimester of pregnancy from an urban hospital. …

Maternal Leisure-Time Physical Activity And Risk Of Preterm Birth: A Systematic Review Of The Literature, Mira Kahn, Loretta Dipietro, Kimberly Robien

GW Research Days 2016 - 2020

Background: Preterm birth is a leading cause of infant death and regular physical activity may reduce the risk for preterm birth because of its beneficial effects on pregnancy complications such as preeclampsia, excessive weight gain, and gestational diabetes. On average, however, pregnant women report lower levels of physical activity compared with those who are not pregnant. This systematic review examined low, moderate and vigorous leisure-time physical activity (LTPA) during pregnancy and the outcome of preterm birth.

Methods: Key words related to preterm birth and physical activity were used to search relevant databases (Medline, Cochrane, CINAHL, Sports Discuss and Scopus). Studies …

Racial And Ethnic Disparities In Health Care: An Examination Of State Inpatient Databases In The Utilization Of And Outcomes Following Total Knee Arthroplasty, Alexis W. Lan, Wei Zhang, Yan Ma

GW Research Days 2016 - 2020

Title: Racial and Ethnic Disparities in Health Care: An Examination of State Inpatient Databases in the Utilization of and Outcomes following Total Knee Arthroplasty

Background: The U.S. population is becoming more racially and ethnically diverse yet disparities in health care still exist. One area of medical care in which racial disparities have been identified is total knee arthroplasty (TKA)¬—an efficacious and cost-effective treatment option for individuals with advanced arthritis of the knee. Previous studies have documented that racial and ethnic minorities tend to have higher rates of adverse health outcomes and face more barriers utilizing the procedure. However, these studies …

A Systematic Review Of Coal Fired Power Plant Proximity And Local Socioeconomic Status Trends And Outcomes, Oshane Mcrae, Peter Lapuma

GW Research Days 2016 - 2020

Among the significant sources of energy, coal based energy bears the largest share (42%) of the electricity produced in the United States. Already existing coal fired power plants are the largest emitter of carbon dioxide emissions in the United States. Among the cumulative emissions contributed by the industrial sector, significant portions are from coal fired power plants. Coal-fired power plants emit 66% of sulfur oxides, 40% of carbon dioxide, 33% of mercury and 22% of nitrogen oxides in the U.S. and are linked as risk factors to respiratory diseases, cardiovascular diseases and other ailments shown to impact environmental and human …

Pregnant Women’S Health Consequences Following Exposure To Pbdes, Alison Chiaramonte, Ami R. Zota

GW Research Days 2016 - 2020

PBDEs (Polybrominated diphenyl ethers) are chemicals introduced by industry in the 1970s to serve as flame-retardants on common consumer products like electronics, plastics, and foam in furniture. They are also suspected to disrupt thyroid activity during pregnancy, which is a time of increased demand on the thyroid gland. Maternal thyroid fluctuations and disease as a result of exposure to PBDEs are therefore a concern. This systematic review aimed to capture all of the relevant peer-reviewed literature investigating the association between PBDEs and maternal thyroid activity. Use of the PRISMA checklist (Preferred Reporting Items for Systematic Reviews and Meta-Analyses), a best …

Predictors Of Malnutrition In Different Geographic Regions Of Peru, Elizabeth Lacroix

GW Research Days 2016 - 2020

Malnutrition is responsible for over 3 million childhood deaths each year. Those who survive early nutritional deficiencies and the subsequent growth failure face life-long consequences, including long-term deficits in cognitive development, decreased academic achievement, and reduced economic opportunities later in life. Low height for age, or stunting, indicates chronic malnutrition, while low weight for height (wasting) indicates acute malnutrition. Caloric deficiencies, micronutrient deficiencies, intestinal parasites, and diarrheal diseases all directly contribute to acute and chronic undernutrition.

Peru is an ethnically and geographically diverse country that has experienced great economic growth and dramatic health improvements in the last decade. Nationally, stunting …

Promotion Of Drinking Water Among Latino Immigrant Youth, Nicole Barrett, Allison Elkins, Uriyoan Colón-Ramos, Ivonne Rivera, W. Douglas Evans, Mark Edberg

GW Research Days 2016 - 2020

Objective: To design an innovative intervention to increase drinking water behaviors among Latino immigrant youth.

Methods: We conducted two rounds of focus groups, totaling 10 sessions (n=61), with Latino immigrant youth, aged 6-18 years, living in Langley Park, Maryland. Participants were stratified into focus groups by age group (elementary, middle, and high school) and language preference (Spanish and English). A professional, bilingual-speaking moderator used a semistructured discussion guide to examine: (1) what youth preferred to drink in different settings and why, (2) their reactions to promotional messages, (3) slogans that would entice them to drink more water in school and …

Consumption Of Low-Calorie Sweeteners In The United States 2009-12, Yichen Jin, Allison C. Sylvetsky, Jean A. Welsh, Kristina I. Rother, Sameera A Talegawkar

GW Research Days 2016 - 2020

We have previously demonstrated that low-calorie sweetener (LCS) consumption increased in the United States (US) between 1999 and 2008 (from 9% to 15 % in kids and from 27% to 32% in adults), but little is known about current consumption. We therefore analyzed National Health and Nutrition Examination Survey (NHANES) data collected in 2011-12 and compared LCS consumption patterns across socio-demographic subgroups. Dietary sources of LCS were identified using NHANES food descriptions. Prevalence of consumption nationally and by age, race, gender, socio-economic status, educational attainment, were estimated using two 24-hour dietary recalls. F-tests were used to evaluate differences in consumption …

Smoking Characteristics And Psychiatric Comorbidities Of Pregnant Smokers: An Analysis Of Quit4baby Randomized Controlled Trial, Shawn Chiang, Lorien C. Abroms, Jennifer M. Schindler-Ruwisch, Leah E. Leavitt

GW Research Days 2016 - 2020

Background: Text messaging or short message service (SMS) programs have been shown to be effective in helping adult smokers quit smoking (Abroms et al., 2014). However, to our knowledge, no prior research has examined psychiatric comorbidities associated with smoking in the text messaging context. The risk of smoking has been shown to increase as a function of the number of psychiatric illnesses with which a person is diagnosed (Aubin, Rollema, Svensson, & Winterer, 2012). The current study examined this association and other correlates of smoking-psychiatric comorbidity in a sample of U.S. pregnant smokers enrolled in Quit4Baby, a smoking cessation text …

Clinical Public Health Integration In Medical School Curriculum: Transitioning Medical Student Training From Medical Problems To Health Solutions, Ashtin Jeney, Bridget C. Huysman, Jamie Majdi, Kent Aje, Madeline Taskier, David K. Popiel, Lawrence R. Deyton, Karla Bartholomew

GW Research Days 2016 - 2020

The current chronic disease burden, growing health disparities, and evolution of our healthcare system require that medical students be equipped with basic public health education to effectively manage patients, navigate the healthcare system, and advocate for health(1,2,3,4,5,6). The Institute of Medicine and the AAMC emphasize the need for physicians to be trained in public health(1,8). The inaugural year of the revised curriculum at The George Washington University School of Medicine and Health Sciences (GW SMHS) represented a first step at the institution to integrate clinical public health into medical education. As part of this process, the Clinical Public Health (CLiPH) …

Assessing The Effectiveness Of Partners In Quitting, A Text Message-Based Smoking Cessation Program, Rachael Schoenbrun

GW Research Days 2016 - 2020

This presentation will discuss the implementation of Partners in Quitting, a new text message-based smoking cessation program. It will also provide preliminary data on client engagement rates, program effectiveness, and program challenges. Partners in Quitting is an outreach program that has been implemented at Bread for the City, a large DC hub for free health and social services. Partners in Quitting provides an evidence-based, easily accessible, and comprehensive smoking cessation program to the clients of Bread for the City.

Progression Of Electrocardiographic Abnormalities In Type 1 Diabetes During 16 Years Of Follow‐Up: The Epidemiology Of Diabetes Interventions And Complications (Edic) Study, Elsayed Soliman, Jye-Yu Backlund, Ionut Bebu, Yabing Li, Zhu-Ming Zhang, Patricia A. Cleary, John M. Lachin

GW Biostatistics Center

Background The electrocardiogram (ECG) is an objective tool for cardiovascular disease (CVD) risk assessment.

Methods and Results We evaluated distribution of ECG abnormalities and risk factors for developing new abnormalities in 1314 patients with type 1 diabetes (T1D) from the Epidemiology of Diabetes Interventions and Complications (EDIC) study. Annual ECGs were centrally read. ECG abnormalities were classified as major and minor according to the Minnesota ECG Classification. At EDIC year 1 (baseline), 356 (27.1%) of the participants had at least 1 ECG abnormality (major or minor) whereas 26 (2%) had at least one major abnormality. During 16 years of follow‐up, …

Unintended Pregnancies In Brazil - A Challenge For The Recommendation To Delay Pregnancy Due To Zika, Cynthia Schuck-Paim, Daniel Lopez, Lone Simonsen, Wladimir Alonso

Global Health Faculty Publications

Because of the potential link between the ongoing Zika virus outbreak and a surge in the number of cases of congenital microcephaly, officials in Latin America have recommended that women postpone pregnancy until this association is firmly established or the outbreak subsides. However, in all these countries a large proportion of babies are still born out of unplanned pregnancies. Teenage girls are particularly at high risk, as they often lack access to preventive contraception methods, or the knowledge to use them appropriately. To gauge the magnitude of the barriers preventing the implementation of such a recommendation in Brazil, the country …

Infant Vaccination Timing: Beyond Traditional Coverage Metrics For Maximizing Impact Of Vaccine Programs, An Example From Southern Nepal., Michelle M Hughes, Joanne Katz, Janet A Englund, Subarna K Khatry, Laxman Shrestha, Steven C Leclerq, Mark Steinhoff, James M. Tielsch

Global Health Faculty Publications

Background

Immunization programs currently measure coverage by assessing the proportion of children 12–24 months who have been immunized but this does not address the important question of when the scheduled vaccines were administered. Data capturing the timing of vaccination in first 6 months, when severe disease is most likely to occur, are limited.

Objective

To estimate the time to Bacillus Calmette–Guérin (BCG) (recommended at birth), diphtheria-tetanus-pertussis-H, influenza b-hepatitis B (DTP-Hib-HepB), and oral polio vaccine (OPV) (recommended at 6, 10, and 14 weeks) vaccinations and risk factors for vaccination delay in infants <6 months of age in a district in southern Nepal where traditional coverage metrics are high.

Design/methods

Infants enrolled in a randomized controlled trial of …

Hospital Discharge Planning In Medicare: Current Requirements And Proposed Changes, Sally Coberly

National Health Policy Forum

Medicare's specific minimum health and safety standards for hospitals, known as conditions of participation, include requirements for discharge planning for patients who need such services. Discharge planning is intended to ensure smooth transitions from hospital to home or other health care facility. This publication reviews the current discharge planning requirements for hospitals as well as changes included in a proposed rule published by the Centers for Medicare & Medicaid Services on November 3, 2015. Key proposed changes include an expanded definition of which patients must receive discharge planning services, a requirement that providers responsible for follow-up care receive timely …

Knowledge, Attitude And Practices: Assessing Maternal And Child Health Care Handbook Intervention In Vietnam, Hirotsugu Aiga, Vinh Duc Nguyen, Cuong Dinh Nguyen, Tho Thi Thi Nguyen, Lien Thi Phuong Nguyen

Global Health Faculty Publications

Background

Maternal and Child Health (MCH) Handbook, an integrated MCH home-based record, was piloted in four provinces of Vietnam (Dien Bien, Hoa Binh, Thanh Hoa and An Giang). The study is aimed at assessing the changes in pregnant women’s behavior towards the frequencies of their antenatal care service utilizations and their subsequent breastfeeding practices up to six months of age, through the MCH Handbook intervention. This is because the levels of pregnant women’s knowledge, attitude and practices (KAP) towards their antenatal care service utilizations and exclusive breastfeeding practices have been previously neither analyzed nor reported in relation to MCH home-based …

The Impact Of Reimbursement Policies And Practices On Healthcare Technology Innovation, Brian K. Bruen, Elizabeth Docteur, Ruth Lopert, Joshua Cohen, Joseph Dimasi, Avi Dor, Peter Neumann, Regina Desantis, Chuck Shih

Health Policy and Management Faculty Publications

No abstract provided.

Assessing Syringe Exchange Program Access Among Persons Who Inject Drugs (Pwid) In The District Of Columbia, Sean T. Allen, Monica S. Ruiz, Jeff Jones

Prevention and Community Health Faculty Publications

Prior research has explored spatial access to syringe exchange programs (SEPs) among persons who inject drugs (PWID), but these studies have been based on limited data from short periods of time. No research has explored changes in spatial access to SEPs among PWID longitudinally. The purpose of this research is to examine spatial access to SEPs among PWID who accessed services at a SEP in Washington, District of Columbia (DC), from 1996 to 2010. The geometric point distance estimation technique was used to calculate the mean walking distance PWID traveled from the centroid point of their zip code of home …

Staphylococcus Aureus Nasal Carriage Among Beefpacking Workers In A Midwestern United States Slaughterhouse, Jessica Leibler, Jeanne A. Jordan, Kirsten Brownstein, Lina Lander, Lance B. Price, Melissa J. Perry

Environmental and Occupational Health Faculty Publications

Occupational contact with livestock is an established risk factor for exposure to livestock-associated methicillin-resistant Staphylococcus aureus (MRSA), particularly among industrial swine workers. While S. aureus is known to infect cattle, livestock-associated S. aureuscarriage among workers in the beef production chain has received limited attention. Beefpacking workers, who slaughter, butcher and process cattle, have intensified exposure to potentially infectious animal materials and may be at risk of livestock-associated S. aureusexposure. We conducted a cross-sectional study of beefpacking workers (n = 137) at an industrial slaughterhouse in the Midwestern United States to evaluate prevalence and characteristics of …

Using Capture-Recapture Methods To Estimate The Population Of People Who Inject Drugs In Washington, Dc, Monica S. Ruiz, Allison O'Rourke, Sean T. Allen

Prevention and Community Health Faculty Publications

No current estimates exist for the size of the population of people who inject drugs (PWID) in the District of Columbia (DC). The WHO/UNAIDS Guidelines on Estimating the Size of Populations Most at Risk to HIV was used as the methodological framework to estimate the DC PWID population. The capture phase recruited harm reduction agency clients; the recapture phase recruited community-based PWID. The 951 participants were predominantly Black (83.9 %), male (69.8 %), and 40+ years of age (68.2 %). Approximately 50.3 % reported injecting drugs in the past 30 days. We estimate approximately 8829 (95 % CI 4899 and …

Medicaid Financing, Sally Coberly

National Health Policy Forum

This publication provides an overview of how the Medicaid program is financed. It explains how the federal and state shares of funding are determined, briefly describes disproportionate share hospital payments and how those are affected by the Patient Protection and Affordable Care Act of 2010, and outlines financing mechanisms states have used to maximize federal Medicaid matching funds.

Medicaid Eligibility And Benefits, Sally Coberly

National Health Policy Forum

This publication provides a brief overview of the Medicaid program. It highlights the range of eligibility and benefits requirements and options and it briefly describes the program's financing structure.

The Medicare Drug Benefit (Part D), Sally Coberly

National Health Policy Forum

The Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA) established a voluntary outpatient prescription drug benefit for Medicare beneficiaries that began January 1, 2006. This publication provides an overview of the drug benefit.

Medicare, Sally Coberly

National Health Policy Forum

This publication provides an overview of the Medicare program including eligibility, covered services, cost-sharing requirements, and program financing.