Public Health Commons^™

Unicef Communications For Development (C4d) Strategy For The Prevention Of Violence Against Children In South Africa., Marc C. Edberg, Rajiv N. Rimal, Hina Shaikh

Center for Social Well-Being and Development

No abstract provided.

Cross-Sectional Associations Between Exposure To Persistent Organic Pollutants And Leukocyte Telomere Length Among U.S. Adults In Nhanes, 2001-2002., Susanna D. Mitro, Linda S. Birnbaum, Belinda L. Needham, Ami R. Zota

Environmental and Occupational Health Faculty Publications

Background: Exposure to persistent organic pollutants (POPs) such as dioxins, furans, and polychlorinated biphenyls (PCBs) may influence leukocyte telomere length (LTL), a biomarker associated with chronic disease. In vitro research suggests dioxins may bind to the aryl hydrocarbon receptor (AhR) and induce telomerase activity, which elongates LTL. However, few epidemiologic studies have investigated associations between POPs and LTL.

Objectives: We examined the association between 18 PCBs, 7 dioxins, and 9 furans and LTL among 1,330 U.S. adults from NHANES 2001-2002. Methods: We created three summed POP metrics based on toxic equivalency factor (TEF), a potency measure including affinity for the …

Medicare's Post-Acute Care Payment: An Updated Review Of The Issues And Policy Proposals, Sally Coberly

National Health Policy Forum

Medicare spending on post-acute care provided by home health agencies, skilled nursing facilities, inpatient rehabilitation facilities, and long-term care hospitals accounted for about 10 percent of total program outlays in 2013. The Medicare Payment Advisory Commission and others have noted several long-standing problems with the payment systems for post-acute care and have suggested refinements to Medicare's post-acute care payment systems that are intended to encourage the delivery of appropriate care in the right setting for a patient's condition. The Patient Protection and Affordable Care Act of 2010 contained several provisions that affect the Medicare program's post-acute care payment systems, as …

Implementation Of The International Health Regulations (2005) Through Cooperative Bioengagement, Claire J. Standley, Erin M. Sorrell, Sarah Kornblet, Julie E. Fischer, Rebecca Katz

Health Policy and Management Faculty Publications

Cooperative bioengagement efforts, as practiced by U.S. government-funded entities, such as the Defense Threat Reduction Agency’s Cooperative Biological Engagement Program, the State Department’s Biosecurity Engagement Program, and parallel programs in other countries, exist at the nexus between public health and security. These programs have an explicit emphasis on developing projects that address the priorities of the partner country as well as the donor. While the objectives of cooperative bioengagement programs focus on reducing the potential for accidental or intentional misuse and/or release of dangerous biological agents, many partner countries are interested in bioengagement as a means to improve basic public …

Developing And Pretesting A Text Messaging Program For Health Behavior Change, Lorien C. Abroms, Robyn Whittaker, Caroline Free, Judith Mendel Van Alstyne, Jennifer M. Schindler-Ruwisch

Prevention and Community Health Faculty Publications

Background: A growing body of evidence demonstrates that text messaging-based programs (short message service [SMS]) on mobile phones can help people modify health behaviors. Most of these programs have consisted of automated and sometimes interactive text messages that guide a person through the process of behavior change.

Objective: This paper provides guidance on how to develop text messaging programs aimed at changing health behaviors.

Methods: Based on their collective experience in designing, developing, and evaluating text messaging programs and a review of the literature, the authors drafted the guide. One author initially drafted the guide and the others provided input …

Community Health Workers: Health System Integration, Financing Opportunities, And The Evolving Role Of The Community Health Worker In A Post-Health Reform Landsacape, Mary-Beth Malcarney, Patricia Pittman, Leo Quigley, Naomi Seiler, Katie B. Horton

Health Workforce Research Center Publications

Community Health Workers (CHWs) have been gaining attention from policymakers because of their unique role in addressing health disparities and socioeconomic drivers of disease, and because of their potential integration into the health care delivery system. To date, there has been limited research specifically describing the variation in CHWs’ roles and relationships, and how that variation relates to management, to financing, to health system integration, and to the competencies CHWs should have in different contexts.

The purpose of this report is to better understand the varied landscape; to offer categories of analysis that may help inform policy, management, and research; …

Challenges Of Forecasting Physician Workforce Needs Amid Delivery System Transformation, Rob Cunningham

National Health Policy Forum

As population growth and the aging of the overall population increase demand for health care, policymakers and analysts grapple with whether sufficient health care providers, particularly physicians, will be available to meet that demand. Some argue there are too few physicians already; others say our current supply-demand problems lie with efficiency. But suppose both are correct? Perhaps the real challenge is to understand how the provision of health care services is changing in response to market forces such as payment changes, patients' expectations, provider distributions, and technology innovations. This issue brief revisits what is known about evolving practice organizations, professional …

Background Literature On Violence Against Children In South Africa: Foundation For A Phased Communications For Development (C4d) Strategy, Mark Edberg, Hina Shaikh, Shaneka Thurman, Rajiv N. Rimal

Center for Social Well-Being and Development

No abstract provided.

Factors Associated With Early Growth In Egyptian Infants: Implications For Addressing The Dual Burden Of Malnutrition., Justine A Kavle, Valerie L Flax, Ali Abdelmegeid, Farouk Salah, Seham Hafez, Magda Ramzy, Doaa Hamed, Gulsen Saleh, Rae Galloway

Prevention and Community Health Faculty Publications

Optimal nutrition is critical to the attainment of healthy growth, human capital and sustainable development. In Egypt, infants and young children face overlapping forms of malnutrition, including micronutrient deficiencies, stunting and overweight. Yet, in this setting, little is known about the factors associated with growth during the first year of life. A rise in stunting in Lower Egypt from 2005 to 2008 prompted this implementation research study, which followed a longitudinal cohort of infants from birth to 1 year of age within the context of a USAID-funded maternal and child health integrated programme. We sought to determine if growth patterns …

Characterizing Ebola Transmission Patterns Based On Internet News Reports., J. C. Cleaton, Cecile Viboud, Lone Simonsen, A. M. Hurtado, G. Chowell

Global Health Faculty Publications

BACKGROUND:  Detailed information on patient exposure, contact patterns, and discharge status, is rarely available in real time from traditional surveillance systems in the context of an emerging infectious disease outbreak. Here we validate the systematic collection of Internet news reports to characterize epidemiological patterns of Ebola virus disease (EVD) infections during the West African 2014-2015 outbreak.

METHODS:  Based on 58 news reports, we analyzed a total of 79 EVD clusters (286 cases) of size ranging from 1 to 33 cases between January 2014 and February 2015 in Guinea, Sierra Leone and Liberia.

RESULTS AND CONCLUSIONS:  The great majority of reported …

Impact Evaluation Of A Policy Intervention For Hiv Prevention In Washington, Dc, Monica S. Ruiz, Allison O'Rourke, Sean T. Allen

Prevention and Community Health Faculty Publications

Syringe exchange programs (SEPs) lower HIV risk. From 1998 to 2007, Congress prohibited Washington, DC, from using municipal revenue for SEPs. We examined the impact of policy change on IDU-associated HIV cases. We used surveillance data for new IDU-associated HIV cases between September 1996 and December 2011 to build an ARIMA model and forecasted the expected number of IDU-associated cases in the 24 months following policy change. Interrupted time series analyses (ITSA) were used to assess epidemic impact of policy change. There were 176 IDU-associated HIV cases in the 2 years post-policy change; our model predicted 296 IDU-associated HIV cases …

Longitudinal Analysis Of Electronic Health Records On Staffing Mix In Community Health Centers, Bianca K. Frogner, Xiaoli Wu, Jeongyoung Park, Patricia Pittman

Health Workforce Research Center Publications

Community health centers (CHCs) have long faced clinical staffing challenges especially in rural areas of the US due to providers perceiving a lack of socioeconomic opportunities. A recent study found that CHCs are adaptable and manage to maintain productivity levels across different staffing configurations by leveraging the clinical staff available. What is unknown is how two major changes in the health care landscape—adoption of an electronic health record (EHR) system and recognition of being a patient-centered medical home (PCMH)—have impacted staffing in CHCs, which may in turn have productivity implications.

How Has The Affordable Care Act Benefitted Medically Underserved Communities? : National Findings From The 2014 Community Health Centers Uniform Data System, Jessica Sharac, Peter Shin, Sara J. Rosenbaum

Geiger Gibson/RCHN Community Health Foundation Research Collaborative

Community health centers represent the single largest comprehensive primary health care system serving medically underserved communities, operating in more than 9,000 urban and rural locations. Newly-released data for 2014 from the Uniform Data System (UDS; the federal health center reporting system) shed important light on the impact of the Affordable Care Act in its first full year of implementation in medically underserved urban and rural communities across the U.S. These communities experience elevated poverty, heightened health risks, lack of access to primary health care, and a significantly greater likelihood that residents will be uninsured.

The UDS data show the ACA’s …

National Advisory Council On The National Health Service Corps (Nhsc), Sara J. Rosenbaum

Health Policy and Management Faculty Posters and Presentations

No abstract provided.

Extended Followup Of A Cohort Of Chromium Production Workers, Herman Jones Gibb, Peter St. John Lees, Jing Wang, Keri O'Leary

Epidemiology Faculty Publications

Background

The current study evaluates the mortality of 2,354 workers first employed at a Baltimore chromate production plant between 1950 and 1974.

Methods

The National Death Index (NDI Plus) was used to determine vital status and cause of death. Cumulative chromium (VI) exposure and nasal and skin irritation were evaluated as risk factors for lung cancer mortality.

Results

There are 91,186 person-years of observation and 217 lung cancer deaths. Cumulative chromium (VI) exposure, nasal irritation, nasal perforation, nasal ulceration, and other forms of irritation (e.g., skin irritation) were associated with lung cancer mortality.

Conclusion

Cumulative chromium (VI) exposure was a …

Sexual Networks And Hiv Risk Among Black Men Who Have Sex With Men In 6 U.S. Cities, Hong-Van Tieu, Ting-Yuan Liu, Sophia Hussen, Matthew Connor, Lei Wang, Gregory Phillips Ii, + 11 More

Epidemiology Faculty Publications

Background

Sexual networks may place U.S. Black men who have sex with men (MSM) at increased HIV risk.

Methods

Self-reported egocentric sexual network data from the prior six months were collected from 1,349 community-recruited Black MSM in HPTN 061, a multi-component HIV prevention intervention feasibility study. Sexual network composition, size, and density (extent to which members are having sex with one another) were compared by self-reported HIV serostatus and age of the men. GEE models assessed network and other factors associated with having a Black sex partner, having a partner with at least two age category difference (age difference between …

Optimisations And Challenges Involved In The Creation Of Various Bioluminescent And Fluorescent Influenza A Virus Strains For In Vitro And In Vivo Applications, Monique I. Spronken, Kristy Short, Sander Herfst, Theo M. Bestebroer, Vincent P. Vaes, Erin Sorrell, + 9 More

Health Policy and Management Faculty Publications

Bioluminescent and fluorescent influenza A viruses offer new opportunities to study influenza virus replication, tropism and pathogenesis. To date, several influenza A reporter viruses have been described. These strategies typically focused on a single reporter gene (either bioluminescent or fluorescent) in a single virus backbone. However, whilst bioluminescence is suited to in vivo imaging, fluorescent viruses are more appropriate for microscopy. Therefore, the idea l reporter virus varies depending on the experiment in question, and it is important that any reporter virus strategy can be adapted accordingly. Herein, a strategy was developed to create five different reporter viruses in a …

Caffeine Consumption Contributes To Skin Intrinsic Fluorescence In Type 1 Diabetes., Karen M Eny, Trevor J Orchard, Rachel Grace Miller, John Maynard, Denis M Grant, Tina Costacou, Patricia A. Cleary, Barbara H Braffett, Andrew D Paterson, Dcct/Edic Research Group

GW Biostatistics Center

Background: A variant (rs1495741) in the gene for the N-acetyltransferase 2 (NAT2) protein is associated with skin intrinsic fluorescence (SIF), a noninvasive measure of advanced glycation end products and other fluorophores in the skin. Because NAT2 is involved in caffeine metabolism, we aimed to determine whether caffeine consumption is associated with SIF and whether rs1495741 is associated with SIF independently of caffeine.

Materials and Methods: SIF was measured in 1,181 participants with type 1 diabetes from the Epidemiology of Diabetes Interventions and Complications study. Two measures of SIF were used: SIF1, using a 375-nm excitation light-emitting diode (LED), and …

Patient Experiences With Family Planning In Community Health Centers, Susan F. Wood, Tishra Beeson, Debora Goetz Goldberg, Holly Mead, Peter Shin, Aliyah Abdul-Wakil, Anna Rui, Bhakti Sahgal, Maya Shimony, Hallie Stevens, Sara Rosenbaum

Geiger Gibson/RCHN Community Health Foundation Research Collaborative

Women of childbearing age represent one of the single largest groups of community health center patients, and family planning plays a critical role in the health, economic, and social circumstances of women, their children, and families. Family planning is a required service at all health centers, and the major expansion of health centers under the Affordable Care Act means that for low-income women of reproductive age this service should be increasingly available. The Quality Family Planning (QFP) Guidelines, jointly developed by the Centers for Disease Control and Prevention (CDC) and the Office of Population Affairs (OPA) and released in 2014, …

Optimal Exposure Biomarkers For Nonpersistent Chemicals In Environmental Epidemiology, Antonia M. Calafat, Matthew P. Longnecker, Holger M. Koch, Shanna H. Swan, Russ Hauser, Lynn R. Goldman, +7 Additional Authors

Environmental and Occupational Health Faculty Publications

We discuss considerations that are essential when evaluating exposure to nonpersistent, semivolatile environmental chemicals such as phthalates and phenols (e.g., bisphenol A). A biomarker should be chosen to best represent usual personal exposures and not recent, adventitious, or extraneous exposures. Biomarkers should be selected to minimize contamination arising from collection, sampling, or analysis procedures. Pharmacokinetics should be considered; for example, nonpersistent, semivolatile chemicals are metabolized quickly, and urine is the compartment with the highest concentrations of metabolites. Because these chemicals are nonpersistent, knowledge of intraindividual reliability over the biologic window of interest is also required. In recent years researchers have …

Intermingled Klebsiella Pneumoniae Populations Between Retail Meats And Human Urinary Tract Infections, Gregg S. Davis, Kara Waits, Lora Nordstrom, Brett Weaver, Maliha Aziz, Lance B. Price, +8 Additional Authors

Environmental and Occupational Health Faculty Publications

Background. Klebsiella pneumoniae is a common colonizer of the gastrointestinal tract of humans, companion animals, and livestock. To better understand potential contributions of foodborne K. pneumoniae to human clinical infections, we compared K. pneumoniae isolates from retail meat products and human clinical specimens to assess their similarity based on antibiotic resistance, genetic relatedness, and virulence.

Methods. Klebsiella pneumoniae was isolated from retail meats from Flagstaff grocery stores in 2012 and from urine and blood specimens from Flagstaff Medical Center in 2011–2012. Isolates underwent antibiotic susceptibility testing and whole-genome sequencing. Genetic relatedness of the isolates was assessed using multilocus sequence typing …

Ambient Air Pollution And Adverse Birth Outcomes: A Natural Experiment Study, Cheng Huang, Catherine Nichols, Yang Liu, Yunping Zhang, Xiaohong Liu, Suhong Gao, Zhiwen Li, Aiguo Ren

Global Health Faculty Publications

Background

Radical regulations to improve air quality, including traffic control, were implemented prior to and during the 2008 Beijing Olympic Games. Consequently, ambient concentrations of nitrogen dioxide (NO ₂ ) and particular matter 10 micrometers or less (PM ₁₀ ), were reduced in a distinct and short window of time, which presented a natural experiment for testing the relationships between maternal exposure to PM ₁₀ and NO ₂ during pregnancy and adverse birth outcomes.

Methods

We estimated the effect of PM ₁₀ and NO ₂ exposure during each trimester of gestation on the risk of preterm birth among live births …

Fetal, Neonatal, Infant, And Child International Growth Standards: An Unprecedented Opportunity For An Integrated Approach To Assess Growth And Development., Cutberto Garza

Global Health Faculty Publications

The recent publication of fetal growth and gestational age-specific growth standards by the International Fetal and Newborn Growth Consortium for the 21st Century Project and the previous publication by the WHO of infant and young child growth standards based on the WHO Multicentre Growth Reference Study enable evaluations of growth from ∼9 wk gestation to 5 y. The most important features of these projects are the prescriptive approach used for subject selection and the rigorous testing of the assertion that growth is very similar among geographically and ethnically diverse nonisolated populations when health, nutrition, and other care needs are met …

Using Whole Genome Analysis To Examine Recombination Across Diverse Sequence Types Of Staphylococcus Aureus, Elizabeth M. Driebe, Jason W. Sahl, Chandler Roe, Jolene R. Bowers, James M. Schupp, Lance B. Price, +11 Additional Authors

Environmental and Occupational Health Faculty Publications

Staphylococcus aureus is an important clinical pathogen worldwide and understanding this organism's phylogeny and, in particular, the role of recombination, is important both to understand the overall spread of virulent lineages and to characterize outbreaks. To further elucidate the phylogeny of S. aureus, 35 diverse strains were sequenced using whole genome sequencing. In addition, 29 publicly available whole genome sequences were included to create a single nucleotide polymorphism (SNP)-based phylogenetic tree encompassing 11 distinct lineages. All strains of a particular sequence type fell into the same clade with clear groupings of the major clonal complexes of CC8, CC5, …

Vaginal Douching And Racial/Ethnic Disparities In Phthalates Exposures Among Reproductive-Aged Women: National Health And Nutrition Examination Survey 2001–2004, Francesca Branch, Tracey J. Woodruff, Susanna D. Mitro, Ami R. Zota

Environmental and Occupational Health Faculty Publications

Background

Diethyl phthalate (DEP) and di-n-butyl phthalate (DnBP) are industrial chemicals found in consumer products that may increase risk of adverse health effects. Although use of personal care/beauty products is known to contribute to phthalate exposure, no prior study has examined feminine hygiene products as a potential phthalate source. In this study, we evaluate whether vaginal douching and other feminine hygiene products increase exposure to phthalates among US reproductive-aged women.

Methods

We conducted a cross-sectional study on 739 women (aged 20–49) from the National Health and Nutrition Examination Survey 2001–2004 to examine the association between self-reported use of …

Nitrate And Nitrite Ingestion And Risk Of Ovarian Cancer Among Postmenopausal Women In Iowa, Maki Inoue-Choi, Rena R. Jones, Kristin E. Anderson, Kenneth P. Cantor, James R. Cerhan, Stuart Krasner, Kimberly Robien, Peter J. Weyer, Mary H. Ward

Epidemiology Faculty Publications

Nitrate and nitrite are precursors in the endogenous formation of N-nitroso compounds (NOC), potential human carcinogens. We evaluated the association of nitrate and nitrite ingestion with postmenopausal ovarian cancer risk in the Iowa Women's Health Study. Among 28,555 postmenopausal women, we identified 315 incident epithelial ovarian cancers from 1986 to 2010. Dietary nitrate and nitrite intakes were assessed at baseline using food frequency questionnaire data. Drinking water source at home was obtained in a 1989 follow-up survey. Nitrate-nitrogen (NO₃-N) and total trihalomethane (TTHM) levels for Iowa public water utilities were linked to residences and average levels were …

How Will Texas’ Affordable Care Act Implementation Decisions Affect The Population? A Closer Look, Sara J. Rosenbaum, Sara Rothenberg, Sara Ely

Geiger Gibson/RCHN Community Health Foundation Research Collaborative

The Affordable Care Act (ACA) gives states two key choices: Whether to expand Medicaid to cover poor uninsured adults; and whether to establish a state Exchange. No population stands to gain more from these choices than residents of Texas, who experience the nation’s highest uninsured rate. National estimates show that by not expanding Medicaid, the state has foregone coverage for 1.5 million people. County‐level estimates show that in 249 out of 254 counties, the proportion of uninsured adults exceeds 20 percent of the total adult county population. In 31 counties, the proportion of low income uninsured adults exceeds 60 percent …

Medical Education Departments: A Study Of Four Medical Schools In Sub-Saharan Africa, Elsie Kiguli-Malwadde, Zohray Talib, Hannah Wohltjen, Susan C. Connors, Jonathan Gandari, Sekelani S. Benda, Lauren A. Maggio, Susan C. Van Schalkwyk

Health Policy and Management Faculty Publications

Background

Many African countries are investing in medical education to address significant health care workforce shortages and ultimately improve health care. Increasingly, training institutions are establishing medical education departments as part of this investment. This article describes the status of four such departments at sub-Saharan African medical schools supported by the Medical Education Partnership Initiative (MEPI). This article will provide information about the role of these institutional structures in fostering the development of medical education within the African context and highlight factors that enable or constrain their establishment and sustainability.

Methods

In-depth interviews were conducted with the heads or directors …

Iarc Monographs: 40 Years Of Evaluating Carcinogenic Hazards To Humans, Neil Pearce, Aaron Blair, Paolo Vineis, Wolfgang Ahrens, Aage Andersen, Melissa J. Perry, +Several Additional Authors

Environmental and Occupational Health Faculty Publications

Background: Recently, the International Agency for Research on Cancer (IARC) Programme for the Evaluation of Carcinogenic Risks to Humans has been criticized for several of its evaluations, and also for the approach used to perform these evaluations. Some critics have claimed that failures of IARC Working Groups to recognize study weaknesses and biases of Working Group members have led to inappropriate classification of a number of agents as carcinogenic to humans.

Objectives: The authors of this Commentary are scientists from various disciplines relevant to the identification and hazard evaluation of human carcinogens. We examined criticisms of the IARC classification process …

Penile Microbiota And Female Partner Bacterial Vaginosis In Rakai, Uganda, Cindy M. Liu, Bruce A. Hungate, Aaron A.R. Tobian, Jacques Ravel, Lance B. Price, +8 Additional Authors

Environmental and Occupational Health Faculty Publications

Bacterial vaginosis (BV) is a common vaginal bacterial imbalance associated with risk for HIV and poor gynecologic and obstetric outcomes. Male circumcision reduces BV-associated bacteria on the penis and decreases BV in female partners, but the link between penile microbiota and female partner BV is not well understood. We tested the hypothesis that having a female partner with BV increases BV-associated bacteria in uncircumcised men. We characterized penile microbiota composition and density (i.e., the quantity of bacteria per swab) by broad-coverage 16S rRNA gene-based sequencing and quantitative PCR (qPCR) in 165 uncircumcised men from Rakai, Uganda. Associations between penile community …